Dollars & Sense: Understanding the Cost of the GeneSight® Test
How much does the GeneSight test cost? As you might guess, it’s a complicated answer that boils down to one word: insurance.
For government insurance plans, the cost of the GeneSight test varies:
- If you have a traditional Medicare or Medicaid plan, your cost is $0.
- If you have a Medicare Advantage plan, you may be expected to cover a portion of the test. This is typically $330 or less.
If you have private (or commercial) insurance, you may also be expected to cover a portion of the test. There are many types of commercial plans with many different levels of coverage within those plans. Because commercial insurance can be complicated, we created the GeneSight Promise. If your cost could be more than $330, we will call you before we process your test.
If you do not have insurance, please call our customer service team (866.260.2394) to talk about potential options.
GeneSight Financial Assistance Program
In addition to the GeneSight Promise, we offer financial assistance for patients with commercial insurance plans that can further reduce your cost for the GeneSight test. This plan is based on household income, the number of individuals in your household, and other federal guidelines. To learn whether you qualify, visit www.GeneSight.com/cost.
If your cost is $100 or more, we also offer an interest-free payment plan that allows you to spread out your cost for the test.
Cost, Insurance and Billing Frequently Asked Questions
I received a call saying my cost will be more than $330. If I agree to pay that amount, will I receive a bill for the quoted price?
Yes. You will owe only the amount we quote you and you will receive a statement for that amount (even if the total ends up being more). If insurance covers more than we estimated and your portion of the cost is lower than what was originally communicated, we will bill you the lower amount.
What is the billing process?
We are committed to keeping you informed during every step of the process. Here’s how it works: Once we receive your sample, we’ll provide you an estimate of your out-of-pocket cost. If it is more than $330, we will call you before processing your test. Once the test(s) are processed, we will bill your insurance.
If you have commercial insurance, you will receive an application for the GeneSight Financial Assistance Program. During this time, your health insurance company will process our claim and will then send you an EOB (Explanation of Benefits) within 30-45 days. Once the claim has been processed and if there is a patient balance owed, we’ll send a bill to you, which is typically $330 or less.
What if I receive a statement for more than $330?
In this case, you probably received an explanation of benefits (EOB), which is not a bill. The EOB is a detailed explanation of the amount your insurance has covered for the GeneSight test(s). Once your claim is complete, we will send you a bill of what you owe, which can be paid online, by phone or via mail. Insurance processing takes time and it will likely be several months before you receive this bill from us.
You can view a sample EOB here: https://genesight.com/wp-content/uploads/2017/05/EOBPROMISE-0617.pdf.
Does the GeneSight test count against my deductible?
That depends on your insurance plan; please call our customer service team with specific questions.
If a doctor orders more than one panel, do I need to pay for both?
No, if the doctor orders multiple panels at the same time, we only bill insurance once.
How long does it take to get the results of the financial assistance request?
The financial assistance process is typically completed within 30 days. If you want to check the status, please call our billing team at 888.496.2391.
Our team works extremely hard to make sure that anyone who wants the GeneSight test is able to receive it, and is able to afford it.
Are you ready for the next step?
Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider.
The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors.
If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.