Ambry’s billing policy has been updated and will be effective October 1, 2015. Our new policy supersedes all current hard copy documents available and is now available in this new "No Billing Surprises” brochure. We have discontinued the "Billing FAQ" brochure. We have also created a short brochure to help you understand an Explanation of Benefits (should you receive one), and this is found below.
We still preverify insurance coverage (with or without your sample) for genetic testing. We will contact you after your sample is received, if your out-of-pocket cost is estimated to exceed $100. If you have any questions, our Billing department can be reached by phone at 949-900-5795 or by filling out the form found here.
"No Billing Surprises" and "Explanation of Benefits" brochures
"No Billing Surprises" brochure (Spanish)
We remain committed to working with you and your patients to make the genetic testing process as simple and cost-effective as possible. If your patient would like to discuss his/her Explanation of Benefits (EOB), please contact the Billing Department at (949) 900-5795.
Medical Professional Notice Regarding Medical Necessity and Billing Compliance
Learn how to consolidate your send-out tests with Ambry and immediately lower your laboratory operating budgets.
Obtain information about setting up an institutional account.
Insurance Billing & Insurance Preverification Requests
Obtain information for billing patients with insurance coverage/preverfication request form to have us verify insurance coverage and share of cost. Please allow up 72 business hours for a response. (Due to recent high volume we are experiencing delays.)
We work with the majority of Medicaid plans and most require pre-verification for genetic testing. Please submit for pre-verification by faxing the completed test request form and insurance information to 949-900-5501. You can also call our Billing Department at 949-900-5794 to inquire about a specific Medicaid plan.
We are a contracted provider with Medicare. For genetic tests that Medicare has specific testing criteria for, the patient must meet Medicare criteria. If the patient does not meet the explicit Medicare criteria, a completed Advance Beneficiary Notice (ABN) is required. Our insurance pre-verification department can verify coverage and provide you with testing coverage details.
Medicare patients are able to have the following NGS cancer panel tests if they meet the specific criteria for each test as explained below:(Please click here for more information)
- To be eligible for Medicare reimbursement for BRCAPlusTM, BreastNextTM or OvaNextTM, the patient must meet Medicare BRCA1/2 testing criteria and not have previously had BRCA1/2 testing
- To be eligible for Medicare reimbursement for ColoNextTM or RenalNextTM, the patient must meet Medicare Lynch Syndrome genetic testing criteria and not have previously had Lynch Syndrome genetic testing
- To be eligible for Medicare reimbursement for CancerNextTM or PancNextTM, the patient must meet Medicare criteria for BRCA1/2 or Lynch Syndrome genetic testing and not have previously had BRCA1/2 or Lynch Syndrome testing
- To be eligible for Medicare reimbursement for PGLNextTM, please submit for pre-verification
As you know, Medicare is not covering any screening genetic tests for patients who have never had an associated cancer diagnosis. We are not able to bill Medicare if the patient is unaffected and genetic testing is being ordered based only on family history.
Obtain information for patients who will be paying for testing out-of-pocket (due to no insurance or other coverage).
Obtain information for clients sending in samples from outside the U.S.
Post-Mortem Genetic Testing
The cost of genetic testing can often be a barrier to post-mortem testing. Insurance companies may not cover this cost because the patient is deceased, but there have been reports of insurance coverage in some situations. If insurance coverage is denied or is not an option for your patient, we offer reduced pricing for cardiovascular post-mortem testing.
- Authorization – An approval to perform testing by the insurance company
- Preverification – A service Ambry provides to our clients to obtain benefit information (out of pocket costs) and coordinate authorization requirements.
- Insurance Verification Representative – An Ambry employee who is specialized in obtaining insurance benefits and approvals.
- OOP – Out of Pocket Costs to the patient
- ABN – Advanced Beneficiary Notice
- LOA – Letter of Agreement
- LMN – Letter of Medical Necessity
- Payer – Insurance Company
- Carrier – Insurance Company
If under any circumstance your patient would like to discuss their Explanation of Benefits (EOB), please contact the Billing Department at (949) 900-5795.
We remain committed to working with you and your patients to make the genetic testing process as simple and cost effective as possible.