All billing requirements must be met prior to
sample processing. Please make sure the patient financial acknowledgment
is signed and all details requested are complete.
Convenient Billing Options:
Insurance
Medicaid
Medicare
Patient Care Plan
Institution
Billing
International
Samples
Payment
Options
Pre-Payment
Credit Card Payments
Wire Transfers
Online
Billing Inquiries
All insurance cases must come with a completely
filled out Test Requisition/Billing Form and also with HMO authorizations/referrals
and ICD-9 code.
Attach a copy of the front and back of patients insurance card for both primary and secondary insurance carriers. If insurance card is not available, a copy of patient's demographic information or the Registration/Billing form should be submitted.
Status of benefits must be verified for all insurance samples before processing. All tests not authorized by the patient’s insurance will be the responsibility of the patient. Ambry Genetics will inform the client and patient of partial or full payment responsibility based on the patient’s current insurance coverage.
If you would like Ambry Genetics to check your patient’s insurance coverage before sample collection, please complete and fax us the following form. We will repond as quickly as possible.
Insurance
Preverification Request | Adobe PDF Document
Ambry Genetics is contracted with the following insurance carriers:
- Beech Street
- Blue Cross
- Blue Shield
- Child Health Plan Plus – CHP
- Community Care Network – CCN
- Coalition America, Inc.
- First Health
- Galaxy Health Network
- Great West Health
- Harvard Pilgrim Health Care
- HUMANA / Choice Care
- Medavant (NPPN)
- Medicare Railroad
- Multiplan
- PHCS PPO/Open Access Networks
- PPO Next
- Premier Healthcare Exchange (PHX)
Patient Care Plan
Some insurance companies do not always provide full payment for innovative genetic testing. Because we believe the Ambry Test provides the most comprehensive analysis currently available, Ambry Genetics has established our Patient Care Plan to assist patients with their insurance companies. The Patient Care Plan was designed to contain a patient’s out of pocket costs to no more than 15% of the amount billed for Ambry tests (excluding any deductible and non-covered items if applicable).
Medicare
Ambry Genetics is approved by Medicare and follows the same billing policy as with private insurance carriers. Collection is based on published Medicare prevailing rates locality 26/31146.
Medicaid
Ambry Genetics is a participating provider in the following states:
- Arizona
- Alabama
- Colorado
- Idaho
- Illinois
- Kansas
- Kentucky
- Louisiana
- Maine
- Minnesota
- Montana
- Nebraska
- New Jersey
- New Mexico
- Ohio
- Oklahoma
- Utah
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Referring clinics, hospitals, labs, and/or physicians may establish institution contracts with convenient invoicing and payment options. Please contact us for details.
Ambry Test®: 508 FIRST™
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Ambry Test: CF Full Gene Analysis
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Ambry Test: CF AMPLIFIED™
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Ambry Test: CF Del/ Dup
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Ambry Test: IPF Telomerase
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Ambry Test: Shwachman-Diamond Syndrome
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Ambry Test: TG Repeat
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Pancreatitis Panel (CFTR, PRSS1, SPINK1)
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Pancreatitis Panel AMPLIFIED (CFTR AMPLIFIED, PRSS1, SPINK1)
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PRSS1
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SPINK1
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Ambry Test: Alpha-1-Antitrypsin
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Ambry Test: Aminoglycoside-Related Hearing Loss
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Ambry Test: ABCA3
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Ambry Test: Surfactant Protein B
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Ambry Test: Surfactant Protein C
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Ambry Test: Beta Globin
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Ambry Test: Canavan AMPLIFIED™
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Ambry Test: Tay-Sachs Plus
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Ambry Test: Maternal Cell Contamination
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Ambry SEQUENCE: Neonatal Diabetes
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Ambry SEQUENCE: Congenital Hyperinsulinism
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Ambry Test: ABCC8-Related Diabetes
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Ambry Test: GCK-Related Diabetes
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Ambry Test: INS-Related Diabetes
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Ambry Test: IPF1-Related Diabetes
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Ambry Test: KCNJ11-Related Diabetes
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Ambry Test: Transthyretin Amyloidosis
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Specific Mutation Analysis (any gene)
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International samples must be prepaid unless an institution has already established an account prior to sample submission. An e-mail address is required to establish an international institutional account. The account ID will be communicated by e-mail once the payment information is verified and all required information is received. Please submit check, money order, credit card, or wire transfer payment with single samples (see Payment Options).
Pre-Payment
Individual prepaid samples receive discounted institution fees when the required payment is received with the sample. We accept checks, money orders, credit card payments, and wire transfers. Please make checks and money orders payable to Ambry Genetics. There is a $20.00 processing fee for insufficient check payments.
Credit Card Payments
Approved credit card (AMEX, Discover, MasterCard, or Visa) payments are accepted. The card type, cardholder name and signature, credit card account number, expiration date, and contact phone number must be provided.
Wire Transfers
Payments can be made via wire transfer from your bank. Please contact Kristen Jones at kjones@ambrygen.com for more information.
Please fill out the following information:
