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Payment Options

Metametrix and Genova Diagnostics have combined efforts in a shared mission to apply a systems-based testing approach to the diagnosis, treatment, and prevention of complex chronic disease. Together, we offer a variety of patient-friendly billing options, including:
  • Insurance / EasyPay Program
  • Practitioner Billing
  • Medicare/Government Health Care Programs

Please Note: Effective October 15, 2012, BCBS of Georgia will begin following its Association Ancillary Billing Guidelines as mandated by the Blue Cross and Blue Shield (BCBS) Association of all BCBS licensees nationally. The change will affect patients whose healthcare providers (HCP) practice outside the State of Georgia. This means that Metametrix will accept assignment of BCBS claims for Georgia and Federal Employee (FEP) BCBS subscribers ONLY. For more information, please contact us.


EasyPay Program Overview

Our EasyPay program allows patients to enjoy the benefits customarily associated with traditional insurance-reimbursed medical services. It is an affordable option for patients with private or commercial health insurance, including Medicare Advantage plans. EasyPay has served as a great benefit to many patients by lowering out of pocket expenses, while we file a claim on their behalf to their insurance provider for processing.†

Our EasyPay program offers two options, which are distinguished as Schedule A” and Schedule B.” The differences in the options are determined based on the presence and health insurance provider by which a patient is covered. Identify the most suitable EasyPay option for you by reviewing the menu options below.

Please note: Health Care Practitioners (HCPs) are provided with our schedule of testing fees.* He/she will inform you of the EasyPay amount that you must submit with your specimen(s).

 

EasyPay Schedule A: You should select this option if:

  • You have private or commercial health insurance coverage AND your insurance plan does not appear on our EasyPay Schedule B list below
  • OR you are a Medicare Advantage subscriber AND your insurance company does not appear on our EasyPay Schedule B list below
  • OR Genova Diagnostics is an in-network provider for your insurance plan


EasyPay Schedule B: Patients should select this option if:

  • You do not have health insurance coverage
  • OR you receive health insurance coverage from one of the following EasyPay Schedule B-eligible insurance companies or plans listed below:
    • Aetna
    • Humana
    • Principal
    • Kaiser
    • Tufts
    • Blue Cross Blue Shield (BCBS) of North Carolina – All BCBS members are eligible, but ONLY when receiving services from health care practitioners in North Carolina
    • BCBS Federal Employee Program (FEP) – All FEP members are eligible EXCEPT when Genova Diagnostics is an in-network provider. When this is the case, FEP members should use our Schedule A option instead. Please refer to the BCBS Federal Employee Program section below for more details.

EasyPay Program Options and Guidelines

When selecting EasyPay Schedule A, please follow the simple steps listed below.

However, if this option is not relevant to your situation, please click here for details on EasyPay Schedule B.

Step 1:
Identify the EasyPay Schedule A amount that applies to your test(s). Please check with your health care practitioner for appropriate EasyPay payment amounts.

Step 2:
Provide a payment method to cover the appropriate EasyPay Schedule A amount. The proper requisition form must accompany your specimen to qualify for the program.

  • If we are an out-of-network provider for your insurance plan: Your EasyPay payment amount will be applied to your balance before we file a claim with your insurance company.
  • If we are an in-network provider for your insurance plan or for Medicare Advantage plans: Your EasyPay payment amount will be applied to your balance after your insurance claim is processed, if applicable.
  • For all patients, a statement will be generated to collect any remaining deductibles, co-insurance, or co-pays that exceed the EasyPay Schedule amount submitted, if applicable. Refunds will be issued automatically in the event that total payments exceed the total amount billed.

Step 3:
Confirm that your health care practitioner has provided all necessary information. The following information is needed in order for us to file an insurance claim on your behalf:

  • Completed requisition form (with ICD-9 diagnosis coding noted)
  • Health care practitioner's National Provider Identifier (NPI) entered on the requisition form

Step 4:
Submit insurance information on the requisition form with a copy of the front and back of your insurance card.

 

Other Program Details and Requirements
If you receive payment directly from your insurance company, then the payment and a copy of the Explanation of Benefits (EOB) must immediately be forwarded to Genova Diagnostics.

  • When payment is received it will be applied toward your total amount due and you will be billed for outstanding deductibles, co-payments or coinsurance under the EasyPay billing guidelines.
  • Failure to forward payment and EOB will result in you being billed for the insurance payment amount in addition to any outstanding deductible, copayments, or co-insurance, and you will not receive the benefits of the EasyPay program.

You may be required to provide a copy of the EOB from your insurance provider in order to be eligible for the EasyPay program.

In order to substantiate medical necessity for testing and to be eligible for insurance reimbursement, health care practitioners may be required to provide medical records to insurance companies. Failure of a health care practitioner to provide this information in a timely manner may result in the patient being billed for the total list price of his/her test.

Please note: Following steps 1-4 (listed above) is required to be eligible for our EasyPay program. If any of the requirements are not followed, then you will not receive the benefits afforded by EasyPay, resulting in you paying a higher amount. You will be responsible for the full patient responsibility, up to the list price of the test, minus payments received by Genova Diagnostics.

Health Reimbursement Accounts (HRAs) and Health Savings Accounts (HSAs)
Sometimes HRAs, HSAs, and other health reimbursement accounts automatically issue payments to us once a claim is processed. These payments will be applied to your balance as an insurance payment under the EasyPay guidelines.

Medicare and Medicaid
Genova Diagnostics is a Medicare provider. Patients who are Medicare and Medicaid subscribers are not eligible to participate in our EasyPay program. However, Genova Diagnostics will submit claims directly to Medicare and eligible Medicaid programs on behalf of patients. Please note eligible health care practitioners must be qualified under the Medicare program. Exception: Patients with Medicare Advantage are eligible for EasyPay (see EasyPay guidelines).

If your primary insurance coverage is through Medicare or Medicaid, click here for more information.

 

When selecting EasyPay Schedule B, please follow the simple steps listed below. However, if this option is not relevant to your situation, please click here for details on EasyPay Schedule A.

Step 1:
Identify the EasyPay Schedule B amount that applies to your test(s). Please check with your health care practitioner for appropriate EasyPay payment amounts.

Step 2:
Provide a payment method to cover the appropriate EasyPay Schedule B amount. The proper requisition form must accompany your specimen to qualify for the program.

  • Your EasyPay payment amount will be applied to your balance prior to filing a claim with your insurance provider.

Step 3:
Confirm that your health care practitioner has provided all necessary information. The following information is needed in order for us to file an insurance claim on your behalf:

  • Completed requisition form (with ICD-9 diagnosis coding noted)
  • Health care practitioner's National Provider Identifier (NPI) entered on the requisition form

Step 4:
Submit insurance information on the requisition form with a copy of the front and back of your insurance card.

Other Program Details and Requirements -
If you receive payment directly from your insurance company, then the payment and a copy of the Explanation of Benefits (EOB) must immediately be forwarded to Genova Diagnostics.

  • When payment is received it will be applied toward your total amount due and you will be billed for outstanding deductibles, co-payments or coinsurance under the EasyPay billing guidelines.
  • Failure to forward payment and EOB will result in you being billed for the insurance payment amount in addition to any outstanding deductible, copayments, or co-insurance, and you will not receive the benefits of the EasyPay program.

You may be required to provide a copy of the EOB from your insurance provider in order to be eligible for the EasyPay program.


In order to substantiate medical necessity for testing and to be eligible for insurance reimbursement, health care practitioners may be required to provide medical records to insurance companies.  Failure of a health care practitioner to provide this information in a timely manner may result in patient being billed for the total list price of his/her test.

Please note: Following steps 1-4 (listed above) is required to be eligible for our EasyPay program. If any of the requirements are not followed, then you will not receive the benefits afforded by EasyPay, resulting in you paying a higher amount. You will be responsible for the full patient responsibility, up to the list price of the test, minus payments received by Genova Diagnostics.

Health Reimbursement Accounts (HRAs) and Health Savings Accounts (HSAs)
Sometimes HRAs, HSAs, and other health reimbursement accounts automatically issue payments to us once a claim is processed. These payments will be applied to the patient's balance as an insurance payment under the EasyPay guidelines.

Medicare and Medicaid-
Genova Diagnostics is a Medicare provider. Patients who are Medicare and Medicaid subscribers are not eligible to participate in our EasyPay program. However, Genova Diagnostics will submit claims directly to Medicare and eligible Medicaid programs on behalf of patients. Please note health care practitioner must be qualified under the Medicare program Exception: Patients with Medicare Advantage are eligible for EasyPay (see EasyPay  guidelines).

If your primary insurance coverage is through Medicare or Medicaid, click here for more information.

The approval of claims and reimbursement amounts are at the discretion of each insurance company/plan.  Additional fees, such as deductibles, copays, and co-insurance may apply.
*As a policy, Genova Diagnostics does not quote prices for testing directly to patients. Our Client Services representatives are available to discuss pricing with a health care practitioner or his/her staff. For the most complete information, patients should direct questions about pricing to health care practitioners or their staff.

Genova Diagnostics as an In-Network Provider

Genova Diagnostics is an in-network provider for a growing list of insurance companies. We submit claims to these insurance companies on behalf of patients, when insurance billing is indicated as the patient’s preferred payment method. These patients should utilize our EasyPay Schedule A option.

If we are an in-network provider for your insurance or Medicare Advantage plan, your EasyPay Schedule A amount will be applied towards your total amount due as indicated on the EOB provided by your insurance provider.

For full EasyPay Schedule A guidelines, please click here.

We are In-Network Providers for the Following Insurance Companies (as of 07/01/13)
For more information, click on the featured links below.

  • Highmark Blue Cross and Blue Shield -  when receiving services ordered by a Pennsylvania or West Virginia health care practitioner only. This includes the following programs:
    • Highmark Blue Shield
    • Keystone Health Plan WEST - Medicare Advantage
    • Freedom Blue - Medicare Advantage
    • Secure Blue HMO - Medicare Advantage
    • BCBS of Northeastern Pennsylvania
    • Pennsylvania Independence Blue Cross
    • Out of state BCBS members receiving services ordered by health care practitioners in Pennsylvania

      Other Pennsylvania Blue Cross and Blue Shield plans are NOT included in our Highmark contract, so we are therefore out-of-network for:

      • First Priority Health
      • First Priority Life
      • Keystone Health Plan EAST
      • Personal Choice
      • Independence Administrators
      • Capital BlueCross of Pennsylvania
    • However, these plans are included in EasyPay Schedule A.
  • CareFirst Blue Cross and Blue Shield:
    • Blue Cross and Blue Shield members, including Federal Employee Program and out of state BCBS members, receiving services ordered by HCPs in MD, DC and Northern VA ONLY
    • CareFirst BCBS HMO products identified with prefixes XIC, XIK, XWR, XIR are not contracted. For these plans, we are considered out-of-network; however, these plans are included in Schedule A
  • Blue Cross and Blue Shield of Kansas City - Blue Cross and Blue Shield patients, including out of state BCBS members receiving services in the Blue Cross and Blue Shield of Kansas City service area in Missouri and Kansas ONLY
  • Blue Cross Blue Shield of Georgia - Metametrix branded testing is in network for BCBS patients, including out of state BCBS members, receiving services from health care practitioners in Georgia ONLY Blue Shield of California - BCBS patients, including out-of-state BCBS members, receiving services from health care practitioners in California ONLY
    • Not Eligible: Anthem Blue Cross of CA members are non-participating, but are eligible for the EasyPay Schedule A program
  • Blue Cross and Blue Shield of Illinois - PPO products and all out-of-state members receiving services from a health care practitioner in Illinois ONLY

Blue Cross Blue Shield Federal Employee Program (FEP)

Genova Diagnostics is an in-network provider for the Blue Cross Blue Shield FEP, but ONLY in the limited cases noted below:

  • FEP members receiving Genova Diagnostics branded tests ordered by health care practitioners in the CareFirst Blue Cross and Blue Shield service area ONLY (MD, DC and Northern VA) are in network
  • For FEP members in all states, the tests listed here are eligible to receive coverage as in-network

FEP members with insurance plans in-network  with Genova Diagnostics should use our EasyPay Schedule A option. All other FEP members should use EasyPay Schedule B.