Baylor Genetics is in-network with several managed care providers. Learn more by clicking the “In-Network Plans” tab below.
Navigating the billing process can be difficult. Baylor Genetics is here to answer any billing questions you or your patient may have. Our verification team can perform a benefits investigation before testing to determine out-of-pocket costs.
If you would like Baylor Genetics to verify benefits coverage:
- Fill out the Patient Insurance Benefit Verification Form.
- Once your request is received, a billing team member will contact you to request additional information or provide any updates.
- After the verification is complete, we will give you and your patient the estimated out-of-pocket.
Some insurance plans have specific criteria that must be completed before testing to ensure coverage. Download payer-specific forms here.
AUTHORIZATION IS REQUIRED FOR ALL HMO SERVICES
To secure HMO authorization or perform insurance verification for genetic testing services, please provide this information to the managed care company:
2450 Holcombe Blvd, O-100
Houston, TX 77021-2039
- Tax ID: 47-2290309
- NPI: 1568860062
- Place of Service: Independent Laboratory
Please contact us if you have difficulty obtaining authorization or performing insurance verification.
For patients using Medicaid, Baylor Genetics will work directly with your plan to obtain prior authorization for covered services. Once the authorization is approved, Baylor Genetics will bill Medicaid directly. In the event Medicaid denies reimbursement, Baylor Genetics will work with the Medicaid plan to obtain coverage for testing. The patient will not be billed for claims denied by Medicaid.
Cash pricing is available for your patient when insurance is not an option. Call us to obtain pricing for any of our genetic tests.
Establishing an institutional account allows for convenient monthly invoicing and payment options.
- An Institutional Agreement Form and/or Laboratory Services Agreement (LSA) must be on file to establish an account.
- Two ways to pay:
- Online Bill Pay
- Payment With Sample
- We accept the following:
- Checks/Money orders (Payable to Baylor Genetics)
- Wire Transfers
- We accept the following:
*Institutional accounts cannot be revised to bill insurance.
We recommend establishing an account with an email address before submitting an international sample. Testing must be prepaid if you are not able to create an account.
If you are prepaying for a test, please submit a check, money order, or wire transfer payment with your patient’s sample.
- Aetna HMO*
- Aetna Elect Choice
- Aetna QPOS
- Aetna Select
- Aetna Managed Choice POS
- Aetna Choice POS II
- Aetna Open Access Student MC
- Aetna Signature Administrators
- Aetna Joint Claims Administration
- Aetna Passport to Healthcare
- Aetna PPO
- Aetna National Advantage
- Aetna National/First Health Network
- AmeriGroup Kansas
- AmeriGroup Texas
- Anthem California
- BeechStreet - PPO
- BlueCross BlueShield of Arizona
- BlueCross & BlueShield TX Blue Essentials HMO*
- BlueCross & BlueShield TX PAR Indemnity
- BlueCross & BlueShield TX Health Select
- BlueCross & BlueShield TX PPO – Blue Choice
- BlueCross & BlueShield of Illinois PPO
- CIGNA HMO*
- CIGNA PPO
- Community Health Choice – Community Marketplace
- Health Spring-Renaissance IPA
- Humana Commercial PPO
- Humana HMO*
- Humana POS
- Humana EPO
- Humana HMO Premiere*
- Humana Choice Care Commercial PPO
- Humana Choice Care POS
- Humana Military - Tricare*
- (New Tricare East, including North and South regions)
- Mail Handlers Benefit Plan
- Maine Community Health Option
- Memorial Hermann Health Solutions Inc. Choice
- Memorial Hermann Health Solutions Inc. EDGE
- Memorial Hermann Health Solutions Inc. PPO
- Molina Health Care of Texas HMO
- OSU Health Plan
- Ped-I-Care (Florida)
- Physicians Health Plan of Northern Indiana (PHPNI)
- POMCO [Government]
- Scott & White Health Plan HMO
- Scott & White Health Plan PPO
- Seton Health Plan PPO
- Seton Health Plan EPO
- Stratose [Network]
- Texas Children's Health Plan
- Texas Health and Human Services [Government]
- Three Rivers Provider Network
- United Healthcare [Commercial]*
- United Healthcare Empire Plan (New York)
- Wellmark Iowa
- Wellmark South Dakota
The Medicaid policies listed below require prior authorization by an ordering provider.
Effective immediately, TX Medicaid and TX Managed Medicaid will no longer process prior authorizations or provide reimbursement for testing that is non-covered by the TX Medicaid fee schedule.
Examples include 81415, 81416, 81479, 81228, 81229, 81460, and 81465, which primarily affect Whole Exome Sequencing (WES), Chromosomal Microarray Analysis (CMA,) Comprehensive Mitochondrial Analysis, and any testing coded with 81479.
Always double check the most recent TX Medicaid fee schedule before requesting a prior authorization.
- BlueCross & BlueShield TX CHIP
- BlueCross & BlueShield TX STAR
- BlueCross & BlueShield TX STAR Kids
- Community Health Choice Inc. CHIP
- Community Health Choice Inc. STAR
- Cook Childrens Health Plan CHIP
- Cook Childrens Health Plan STAR
- Dell Children’s Health Plan CHIP
- Dell Children’s Health Plan STAR
- Molina Health Care of Texas CHIP
- Molina Health Care of Texas STAR
- Molina Texas Medicaid STAR+PLUS
- Scott & White HealthPlan Medicaid CHIP
- Seton Health Plan STAR
- Seton Health Plan CHIP
- Superior HealthPlan CHIP
- Superior HealthPlan Medicaid
- Superior HealthPlan STAR
- Superior HealthPlan STAR Kids
- Superior HealthPlan STAR Health
- Superior HealthPlan STAR+PLUS
- UnitedHealthcare Community Plan of Texas
- New Mexico
- New Jersey
- New York
- North Carolina
- South Carolina
We are a certified Medicare provider. The patient must meet Medicare’s specific testing criteria for genetic tests. A completed Advanced Beneficiary Notification (ABN) form is required if the patient does not meet the criteria.
*Requires prior authorization by an ordering provider.
What if insurance does not cover my patient’s test?
Our team can verify your patient’s benefits prior to ordering. If you would like Baylor Genetics to verify coverage, please fill out the Patient Insurance Benefit Verification Form.
If insurance will not cover testing for your patient, we offer Self-Pay options as well as Financial Assistance to eligible households.
Do you offer discounts, payment plans, or financial assistance to patients?
Baylor Genetics is committed to providing you with support when our patients experience financial burden. Please call us to discuss discounts, interest-free payment plans, and learn more about our financial assistance program.*
* Financial assistance is based on the Federal Poverty Income Sliding Scale. Combined household income must be less than or equal to four times the federal poverty guidelines. This is based on the HHS Poverty Guidelines. Restrictions may apply.
Can I request the fee schedule?
We do not provide a copy of our comprehensive fee schedule to our clients unless a specific fee schedule has been established for your institution.
How do I send a wire transfer?
For wire transfer instructions, please contact our billing department at 1.866.848.4228 or contact us.
What if I have questions regarding managed care?
For questions regarding managed care, please contact us.
Baylor Genetics can cancel testing within 24 hours of sample receipt at the request of the institution. If there is missing information that prevents Baylor Genetics from completing the billing process, you will be notified and given 5 business days to resolve the issue. Otherwise, testing will be cancelled. All efforts will be made to communicate any missing information. For more information, please visit our Test Cancellation page.