Fulgent is committed to putting patients first by working side-by-side with our clients and their patients to provide access to quality genetic testing. We accept all commercial insurance plans and, whenever possible, will obtain the required prior authorizations.

What is Fulgent's billing policy?

Once we receive a sample or completed forms (see below), it is our practice to work with the provider and the patient on an individual basis. We will determine the patient's out-of-pocket cost for the genetic testing.

If a provider or patient wants to be notified for a different out-of-pocket amount, please indicate that on the test requisition.
(i.e. Please notify me if patient out of pocket exceeds $500 )

Testing will not be released until a reasonable path has been determined for reimbursement.

When can the verification of insurance coverage be done?

We can verify insurance coverage either before or after a sample is received in the laboratory.

To submit the required information, providers can:

• fax the benefits investigation request form to: 626-350-8802
• call us: 626-434-3598
• email us the benefits investigation request form: preverification@fulgentgenetics.com

Fulgent will fax the provider a summary once the process is completed.

Authorization will be obtained before samples are processed by Fulgent. If the insurance does not cover testing, or if the out-of-pocket is expected to be more than $100, we will contact the patient within a week to discuss. Fulgent does offer financial assistance and no-interest payment plans.

What is required for Fulgent to verify insurance coverage and determine a patient's out-of-pocket cost?

1. Copy (front and back) of the patient's healthcare insurance card (or cards if the patient has a secondary healthcare insurance plan).
2. Completed test requisition form, including patient information: address, telephone number, etc. This is critical as orders not complete will require manual processing and could create an unnecessary delay.
3. Make certain that the appropriate ICD10 code(s) are included on the requisition form
4. A clinical note, pedigree, and/or pertinent medical records that document the medical necessity of the genetic testing being ordered.

How does Fulgent verify coverage?

Fulgent accepts all private healthcare insurance plans. Fulgent will call the patient's insurance company to determine:

1. If a prior authorization is required, Fulgent will submit the needed documentation (see below for what information needs to be submitted).
2. What the patient's out-of-pocket cost will be. This includes unmet deductible, copay and coinsurance.

What is prior authorization?

Some insurance companies require a review of medical records before determining if genetic testing is covered by the plan. Fulgent will submit the medical information from the healthcare provider in an attempt to obtain a prior authorization.

In addition, certain insurance providers require a special authorization form to be completed by a genetics specialist if a specific test is being performed. To locate a genetic counselor in your area, please visit www.nsgc.org. While Fulgent Genetics has certified genetic counselors on staff to answer your questions, it is important that an independent genetic counselor/specialist provide pre-test counselling to your patients. Please see below for the corresponding forms.

Beginning in 2016, UHC requires prior authorization for BRCA genetic testing and should be completed by a Genetic Specialist (ie: genetic counselor, genetic nurse, clinical geneticist).

Aetna requires prior authorization to be completed by the ordering physician for tests that includes the BRCA genes.

Cigna has expanded the scope of requirements to most genetic testing including whole exome sequencing, hereditary cardiomyopathies/arrhythmias, microarray analysis, and hereditary cancer susceptibility. The following form should be completed by a Genetic Specialist (ie: genetic counselor, genetic nurse, clinical geneticist).

How does the insurance verification process impact turnaround-time?

Testing will not begin until:

• Prior authorization for the testing is obtained (if required)
• Patient agrees to the out-of-pocket amount (if more than $100).

What if a patient has Medicare?

Fulgent is contracted with Medicare. However, Medicare has limited coverage for genetic testing.

• For non-HMO Medicare plans, cancer panels are typically covered if the patients meets Medicare criteria for Hereditary Breast and Ovarian Cancer or Hereditary Colorectal/Lynch Syndrome testing.
  Breast-Ovarian Cancer BRCA1-BRCA2 Medicare Criteria Form

  Hereditary Colorectal Cancer Lynch Syndrome Medicare Criteria Form
  If a patient with a non-HMO plan does not meet the criteria for one of the cancer panels, they will need to sign an ABN.
  Advance Beneficiary Notice (ABN) Form
• For HMO Medicare plans:
  • Providers must obtain a prior authorization.
  • Deductible, coinsurance and copays may contribute to a patient's out-of-pocket.

What if a patient has Medicaid?

Fulgent is a registered provider with various Medicaid plans. However, these plans often do not cover the cost of genetic testing. Prior authorization is typically required.

• If Fulgent has a contract with the Medicaid plan, we will submit the required information and attempt to obtain a prior authorization.
• If we are not under contract with the Medicaid plan or if the test is not covered, we can offer our Medicaid Self Pay price.
• If the patient has a Managed Medicaid plan, the provider is required to obtain the prior authorization per the plan requirements.
• Any Medicaid test sent without a prior authorization will go on hold until a path for reimbursement has been determined.