Billing
Insurance
Billing
Institutional
Billing
Medicare / Medicaid Billing
Patient Self
Pay
Compassionate
Care

Insurance Billing

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.
Before the sample is received in the lab
Benefits Investigation Request Form
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.
After the sample is received in the lab
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. Insurance Billing Section
  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.

United Health Care (UHC)
UHC Genetic Counseling Attestation Form

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
Aetna BRCA Precertification Request Form

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

Cigna
Cigna Genetic Testing Recommendation Form

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).

Institutional Billing

How does Fulgent handle institutional billing?

To choose institutional billing, please completely fill out the Institutional Billing section of the requisition.

Organizations will be invoiced directly for services once testing has been completed. Please email, fax, or ship all corresponding documents with the sample.

Institutional Billing Section

Medicare / Medicaid Billing

What if a patient has Medicare?

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

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.


Patient Self Pay

Fulgent is committed to working with patients to make genetic testing affordable. We offer cash pricing at a discounted rate to make our tests accessible to all patients. Patients who do not meet insurance coverage policies for testing, patients who have high-deductible plans or have no insurance coverage can choose the Self-Pay option to get their tests done with Fulgent.

  • Full payment or initial deposit if on a payment plan (Payment Plan Agreement is signed) must be made before test results can be released, either by credit card or check.
  • The Self-Pay option is not applicable for the Compassionate Program.

To take advantage of the self-pay price, select the “Self-Pay” option on our test requisition form and provide the patient’s contact information. If ordering online, select the “Self-Pay” option in the billing portion of the ordering process. Fulgent will follow up with the patient directly regarding payment.


Compassionate Care Program

Fulgent Genetics is a compassionate company offering a wide range of financial assistance programs based on the individual’s financial need. These programs are available to patients in the United States who want to have their tests done with Fulgent. Patients must meet clinical and income criteria to apply for these programs.

Interest-free Payment Plans

Fulgent offers interest-free payment plans.

Economic Hardship

For patients with no medical insurance and limited financial resources to cover the cost of testing.

To apply for Economic Hardship please complete the Application For Economic Hardship and submit it to Fulgent Genetics via email or fax.
Form:
Application For Economic Hardship
Email: insurance@fulgentgenetics.com
Fax: 626-350-8802

Patient with commercial insurance

For patients who are insured with commercial insurance, Fulgent can offer financial assistance based on the criteria (see the Financial Disclosure Form for details). Patients with U.S. Federal and/or State funded health plans (i.e. Medicare, Medicaid, TriCare, Champus) do not qualify.

To apply for Financial Assistance, please complete the Financial Disclosure Form and submit it to Fulgent Genetics via email or fax

Form:
Financial Disclosure Form
Email: insurance@fulgentgenetics.com
Fax: 626-350-8802

Remember that our Client Services Team is available to assist you. If you have any questions about our billing process or any of Fulgent's programs, please

  • Call us on 626-350-0537 or
  • Chat with us at fulgentgenetics.com (look for the orange bar “chat with us”) or
  • Email us at info@fulgentgenetics.com.

Please contact a Billing Representative at 626-434-3598 or insurance@fulgentgenetics.com for more information.

Our mission is simple: to ensure all patients have access to important and clinically relevant genetic testing.

We believe in empowering patients and clinicians to make the most informed treatment decisions. Fulgent Genetics understands that costs associated with a patient’s testing can potentially pose a financial hardship which may influence a patient’s decision in selecting genetic testing options. Fulgent Genetics will always continue to provide all patients with access to cost effective genetic testing and promises to work one on one with each patient to meet their testing needs.