Billing and Insurance

Will my insurance cover genetic counseling?

Many insurances cover genetic counseling services, including those provided by telehealth, but coverage varies by state and by insurance plan. Insurances may only cover genetic counseling visits for certain indications, may not cover telehealth genetic counseling, or may not cover genetic counseling services at all. Please check your individual insurance plan. 

Prior authorization may be required. It is your responsibility to know and understand the benefits and coverage of your insurance plan. If you would like to contact your insurance to find out if they cover genetic counseling services, they may ask for a procedure (or CPT) code for the visit. The code GSF bills for genetic counseling visits is 96040.

As a courtesy, GSF will bill your insurance carrier on your behalf, but it is important to understand that you are ultimately responsible for the payment of your bill. You are responsible for any co-pays, co-insurance, deductibles, and all other procedures not covered by your insurance plan. If you are requesting that GSF bill your insurance, your insurance information will be collected when you schedule your appointment. You may also choose to pay for the genetic counseling visit and then submit the claim to your insurance company yourself for reimbursement. 

Whether GSF is in-network or out-of-network may determine whether insurance will cover the visit. GSF is currently in network with the following insurances:

  • Aetna
  • First Choice Health
  • Kaiser Foundation Health Plan of Washington Options, Inc
  • Premera
  • Regence
  • Community Health Plan of Washington
  • Molina

We cannot guarantee coverage by your insurance. Any questions or complaints regarding coverage should be directed to your insurance carrier.

How much does an appointment cost if insurance does not cover it or if I choose to pay out-of-pocket?

A new patient genetic counseling visit is $250, and includes the initial consult as well as a summary note that will be provided to you and any medical providers you designate. Some situations are more complex, and thus may take more time (gathering records, coordinating testing, etc). Any follow-up work from your visit will be billed at $100 per hour, and will only be done with your consent. Follow-up genetic counseling visits are also billed at $100 per visit. 

If insurance is not being billed, payment for the visit is due at the time of scheduling. If you cancel or reschedule with less than 48 hours notice before your appointment, a $60 cancellation fee will be billed. Cancellations or reschedules prior to 48 hours from the appointment will be refunded in full.

Prompt Pay: A 20% discount will be applied if appointment fee is paid in full at time of in-person service, or paid online at time of telehealth booking. 

Does GSF have a financial assistance program?

It is both the philosophy and practice of GSF that genetic services, including genetic counseling, should be available to those in need, regardless of their ability to pay. Financial assistance is available secondary to all other financial resources available, including but not limited to insurance, third party liability payors, government programs, and outside agency programs.

Eligibility for financial assistance shall be based on financial need at the time of the application, and is granted on a sliding scale based on the Federal Poverty Guidelines. For 2020:

Income and assets as a percentage of Federal Poverty GuidelinePercent of discountBalance billed to guarantorPaid at visitPaid after visit
Over 0 up to and including 100%100%0%$0$0
Over 100 up to and including 200%75%25%$50$63
Over 200 up to and including 300%50%50%$100$125
Over 300 up to and including 400%25%75%$150$188
Over 400%0%100%$200$250

Supporting income documentation is required with this application to be eligible for this program. Supporting documentation must be in the form of an IRS Form 1040. If an IRS Form 1040 is not available, submit a brief letter explaining your income source and why an IRS Form 1040 is not available. Additional documentation such as W-2 statements, copies of recent paychecks, and/or bank statements showing activity may be included as well.

Upon completion of the financial assistance application, the applicant will be notified of a decision in writing within 10 business days. Click here for a copy of the financial assistance application.

If you have more questions, or need to speak to a representative, please contact us at 844-743-6384.