By signing this form, I understand that Ann Arbor Psych is not responsible for any charges incurred by Genesight Genetic Testing. I understand that all payments are made by me to Genesight, if a payment is necessary, and that it is my responsibility to contact Genesight in order to confirm pricing for genetic testing, and a payment plan, if needed.
I understand that Traditional Medicare, Medicaid, and Managed Medicaid are the only insurances accepted, and that all other insurances will not cover my test. I understand that as of 9/18/2020 the full cost of a test is $330, but that this price may be less if I qualify based on my household income. I understand Ann Arbor Psych charged a $40 paperwork fee to enter genetic testing into GeneSight's (complicated) system.
I understand on the very rare ocassion that insurance asks for additional justification for testing, Ann Arbor Psych has found that this is generally denied. Regardless of denial, as of 4/6/22 the price is capped for patient as stated above. Therefore, Ann Arbor Psych does not recommend doing additional documentation to justify testing, but if patient desires us to do so the charge is $20 per clerical hour and $200 per clinician hour, billed in 6 minute increments.
For further information on privacy I know I can contact GeneSight. For more information on pricing and payment plans, I can visit Genesight online at GeneSight.com/cost or call Customer Service at 866-757-9204.