Insurance Coverage: Thrombophilia Testing

Most insurance policies will cover genetic testing for thrombophilia (inherited blood clotting disorders). When you test with DNA Direct, we provide the support you need to seek reimbursement.

How to Apply for Reimbursement
Insurance Coverage
Anonymity
Insurance Company Websites

How to Apply for Reimbursement

To secure reimbursement for the cost, most insurance companies will ask you for the following:

  • Invoice and Receipt. DNA Direct will email you a receipt after you order a test.
  • CPT Codes. These codes tell the company what lab work was done, and how much their policy will pay for it. CPT Codes for Thrombophilia Testing
  • Reimbursement Form. Each insurance company has their own form. Call your company to request this form. If you need help filling it out, you can call our Customer Service at the number and we will assist you.
  • Letter of Medical Necessity. Some insurance companies will ask for a letter from your doctor that confirms this testing is medically important. You can phone your doctor's office to request this. If your doctor has a question, they can call our Clinical Director at the number below. See Sample Letter (.PDF)
  • ICD-9 Codes. These codes specify a medical diagnosis. Your doctor will need to provide these codes. If a letter of medical necessity is required, ICD-9 codes can be included in the letter.

Insurance Coverage

Insurance policies usually cover testing according to medical necessity. Most insurance companies will reimburse you if you are testing because:

  • You have had a blood clot such as a DVT (deep vein thrombosis) or a PE (pulmonary embolism).
  • You have had blood tests that indicate you may have an inherited blood clotting disorder.
  • You have a family history of thrombophilia.
  • You have a known genetic change (mutation) for thrombophilia in your family – factor V Leiden or the prothrombin mutation.

Insurance companies may be less likely to reimburse if you are testing because:

  • You have symptoms of thrombophilia other than blood clots (such as recurrent pregnancy loss).
  • You are in a high-risk group (for example, you are Caucasian)
  • You just want to determine if you are a carrier but you have no signs, symptoms, or family history.

Insurance coverage will depend on your individual policy. If insurance coverage is necessary for you to test, you can call your insurance company's customer service line before testing to secure pre-authorization. List of Insurance Company Websites

For insurance questions or assistance, call Customer Service at 1-877-646-0222.

Anonymity

Some of our customers prefer to test through DNA Direct and not use insurance, in order to keep their testing and test results off their medical record. DNA Direct's secure system separates billing and clinical information, so the testing lab only sees your Order ID, not your name. We do not share your information with any third party without your written permission.

Insurance Company Websites

Learn more about testing with our pre-test questionnaire: Start Women's   Start Men's
this page last updated: November 5, 2007