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  • Commercially Insured Patients

  • Medicare, Medicare Advantage and Medicaid

  • Uninsured or Underinsured

  • While many commercial carriers cover our tests for eligible patients, coverage varies by product and your specific plan. Contact our Customer Service team or your insurance carrier for an individual assessment.
  • Exact Sciences† is an in-network provider with many health plans, including Aetna, Anthem, Cigna, Humana, and UnitedHealthcare.
  • Exact Sciences performs the services ordered and deemed medically necessary, regardless of network provider status.
  • Medicare covers the tests for eligible patients.
  • $0 financial responsibility when Medicare fee-for-service (FFS) coverage criteria are met.
  • Medicare Advantage, which is provided by commercial insurance companies, may have different financial responsibility compared to Medicare FFS.

Our Customer Service team can help evaluate your situation and options.

Patient Support

We will help patients understand and navigate the insurance and billing process for the Precision Oncology portfolio of tests. Our team can assist with prior authorizations, billing insurance, appealing denied claims, and providing flexible payment options when necessary.

Billing Process

1Your doctor orders a test.

We check your insurance coverage, and when necessary, we will work with your doctor’s office and insurance company to submit a prior authorization.

2Once your test results are ready, we will bill your insurance.

Your insurance company will send you an Explanation of Benefits (EOB). Your insurance will determine if you owe any out-of-pocket costs, and this should be detailed on your EOB. Note an EOB is not a bill.

Because insurance coverage varies, we strongly encourage you to contact your insurer if you have questions about coverage and potential out-of-pocket costs.

3If your insurance denies payment, Exact Sciences will submit appeals on your behalf.§

Appeals processes sometimes take several months, and you may receive multiple EOBs and coverage status letters from your insurance.

4Once all actions with your insurance are complete, if you have any remaining balance, you will receive a bill from Genomic Health.

5If needed, we can work with you to set up an interest-free payment process. Contact us at 1-866-662-6897 to learn more.

Exact Sciences Patient Assistance Program

Exact Sciences believes that everyone should have the opportunity to be as healthy as possible, no matter WHO they are, WHERE they live, or HOW much money they make. A patient may qualify if they:

  • Are an Exact Sciences patient
  • Reside in the United States or its territories AND
  • Have a household income at or below 400% of the Federal Poverty Level (FPL)*

Use the estimator below to assess your eligibility.

Disclaimer: *Exact Sciences uses the Federal Poverty Guidelines for the 48 contiguous states and the District of Columbia, which are subject to updates that may vary from those listed in this resource.

Patient Assistance Estimator

See if you are eligible for testing at no or low cost with the Patient Assistance Estimator.

Complete the following fields and submit:

Patient State or U.S. Territory*
Patient State must be filled in
Household Size*
Household Size must be filled in
Annual Income*
Annual Income must be filled in
Submit

Exact Sciences may change or update its program criteria at anytime, without notice. Eligibility is not guaranteed. Exact Sciences may require that a patient provide proof of financial need if their information is not already available to Exact Sciences. If you have questions please contact help@exactsciences.com or call 866-267-2322

Patient Qualification:

 Qualify for patient assistance

Based upon the information provided you could have no out-of-pocket costs for this test.

Please note that additional information is required to apply:

 

1

Download the Financial Assistance Disclosure and Application Form
Download application in Spanish

2

Complete and submit the form along with required supporting documentation

3

Exact Sciences will review your completed application and confirm eligibility

Download the Application

Please return the enclosed application with supporting documents to one of the following:
Patient Assistance Program
Mail: ES Labs, 145 E. Badger Road, Madison, WI 53713
Fax: 844-870-8875
Email: help@exactsciences.com
Phone: 866-267-2322

Patient Qualification:

 Do Not Qualify to Patient Assistance

Based upon the information provided, the patient assistance criteria have not been met.

However, Exact Sciences offers flexible payment options and can discuss any extenuating circumstances the patient may have.

Contact Customer Service at 888-662-6897, option 2 to discuss further.

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Billing FAQs

* Exact Sciences may change or update its program criteria at anytime, without notice. Eligibility is not guaranteed. Exact Sciences may require that a patient provide proof of financial need if their information is not already available to Exact Sciences.

† Genomic Health, Inc., an Exact Sciences company, is the billing entity for Oncotype® and OncoExTra™ tests.

§ In some cases, consent to appeal is required. If your insurance company requires consent for Exact Sciences to appeal on your behalf, we will contact you. It is important to sign and return consent forms as soon as possible to allow timely appeals in case the claim is denied.

We’re here to help

Let the Exact Sciences Customer Service group help you with Medicare coverage, private insurance coverage, and financial assistance.