Health plans are critical for Ambry’s profitable growth. But how do you get a health plan to cover genetic testing as part of their in-network offerings?

Enter the Ambry Market Access Team. This six-person team, led by Greg Nogle, develops contracts with health plans to ensure Ambry’s lab and testing are included in their benefits. Market Access makes it happen.

Greg Nogle with his family

Landing the Deal

Getting a deal with a health plan is all about relationships. It’s a slow sales cycle that can often take up to 18 months. As of 2022, thanks to the tireless efforts of the market access team, most U.S. health plans include Ambry’s genetic testing as part of their benefits. This coverage includes private insurance, Medicare, Medicaid and military health benefit plans. The two most approved tests are cancer susceptibility testing for breast and ovarian cancer.

Talking in Code: The Key to Getting Reimbursed

Landing the deal is only one part of the Market Access team’s job.

The health care industry talks in codes. To get reimbursed by a health plan, their codes must match the genetic test coding. The team works hard to ensure codes align with the specific health plan’s benefits structure and the medical policy contracted fee schedule. Their work is part of Ambry’s Billing Excellence plan, which aims to streamline efficiencies and minimize the administrative burden that may cause delays in reimbursement. The Market Access Team is the tip of the spear with the health plans for this critical reimbursement work.

Challenges often occur when Ambry wants to add a new clinical test option for a patient’s health care regimen. The molecular space changes fast, but health care companies are slow to adopt testing based on new technology. Even if the insurance company is receptive to new testing, some can’t keep up with the administrative challenges of change. In these cases, the Ambry team works collaboratively with the insurers to help them through the process and changes. This leads to expanded reimbursement for Ambry.

The Future is Focused on Increasing Testing Access

The Market Access team is small, but they have big goals for Ambry. In the coming year, they are working to increase RNA testing access for patients in participating insurance plans and overcome restrictive medical policies that hinder patients from receiving lifesaving clinical testing. In addition, they believe that clear communication and working with existing and future payer partners will pave the way for better health care, not to mention increased reimbursement.

Nogle describes the team: “We are the only team that can make insurance fun.” In addition, they give back to the local community. For example, they supported families in need throughout the year and donated much-needed items to the troops at Camp Pendleton during the Holidays.

Nogle has worked for Ambry for seven years and has been in the market access arena for 24 years. He compares the Market Access department to “the electric company. You don’t think about us until the lights go out.”

A photo taken by amateur photographer Greg Nogle