Talk“Will Insurance Cover My Genetic Test?”
“Will insurance cover my genetic test?” is one of the most popular - perhaps the most popular - question we get at DNA Direct. For some genetic tests, the answer is pretty straightforward (”probably, here’s why…”). For other genetic tests, it’s more complicated.
Recently the magazine, Managed Care, ran a detailed article about exactly this issue. It begins with scenarios in which insurance company medical directors granted and denied coverage for genetic tests, and why:
- “It can’t be a fishing expedition.” Coverage denied for a handful of genetic tests.
- “This is the role genetic testing should play — when all else has been eliminated.” Coverage granted for Fragile X testing.
Of more interest to me is the detailed exploration, from the position of the insurance companies, how their policies and coverage is evolving in the face of cheaper genetic testing, patient fears of genetic discrimination, and the advent of personalized medicine.
Here’s one perspective, from an insurance company:
Some payers have established coverage policies. Great-West’s [Medical Director] Finkelberg approves genetic tests based on four criteria:
- If there is a clinical basis for suspecting that the patient could have the disease for which he or she is being tested,
- If the test is validated and reviewed by peers,
- If a treatment is available that can be offered if the test is positive, and,
- If the patient undergoes genetic counseling so that he understands how to evaluate results.
Here’s another, from the NIH-supported organization, GeneTests:
GeneTest’s [Principal Investigator] Pagon says that even if there is no current therapy, testing has value. “The tests resolve the diagnostic odyssey,” she says. “People can spend huge amounts of money doing a range of tests, seeing a lot of physicians trying to get to a diagnosis. And health care payers can save a lot of money on excess tests and specialists. You can’t begin to design a treatment without a diagnosis.”
If you have had genetic testing, did you seek insurance coverage? And did they cover it? Do tell!
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