What Genetic Tests Are Covered by Insurance?
More Programs and Publications Featuring Dr. Brandy Gunsolus
In this program:
Genetic test coverage can sometimes vary depending on insurance. Watch as medical laboratory scientist Dr. Brandy Gunsolus explains some cases when genetic testing is covered, the value of pre-authorizations, and how coverage can differ for Medicare patients.
Transcript
Interviewer:
So, what genetic testing would you typically find covered by insurance? And if there are ones that are not covered, could you speak to that as well please?
Dr. Brandy Gunsolus:
So really, it depends on what insurance you have. Unfortunately, it does when you're talking about most commercial insurance, as long as the provider has documented in your chart the reasons for getting that genetic test or the reasons why they believe that you have this condition, most insurance, commercial insurance, companies will cover the test. When it comes to Medicare, it's a little bit different. Medicare has something, what's called MolDX program, and that came about a number of years ago, and this program evaluates to see if testing, all testing, especially genetic testing, is payable from Medicare recipients. The reason that they have something different because of commercial insurance covers...that's great. The reason they have something different compared to those covered by commercial insurance is that the vast majority of people that are covered by Medicare or older, they're at least 65 years old. So a lot of the genetic testing is not covered by Medicare on the premise that this condition that they do not cover should have been diagnosed prior to the person becoming 65 years of age, so there are a lot of those types of nuances that Medicare does not cover genetic testing. There are also, even within the commercial insurance side, things called pre-authorizations, a lot of our audience may be accustomed to pre-authorizations when it comes to getting certain medications. But this is also becoming more of a commonplace in genetic testing as well, where you have to get the pre-authorization before, and just like with pharmacy, it's another layer of paperwork, another way for insurance to not cover the test. If the physician failed to get the pre-authorization before, the insurance company will not cover the test, unfortunately, that will result in individuals getting billed, which is unfortunate.
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