Today is Scientific Sunday at Aortic Hope and we are excited to continue our Genetics 101 Series with Ryan Rodarmer.
Over the next couple of weeks, Ryan will discuss a variety of topics related to genetics. Use these discussions as a way to have a conversation with your physician.
Genetic testing, once a far-off dream, has transformed into a reality that's as close as our fingertips. With it comes the promise of personalized medicine, the potential for early disease detection, and a wealth of insights into our own genetic makeup. But while the scientific strides are exciting, they can also leave you scratching your head, wondering: "So... how much is this going to cost me?"
Let's chat about costs, insurance coverage, and all things financial in the world of genetic testing. No need for any penny-pinching panic or insurance-induced insomnia here, we've got you covered (no pun intended). And as always, if you have questions, don’t hesitate to reach out to me at ryan@myaorticjourney.com, and remember, #thinkaortathinkfamily.
Genetic Testing and Insurance: Breaking It Down
Let's get down to the nitty-gritty. Insurance coverage and genetic testing can be a tangled web to untangle, but don't throw in the towel just yet! Here's a closer look at the key points:
Insurance Coverage
The good news is, many insurers are stepping up to the plate. But like any good relationship, it's all about communication. Before you jump in, get in touch with your insurance provider to understand what is covered and what isn't. It's a little legwork upfront, but it could save you a heap of headaches later. And keep in mind, you don’t have to do this alone! Genetic counselors and lab billing staff can often take on much of this work. They order and/or perform genetic testing so often, that they usually have the process very streamlined and can get insurance coverage figured out way more quickly and clearly than you may be able to!
Self-Pay Discounted Rates
If the thought of dealing with insurance sends you into a tailspin, consider self-pay discounted rates. Many labs offer this option and it can be a game-changer, particularly if your personalized cost estimate with insurance exceeds the self-pay price. Once you've gone down the insurance route and a claim has been submitted, you may be locked in and no longer able to choose the self-pay option. It may make sense to choose that option from the start. Testing costs won’t count toward your deductible, but again, these reduced rates could end up saving you hundreds or thousands of dollars compared to your out-of-pocket cost when billing insurance. There are a handful of labs that cap the self-pay cost at $250 dollars or less – the days of losing the farm in order to afford genetics tests are long gone.
The Role of Prior Authorization
A heads up here—many health plans require prior authorization for certain tests and services, including genetic testing. What does that mean? It means that your insurance company needs to give the nod of approval for the test before they determine whether they'll cover it. If prior authorization is denied, you might be offered the self-pay price for your specific genetic test. Again, you are not responsible for seeking prior authorization. This needs to come from your ordering provider – but again, if that provider is a genetics professional, they likely have a prior authorization template letter written up and ready to go, and they know just the right words to maximize the chance of your insurance approving the test! Some genetics labs will also submit the prior authorization on behalf of your provider. If your provider seems overwhelmed, if you’re getting pushback because they’re unsure about how to navigate cost, insurance, ordering, follow-up – simply ask for a referral to genetics. If the closest genetics clinic is too far away, there are multiple telehealth genetic counseling services available as well.
In-Network Laboratories
Some labs are in-network for most health plans, including big names like Aetna, Anthem, Cigna, and UnitedHealthCare. They also accept all national and regional carriers in the United States. But even if a lab is in-network for your insurance plan, it doesn't always mean that 100% of the cost of testing will be covered by your plan. The total amount you'll owe is determined by your individual health plan, so it's best to contact your plan’s Member Services department for more info (or better yet, let the genetic counselor or genetics lab figure that out!)
Medicare and Medicaid
Medicare does not have guidelines for the coverage of genetic testing as it relates to cardiology; however, some labs, such as Invitae, may not balance bill the patient if they have straight Medicare (this may be subject to change). If your Medicare policy is managed by another insurer, such as BCBS Medicare for example, it may actually be best to go with the self-pay discounted rate. When it comes to Medicaid, most labs will not accept payment from Medicaid but many still have a policy in place where they will not balance bill the patient. Back to the theme of the day, let a GC help. ;)
How Genetic Counselors Can Help
Now, onto the superheroes of our story: genetic counselors. These knowledgeable professionals can work with the lab, patient, and insurance to find the most cost-effective option for your genetic testing. They're equipped with the expertise to help you navigate the maze of genetic testing costs and insurance coverage, giving you peace of mind and potentially saving you a pretty penny in the process. (I’m getting ahead of myself, but they can also make sure you understand everything you need to know before testing, and can help with interpreting the results and managing risk for yourself and family members when results come back!)
Conclusion
Navigating the costs and insurance coverage in genetic testing might seem like a daunting task, but armed with the right knowledge, it doesn't have to be. Whether it's understanding your insurance coverage, considering self-pay discounted rates, or enlisting the help of a genetic counselor, there are plenty of routes to making genetic testing affordable and accessible. So, don't let the cost conundrum hold you back from uncovering potentially lifesaving information about your genes.