Kimberly explains if genetic cancer risk assessment is paid for by medical insurance.
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Medical Insurance Cover for Genetic Cancer Risk Assessment In general, yes. When you are thinking about genetic cancer risk assessment, from an insurance perspective there’s two components: there’s the consultation and there’s the blood draw. The consultation, every insurance company is different, but most of them are the standard codes that office consultations are billed under, or a specific genetic counseling code. Every policy is different; majority of patients that we interact with have coverage. We verify that for every patient before we bring them in. In regards to genetic testing, which is the more expensive part; the consultation is usually in the range of a couple of hundreds at most. Genetic testing is in anywhere from two to three thousand dollars for the initial test. Once something is found in the family, it’s around three to four hundred dollars because you know what you are looking for. So for that two or three to four thousand dollar component, we find that the majority of patients who we recommend testing for, they have coverage for it. Is an insurance company going to cover for every woman? No. There has to be indications that there’s a likelihood that we would find something. So when testing is ordered, that’s considered medically necessary. There’s indications for testing; there’s a likelihood of finding something. We find that the majority of patients have coverage. When we come across an instance where it’s denied by the insurance company, there’s always an appeal process, and we are usually successful in that appeal. Mostly it’s education. The person on the other end, the insurance company, helping to educate them as to why the information is important. So in general, majority of patients we find do have coverage for the service.
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