Here are some facts about current coverage and reimbursement policies:
- Coverage decision-making is the process that health insurance plans and purchasers go through to figure out which services will be covered and in which situations the providers (such as doctors or genetic counselors) will be reimbursed for the services.
- The coverage decision-making process also happens when someone submits a claim for reimbursement or a request for preauthorization for the services is submitted.
- Public insurance plans vary from plan to plan on what they cover, however most cover the following:
- Genetic testing for chromosomal abnormalities
- Prenatal and neonatal diagnosis
- In some cases, preimplantation genetic diagnosis (e.g., advanced maternal age, suspected fetal anomaly, or history of miscarriage or developmental problems in prior pregnancies)
- Some plans have specific rules for certain conditions such as:
- Hereditary cancer testing
- Cystic fibrosis
- Tay-Sachs disease
- Hereditary hemochromatosis
- Evidence-based coverage of genetic tests is when the health insurance plan looks at the test’s accuracy and if there is a treatment in order to determine if it will be cost effective to cover the genetic test.
The most important thing that you can do is to talk to your health insurance company about which tests and counseling they cover or will reimburse, and under what circumstances they will cover these services. Your provider also may be able to help guide you through insurance coverage and reimbursement process.