Does health insurance cover genetic testing?
Not all health insurance companies currently cover genetic consultation and/or genetic testing. A health insurance company can provide a list of any genetic tests they cover. The company, however, may request special medical codes used for billing purposes called CPT codes. These codes can often be obtained from a doctor's office business manager or a genetic counselor.
Can genetic testing results affect my health insurance?
Some people choose not to bill their health insurance company for genetic testing because of privacy issues and fear of genetic discrimination. The Genetic Information Non-Discrimination Act (commonly called GINA) is expected to alleviate some of these fears. GINA is a two-part piece of legislation that many are calling the most important anti-discrimination law in decades.
Title I of this law, which prohibits health insurance companies from using genetic information to deny coverage or set payment rates, took effect in May 2009. Title II of this law, which prohibits employers from using genetic information when making decisions about hiring, firing, privileges and compensation took effect in November 2009. Click here for more information on what GINA can and can't do.
When considering genetic testing, it may be beneficial to weigh the pros and cons of billing health insurance.
Pros of billing insurance:
Genetic testing can be expensive. In addition, in the case of a positive result, medical and preventative treatments and increased disease surveillance specific to the condition will more likely be covered by a health insurance company.
Cons of billing insurance:
The test order and/or test results will likely be recorded into medical record. Once recorded, this information can be accessed by present and future health insurance companies. Many people fear this will allow their health insurance company to increase insurance premiums and/or deny future coverage. GINA addresses this concern.
Pros of paying out of pocket:
The test order and/or test results will not be recorded into medical record.
Cons of paying out of pocket:
A health insurance company may not cover medical and preventative treatments or increased disease surveillance for people who have not gone through testing.