Preapproval requires proper coding, some diseases do not fit standard codes, and reviewing agencies are quite concerned about the costs of testing. Reviewers may not understand the neccesity of the test and will require multiple letters of explanation. Denial rates are hard to determine, but subjectively they are frequent. Also, the patient must pay the deductible when applicable.
Prior to ordering genetic testing is important that patient be aware of the cost and the preapproval process. Many hospital laboratories refuse to draw the studies without a fee, which the patient may have to pay, and a quarantee that the laboratory will be reimbursed. This is especially a problem for studies sent out of State.
Preapproval requires a great deal of time, and routinely falls on the Genetic Counselor. It is expensive in terms of person hours and it does not get reimbursed. Patients and their family are often angry about denial of testing, and worry about their medical care without a diagnosis.
There are no easy solutions, awareness is the first step. Hospital administrators, Pathologists, and groups like the American College of Medical Genetics will need to support efforts to convince funding agencies to understand the importance of this testing for disease prevention and treatment. Early intervention and prevention can save money for these companies and agencies. Genetic testing of at-risk and affected individuals is becoming the standard of care. These hidden costs are denying individuals appropriate counseling and treatment.
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