Health insurance almost aways covers a genetic counseling consultation and risk assessment. As with most healthcare services, you may have a co-pay or be asked to cover a portion of the cost of the visit, depending on your insurance plan and factors such as unmet deductible. As part of the discussion of genetic testing, your genetic counselor will review cost and insurance coverage of the relevant tests.
As always, it is important to check with your insurance company to verify coverage because different companies have different policies and these policies change over time. We suggest calling your insurance company directly to ask about your specific policy. They will often ask you for which billing codes are associated with the service you're interested in (in this case, genetic counseling). A common CPT code (billing code) for genetic counseling is 96040; however, if you have a Medicare plan or other government insurance, this code may not be applicable.
If you have an HMO or managed care, you will need a referral to genetic counseling from your doctor and prior autorization for the visit.
Genetic counseling and genetic testing are billed separately. Coverage of one does not guarantee coverage of the other.
Generally, there are specific personal and/or family history criteria that must be met for insurance to cover genetic testing.
When you meet with a genetic counselor, the consult will include a discussion of whether your testing is expected to be covered, based on your personal and/or family history of cancer and insurance plan. We will also discuss options for paying out of pocket for genetic testing if applicable. The cost of genetic testing has dropped significantly in recent years.
UCLA Health System accepts Medicare-assignment and private indemnity insurance. It also participates in more than 100 local and national managed-care networks. If you are unsure, speak with your benefits coordinator or consult your health-plan provider directory to confirm that UCLA Health accepts your insurance coverage.
The Genetic Information Nondiscrimination Act of 2008 (GINA) was designed to protect you and your genetic information from being used in employment decisions and when determining your eligibility for medical insurance. In other words, your genetic information cannot be held against you regarding your job or being hired for a job, or in receiving medical insurance.
However, GINA does not offer protection for other types of insurance, including life, long-term care and disability insurance. If genetic testing indicates that you have increased risk for cancer, this may impact your rates or ability to get some types of these insurance plans.
For more information about the protections and limitations of GINA, please visit ginahelp.org.