Unnecessary Genetic Tests and Dealing With Insurance

Interviewer:

If an individual suspects something is unusual with their genetic test or an unnecessary test was provided, what is the best way to approach their healthcare team or insurance carrier?

Dr. Brandy Gunsolus:

When it comes to an unnecessary test, really the best way is to go through a patient advocate. That way, there is a formal documentation of the complaint if that test was unnecessary, and a lot of times going that way, if it's proven to be unnecessary, the bill can be erased by also by going through a patient advocate. Every facility that accepts Medicare, Medicaid, or TRICARE, just all of your national and state payers is required to have the documented process for documenting patient complaints and the follow-up, and they are required to reply to your complaint with a letter that's outlining exactly what they're going to do in writing. And so that is the best way when it comes down to unnecessary tests. Now, when you're talking about unusual test results, the most unusual test result that we commonly come across is variant of unknown significance, and this is when everyone's going to be the change in their own genetic code, you really don't know what the significant of that will change is, it could be highly significant in causing disease or it could just mean the reason why your eyes are blue, we don't know, and...so what's commonly reported is a variant of undetermined significance, most companies will...

Let's say five years down the road, they find out what that variant means, will send your position and update a report when they identify what that varies, so it's good that if you have genetic testing, you do keep in contact with that physician and that facility that you had it done, especially if you can get one of these reports that says very undetermined significance, that way you can get an updated report with the science and the research has caught up with the various epic family.

Dr. Kyle Riding:

And to add on to that, I just need to reiterate that molecular diagnostics, all this genetic testing is truly the newest avenue of biomedical science that we have to provide for physicians and their patients. So as Dr. Gunsolus said, there is so much data coming out on a daily use, hourly basis on all of these different genetic tests, these variants of that are related to different diseases, and so really it boils down to what she advocated for earlier, making sure you understand what you do, with either or whatever result is possible, your physician and you as a care team for your own health and wellness, understanding what you're going to do in those different result potentials so that you feel empowered in that case to make sure it isn't unnecessary testing.

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