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‘Will my insurance cover genetic counseling and testing? What do I do if coverage is denied?’
Boy, if I had a penny for every time I heard these questions…
It is well established that 1 in 40 individuals of Ashkenazi Jewish ancestry carries a BRCA mutation, predisposing them to breast cancer and ovarian cancer. When I speak with the women and families of Sharsheret about their family history of cancer, one of their most common concerns is insurance coverage of genetic counseling and testing. Insurance coverage and financial considerations are a valid concern for many women, and simply a reality in today’s day and age.
Most insurance companies set their criteria for coverage based on various established medical recommendations for who should have genetic testing. These criteria are designed to ensure that only those with a “strong” family history or those for whom genetic testing is appropriate are covered. However, it can be frustrating, especially as an Ashkenazi Jewish individual with increased risk, to be denied coverage. Genetic counseling itself is typically covered and billed as a medical office visit, however every center bills for genetic counseling services differently. If you are unsure, I recommend checking with the genetic counselor you meet with and your insurance company to ensure that counseling services are covered. Coverage of genetic testing, however, varies. Every insurance company, including Medicare, has its own criteria and will vary from person to person based on their personal and family cancer history. Additionally, coverage of genetic testing will likely change over time due to new health care laws. Each situation is truly unique, and so it may not always be possible to know before one meets with a genetic counselor if testing will be covered.
However, clinical cancer genetic counselors can assist you with the insurance coverage process. Genetic counselors working in a hospital or medical center setting can assist you with appealing for coverage or working with the laboratory (some have financial assistance programs, although not all.) The genetic testing process can be complex and it is important to meet with a genetic counselor who has the experience and knowledge to handle these concerns.
We welcome anyone with questions about genetic counseling or testing, or their family history, to contact our clinical team at 866.474.2774 for free, individualized support as part of our Genetics for Life program.
The Jewish Women’s Foundation of New York (JWFNY) visit to Sharsheret headquarters the other day just impressed us all. We were there to learn about the latest and greatest idea coming out of this amazing organization, the Financial Wellness Took Kit, which is funded by the Jewish Women’s Foundation of New York. After the tour, after meeting the staff behind the scenes, after visiting their impressive wall of awards and the empty wall on reserve for future awards, we went into a conference room to talk about the details.
The Financial Wellness Tool Kit was borne out of a roundtable discussion about women taking control of their financial health during and after a health crisis. As Sharsheret researched how to go about handling this for its community, it realized the following: women want to know about how to handle their financial information right away, at the start of the diagnosis. They need a place to keep it—staying organized is crucial to staying on top of this. And lastly, they need all the information in one place—a one stop shop.
In the tool kit, you will find compartments for health insurance, disability insurance, financial planning, estate planning, and resources. The truth is that this tool kit and its financial wellness planner could and, arguably, should be used by any and all of us as we age and need to plan for a future.
It is always inspirational to see Rochelle Shoretz and her devoted staff. And as part of the Jewish Women’s Foundation of New York, we are doubly proud that we have helped fund this new and necessary tool kit. But the truth is, Jewish women all over can be part of this—by telling friends, by getting educated on campuses, by using the tool kit. Sharsheret once again meets a need for all Jewish women. We thank you and know that this new year is better because of Sharsheret and the work they do.
© 2015 Sharsheret: Your Jewish Community Facing Breast Cancer
Sharsheret is a 501(c)(3) charitable organization ID# 13-4198529
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