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Leslie Parks was 34 and ready to start a family, but struggled for a year and a half to conceive. Before embarking on fertility treatments, her doctor required that she and her husband get screened to determine their carrier status for various genetic diseases. He recommended a Silicon Valley-based startup called Counsyl and assured her that the test would be fully covered by her insurance.
Weeks later, Parks received a bill for more than $1,494 after her insurer deemed the test “experimental.” Parks was shocked. As she later learned, that is the rate that Counsyl charges insurance companies; by contrast, their fee for uninsured patients is $349.
The crux of the problem is that genetic testing has exploded, but regulation has been slow to catch up. The U.S. Food and Drug Administration is still finalizing its guidance for how it will oversee the category of lab-developed tests, which includes some 60,000 genetic testing products already on the market.
Furthermore, insurance companies are in the midst of determining whether to reimburse for all or part of the cost of genetic tests that do not offer clear diagnoses, but instead dabble in probabilities. Some insurers have opted to cover genetic tests in cases where the patient is deemed high risk. Other insurance companies will only reimburse for tests that it determines are “medically necessary.”
Read full, original post: Why Patients Are Getting Hit With Surprise Bills After Genetic Testing