Medical Malpractice

More Insurers Requiring Genetic Counseling Prior to Testing, OB/GYNs Disagree on its Necessity

September 20, 2016

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Breast cancer screening is a routine part of women's health care, but those with a family history of breast cancer may require genetic testing in order to determine if they are at high risk for developing the disease. In general, both health care providers, as well as health insurers, believe that genetic testing is beneficial when it comes to providing individual patients with the right type of preventative care and guidance.Recently, however, some insurers are beginning to find that genetic counseling with a certified counselor is beneficial to those patients who are about to undergo genetic testing in order to determine their risk level for breast cancer. While this sounds like an important step in the process, there are many obstetrician-gynecologists who find it unnecessary for their patients to be required to receive genetic counseling from a certified counselor with special training prior to ordering the actual test, and that the medical standard of care should not require such counseling. According to an article published on MedCityNews, there is an ongoing debate amongst providers and insurers as to what is necessary and what is most beneficial for the patients.

An Unnecessary Measure: Why Some OB/GYNs Oppose Certified Genetic Counseling

  • Many OB/GYNs note that the simple criteria that make a person eligible for genetic testing negate the need for additional counseling prior to having the testing performed. In most cases, a person is able to have genetic testing done to determine their risk of developing breast cancer if they have a family history of the disease.
  • Receiving genetic counseling from a certified counselor at an outside office or practice adds an additional step to the process for the patient. The counseling can delay the testing, and subsequently the results, by up to a few weeks. This delays the doctor's ability to assess the results and provide the patient with the options that are available to them at that time.
  • Some physicians also said that genetic counseling by a certified counselor is unnecessary because patients are counseled within their practice as to whether or not genetic testing is the best option for them. This counseling is compared to the same type of counseling that pregnant women might receive when deciding whether or not to have genetic testing performed during that time.

Determining the Right Option: Why Some Insurers Require Specialized Counseling

  • In many cases, insurance providers will cover the cost of genetic testing. The number of genetic tests being performed on patients who may have a family history of breast cancer has increased significantly, and insurers want to verify that these tests are necessary prior to ordering them for the patient.
  • Insurers also found that due to the increase in tests being ordered, many patients were having the testing done without truly understanding it. They found that genetic counselors helped patients develop a better understanding of the test itself, and gave them further information about the results.
  • Genetic counselors also can help patients determine the specific genes and mutations that need to be tested based on their family history. This allows insurers to provide coverage for specific types of genetic testing, rather than broad genetic tests that cover a wide range of genes and mutations that may not be necessary.

Insurers Who Require Genetic Testing with a Certified Counselor Prior to Genetic Testing for Breast Cancer

Several major insurance providers require genetic testing with a certified counselor prior to having genetic testing performed. UnitedHealthcare is one of the providers who began requiring genetic counseling in 2016. Under the company's policies, patients can receive counseling from their physician and still receive coverage for the test as long as the physician can prove they have the qualifications to adequately counsel the patient. Cigna requires certified counseling for all genetic cancers and has required this type of counseling for breast cancer since 2013.Genetic counselors agree that genetic testing can be quite complex—and many patients can benefit from a session with a certified counselor. These counselors work with patients on an individual basis in order to explain the need for genetic testing and help them make the right decision for their own personal health and well-being. However, many genetic counselors understand the need of physicians to begin testing as soon as possible, so they recognize that it can be a challenge to balance the demands of a person's health with the benefits of genetic counseling.We invite you to contact our New York law firm if you have questions about whether your doctor has complied with the applicable standard of care regarding your genetic testing.