#405 Why Insurance Denies Genetic Testing, and How to Navigate Coverage

Genetic testing can change the course of a patient’s care, but accessing the right test is not always straightforward.

Behind the scenes, insurance coverage decisions, documentation requirements, prior authorization, denials, appeals, and cost concerns can all influence whether a patient receives timely answers.

In this episode of DNA Today, we launch a new special series sponsored by Revvity in this episode exploring the health economics of genetic testing and the real-world systems that shape access to genomic medicine.

Host Kira Dineen is joined by Dr. Madhuri Hegde, Senior Vice President and Chief Scientific Officer at Revvity, and Mackenzie Mosera Derby, a pediatric genetic counselor at UW Health. Together, they examine genetic testing access from both the diagnostic laboratory and clinical perspectives exploring why insurance coverage remains so inconsistent, what goes into a prior authorization, why genetic tests are commonly denied, and how clinicians can approach appeals and peer-to-peer reviews.

In This Episode, We Discuss

The transition from stacked laboratory procedure codes to codes for genes, panels, exomes, and genomes

How and why insurance coverage varies among payers and individual health plans

Coverage differences across hereditary cancer testing, exome sequencing, genome sequencing, reproductive testing, and population screening

How rapid and ultra-rapid genome sequencing may be covered differently from standard genome sequencing

The limited coverage available for preventive and population-based genomic testing

The coordination required among patients, clinicians, laboratories, and insurance companies

Why laboratories offering tests with similar names may differ in technology, interpretation, turnaround time, and clinical support