Cigna medical coverage policy criteria for genetic testing

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Instead, they may opt to pay out-of-pocket for the test or pursue direct-to-consumer genetic testing , if available. People considering genetic testing may want to find out more about their state's privacy protection laws before they ask their insurance company to cover the costs. Refer to What is genetic discrimination?

Other chapters in Help Me Understand Genetics. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Will health insurance cover the costs of genetic testing? Topics in the Genetic Testing chapter What is genetic testing? What are the different types of genetic tests? What are the uses of genetic testing? How is genetic testing done? What is informed consent? How can I be sure a genetic test is valid and useful? What do the results of genetic tests mean?

At least three relatives must have a cancer associated with HNPCC colorectal, cancer of uterus, small bowel, ureter and renal pelvis ; and ALL of the following criteria should be present:. PMS2 mutation testing is only necessary if no mutation is found in the other genes. Several state Medicaid programs offer coverage for BRCA testing, however this coverage varies by state.

It is important to note that this provision applies only to those Medicaid patients who are newly eligible under the ACA Medicaid expansion and does not apply to current Medicaid beneficiaries.

ASCO recommends consulting your state Medicaid guidelines to understand what genetic testing and counseling services may be covered for your patients. Further, once an individual has insurance coverage, the coverage cannot refuse to cover treatment due to a pre-existing condition; this is true even if a patient has been turned down or refused coverage in the past.

One exception: Grandfathered individual health insurance plans. The only exception is for grandfathered individual health insurance plans--the kind purchased by an individual and not provided through an employer.

These policies do not have to cover preexisting conditions. However, an individual can now switch to a Marketplace plan during open enrollment and immediately get coverage for the preexisting conditions. Specifically for women who are at an increased risk, plans are required to cover, without copay, counseling and genetic testing for BRCA mutations.

However, coverage of genetic counseling and testing for other cancer syndromes is not required under the ACA, leaving this provision up to individual health plans to determine if and how they will cover these services.

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