What Should I Expect During the Genetic Counseling Session?
Genetic counseling involves reviewing your personal medical and
family history and obtaining medical records on those affected with
cancer, when possible. You will receive a questionnaire by mail, which
will need to be completed before your visit. This information will allow
the genetic counselor to determine your personal risk for developing
cancer as well as the likelihood that there is a genetic predisposition
for cancer in your family.
What Does Genetic Testing Involve?
We will discuss the benefits, limitations, and potential outcomes of
genetic testing during your visit and how they may have an impact on
medical management for you and your family.
Genetic testing may not be appropriate for everyone, and many factors
need to be considered during your session. Currently, genetic tests are
available to detect a variety of hereditary cancer syndromes. These
include (but are not limited to) cancers that involve the breast, colon,
ovary, thyroid, kidney and prostate. A genetic consultation is billed
as an outpatient visit and is usually covered by insurance. Genetic
testing is generally quite expensive, but most insurance plans cover
most or all of the cost. There are also options for financial assistance
and payment plans that may be investigated if testing is not fully
Genetic Testing and Insurance
Will my insurance cover genetic testing?
genetic counseling session is typically covered by most insurance
companies. Genetic counseling is billed as an outpatient visit, or
“facility fee,” with no attached provider. Generally, if visits to St.
Vincent are covered, then this visit is typically covered.
Some people will have a co-pay for outpatient visits. You are
responsible for finding out if a preauthorization or referral is
necessary for the consultation.
Genetic counseling is not a covered benefit for those on Medicare,
although Medicare frequently covers the cost of genetic testing. If
paying out of pocket, the cost of the visit averages around $130 for the
We cannot establish preauthorization for genetic testing until we
assess medical and family history during our initial genetic counseling
session, as this information is important to determine coverage. We will
work with the laboratory that provides genetic testing in order to
We do recommend that you find out whether or not your deductible has
been met. The out of pocket cost for genetic testing may be higher than
expected if you have unmet deductibles.
You also can find out from your insurance company whether or not
genetic testing is a covered benefit. If there is an exclusion in your
policy, it is likely that genetic testing will not be covered. As long
as there is no exclusion, testing may be covered, depending on medical
necessity and other criteria set forth by the insurance company.
For more information on Genetic Discrimination/Public Policy, please see these resources: