How Laboratories Play a Role in Member Benefits by Forming a Bridge Between the Ordering Provider and the Health Plan

In this session we will review how the laboratory and health plan work together in order for the patient to better utilize his/her member benefits. We will discuss the claims submission process, how medical necessity is determined, and the appeals process for genetic diagnostic testing.

Level of Instruction: Intermediate

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Robert Pilarski
Medical Affairs Director at Ambry Genetics
Robert Pilarski is Medical Affairs Director at Ambry Genetics, working on aligning payer policies and national genetic testing guidelines and overseeing medical necessity review processes. Prior to this he was a licensed and board-certified genetic counselor and Professor of Clinical Internal Medicine at the Wexner Medical Center and James Comprehensive Cancer Center at The Ohio State University. […]

Robert Pilarski is Medical Affairs Director at Ambry Genetics working on aligning payer policies and national genetic testing guidelines. Prior to this he was a licensed and board-certified genetic counselor and Professor of Clinical Internal Medicine at the Wexner Medical Center and James Comprehensive Cancer Center at The Ohio State University. Mr. Pilarski’s clinical responsibilities included counseling patients and families with a variety of hereditary cancer syndromes. He has presented regularly at national and regional conferences and has served as an ad hoc reviewer for numerous medical and genetics journals. Mr. Pilarski was a past board member of the National Society of Genetic Counselors, and co-founder and past president of its Cancer Genetics Special Interest Group. Until joining Ambry Genetics he was the vice-chair of the National Comprehensive Cancer Network’s guidelines panel on Genetic/Familial High-Risk Assessment: Breast and Ovarian Cancers, which set testing and management guidelines for individuals at risk for hereditary breast and ovarian cancers.

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Rachel Bluebond
Genomic Science Liaison
Rachel Bluebond joined Ambry in 2020 as the Oncology Genomic Science Liaison for the South Central Region.  In her current role she serves as a clinical liaison for the field team to educate health care providers and key opinion leaders on genetic testing and genomic medicine. Rachel previously worked as a clinical oncology genetic counselor […]
Rachel Bluebond joined Ambry in 2020 as the Oncology Genomic Science Liaison for the South Central Region.  In her current role she serves as a clinical liaison for the field team to educate health care providers and key opinion leaders on genetic testing and genomic medicine. Rachel previously worked as a clinical oncology genetic counselor at the University of Texas MD Anderson Cancer Center in Houston, Texas for 7 years and has worked with PWNHealth providing telehealth genetic counseling for 4 years. Rachel has been involved in graduate education at the UT MD Anderson UT Houston School of Biomedical Sciences. She is a member of the National Society of Genetic Counselors and the chair of the Billing Workgroup of the Access and Service Delivery Committee. Rachel received her Master of Medical Science degree in Human Genetics and Genetic Counseling from Emory University, and is certified by the American Board of Genetic Counseling.