Continued coverage and reimbursement challenges for diagnostic exome sequencing after 5 years, genetic counselors can help to overturn denied cases
Despite recommendations and literature demonstrating clinical utility of DES, over 97% of cases were denied due to insurance companies’ rationalization that the DES does not have enough evidence to benefit patients.
The number of overturned appeals (32.3%) is encouraging and eludes that genetic counselors can help in insurance authorizations and obtaining coverage for DES.
While a number of insurances (both private and public) are covering DES, genetic counselors are needed to aid in education of payers and demonstration of the clinical utility of DES.
Authors: Zöe Powis; Kelly Hagman; Taylor Cain; Layla Shahmirzadi; Sha Tang