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Continued coverage and reimbursement challenges for diagnostic exome sequencing after 5 years, genetic counselors can help to overturn denied cases

Date:
Wednesday, Sep 28, 2016 11:00am – 12:00pm
Conference:
NSGC 2016
Authors:
Kelly Hagman, MS, CGC, LGC, Layla Shahmirzadi, Sha Tang, Taylor Cain, Zöe Powis
  • 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.
Abstract