Genetic Counseling Session

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 covered.

Genetic Testing and Insurance

Will my insurance cover genetic testing?
A 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 initial visit.

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 determine this.

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: