Has anyone had Medicare cover their genetic testing?

Posted by trki @trki, Mar 22 7:46pm

My husband's genetic testing ( for the aortic root aneurysm) was denied by Medicare.

For those who had genetic testing, was it covered by Medicare? If not were you able to get it appealed?

Thanks

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

Update: Just had a call with a Medicare representative. Unfortunately, I was told that Medicare only covers genetic testing in two cases: (1) To determine if one’s genetics allow for the use of warfarin, or, (2) In the case of advanced cancer, to determine which drug therapy would be compatible.
So this differs wildly from any previous assurances I had been given.
Maybe the Medicare approval does mean you have to go through the whole appeal process, but that was not what I was told. The genetics company implied it depended on whether or not my Medicare premium had been met, and the hospital implied it was most likely covered.
Waiting with bated breath for the bill…..

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@thisnthat

Update: Just had a call with a Medicare representative. Unfortunately, I was told that Medicare only covers genetic testing in two cases: (1) To determine if one’s genetics allow for the use of warfarin, or, (2) In the case of advanced cancer, to determine which drug therapy would be compatible.
So this differs wildly from any previous assurances I had been given.
Maybe the Medicare approval does mean you have to go through the whole appeal process, but that was not what I was told. The genetics company implied it depended on whether or not my Medicare premium had been met, and the hospital implied it was most likely covered.
Waiting with bated breath for the bill…..

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Thanks.., that’s interesting… and explains why my husband’s previous genetic testing for prostate cancer was approved with no problem.

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@thisnthat

That amount was the same number quoted to me by my genetics counselor, but then she pretty much assured me Medicare would more than likely cover it. She also suggested I call the genetics lab the next day just to make sure. The genetics lab rep kind of danced around the answer, advising me to confirm with Medicare. 🙄 After reading your post, guess it’s a good idea!

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We should have called I guess , but my husband needed the test whether insurance covered it or not.

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@hsminc

We don't have Medicare B (only A-hospital) but my husband's bill was sent to medicare B by mistake. (That is another long debacle story.)
If you go to the genetics testing website and look at prices, you may find that the bill (if you ordered and paid it yourself) would be less than if you used a provider.
Whatever, I don't think the genetic testing is useful. The genetic testing for aortic aneurysm risk looks at whether you have a connective tissue disorder (e.g., Marfans)- and not other risk factors. (This can be done with a physical exam.) My husband was so relieved when his genetic tests came back totally negative but these DNA tests probably did not capture the risk. I say this because his first cousin (same age) had a dissected aortic mid level aortic aneurysm (same as my husband's) and now he has a descending aortic aneurysm and an abdominal aneurysm. This cousin's father clearly died from a ruptured thoracic aneurysm (where it was, we do not know). and my husband's mother died from a couple of cerebrovascular bleeds. She also had giant cell arteritis (which is consistent with connective tissue disorders - at least on one of the charts).
I don't know whether our billing mess with the genetics testing group and Medicare and our commercial insurance was ever resolved. In the end, we never received a bill from the genetic testing group - or at least I never paid one. The provider was supposed to bill our commercial insurance and not send the numbers to the genetics testing group. I do know that Medicare refused to pay - but this could have been because we don't have Medicare B - not because it was not a covered benefit. If you went through your provider, rather than ordering direct through the genetics testing group, your provider should have checked out coverage before ordering the testing - and I think they should also have figured out whether this testing would be informative for you. If you have no physical signs of connective tissue disorder, maybe it should not have been ordered. This was the case with my husband.

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Two cardiologists thought he had some characteristics of Marfan Syndrome..

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@fpignanelli

I just had genetic testing done about 2 months ago & it was covered under my Medicare Advantage plan.

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Thanks for your feedback!

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@trki

We should have called I guess , but my husband needed the test whether insurance covered it or not.

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Yes, it’s difficult to turn down the test since the info it may yield coukd be so valuable. I just wish the providers had been more forthcoming avout the true bureaucratic bunny hole and ultimate cost!

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@thisnthat

Yes, it’s difficult to turn down the test since the info it may yield coukd be so valuable. I just wish the providers had been more forthcoming avout the true bureaucratic bunny hole and ultimate cost!

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Yes! That would have been helpful!

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