I need a Whole Genome Sequencing under the Medicare rules.

Posted by oldkarl @oldkarl, Nov 2, 2021

I need a Whole Genome Sequencing under the Medicare rules. Medicare says insurance will pay, if I can find a lab which will work by their rules to get it done. I have tried many labs, but so far, none will work by these rules. Any idea who will do it? I have tried Sequencing.com, Dante and others, but it seems hopeless. A good analysis will save me, Medicare and my insurances several hundred thousand dollars. Anyone???

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@oldkarl I am not sure if you've looked into Mayo Clinic for this request but I found the following information that may be helpful.

– Research: Core Resources Genome Analysis Core:
https://www.mayo.edu/research/core-resources/genome-analysis-core/services/sequencing
– Center for Individualized Medicine:
https://www.mayo.edu/research/centers-programs/center-individualized-medicine/research/programs/clinomics
Do you have the rules Medicare is asking for? Have you reached out to Mayo Clinic?

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@amandajro

@oldkarl I am not sure if you've looked into Mayo Clinic for this request but I found the following information that may be helpful.

– Research: Core Resources Genome Analysis Core:
https://www.mayo.edu/research/core-resources/genome-analysis-core/services/sequencing
– Center for Individualized Medicine:
https://www.mayo.edu/research/centers-programs/center-individualized-medicine/research/programs/clinomics
Do you have the rules Medicare is asking for? Have you reached out to Mayo Clinic?

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@amandajro , I have have looked into Mayo very much. Spent 4 months and about $10,000 there in Phoenix. Except for learning that I had cancer all over my body that they either could not or would not help me with, it was a total waste. Oh, not a waste for the staff and bosses; they did fine on my money. And the contractors who put up those fine buildings. And the airlines, and hotels and restaurants. But I went there for genetics purposes, and they wanted another $7,000 before they would help me, even with the stuff I already knew I had, and still have. oldkarl

REPLY

I asked for a genome analysis at the Mayo Clinic in Rochester, MN, and they told me that I have to pay for it out of my own pocket, about $7200.
I am intersex, and have many known genetic mutations, and I was told, as long as there is not a known health problem, Medicare would not pay for it.

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@oldkarl

@amandajro , I have have looked into Mayo very much. Spent 4 months and about $10,000 there in Phoenix. Except for learning that I had cancer all over my body that they either could not or would not help me with, it was a total waste. Oh, not a waste for the staff and bosses; they did fine on my money. And the contractors who put up those fine buildings. And the airlines, and hotels and restaurants. But I went there for genetics purposes, and they wanted another $7,000 before they would help me, even with the stuff I already knew I had, and still have. oldkarl

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@oldkarl I am sorry your outcome with your appointments weren't what you had expected. I would encourage you to reach out to The Office of Patient Experience with your concerns.

Office of Patient Experience
Mayo Building, lobby level
8 a.m. to 5 p.m., Monday–Friday
507-284-4988

Staff are available to discuss comments or concerns you may have regarding your medical care at Mayo Clinic.

REPLY

Interesting topic, I had genetic testing after cancer diagnosis when still on private insurance. May not been same as your asking about. I am now on Medicare and did search for rules. Here is Medicare document with rules for coverage:
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=372&ncdver=2
Of course, would try to verify with billing dept before any testing. Mayo does have a dept in billing that does estimates, I tried to get an estimate for a different non-covered appointment / test and provider actually had to ordered first, then billing could provide me an estimate. Once found out cost, I cancelled the appointment / test.

Good luck., Laurie

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@roch

Interesting topic, I had genetic testing after cancer diagnosis when still on private insurance. May not been same as your asking about. I am now on Medicare and did search for rules. Here is Medicare document with rules for coverage:
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=372&ncdver=2
Of course, would try to verify with billing dept before any testing. Mayo does have a dept in billing that does estimates, I tried to get an estimate for a different non-covered appointment / test and provider actually had to ordered first, then billing could provide me an estimate. Once found out cost, I cancelled the appointment / test.

Good luck., Laurie

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Laurie, from your post I'm taking it you had a Medicare advantgage plan prior to Orginal Medicare?

I have a Medicare advantgage plan now, & will need to have genetic testing done, was planning on coming to Mayo, worried about having extras covered changing to orginal Medicare.

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@lilli64

Laurie, from your post I'm taking it you had a Medicare advantgage plan prior to Orginal Medicare?

I have a Medicare advantgage plan now, & will need to have genetic testing done, was planning on coming to Mayo, worried about having extras covered changing to orginal Medicare.

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Actually when I had genetic testing, it was pre-65 and I was on an employer's insurance.

I suggest you contact your Medicare advantage plan and ask about coverage.

Laurie

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