While annual physical exams and routine screenings are included in your healthcare plan, not every medical test, such as genetic testing, is considered standard medical treatment and covered by your plan.
Genetic testing is a fairly new screening that analyzes DNA, your unique genetic information, to determine if there are damaged or abnormal genes that may develop into illness. Some of these gene mutations may run in families, so genetic testing is used to see if you’ve inherited those genes that can cause certain illnesses. However, for many diagnoses, genetic testing is considered experimental and not covered by TeamCare unless the patient meets specific criteria.
For example, genetic testing on a patient with a family history of breast and/or ovarian cancer who is seeking BRCA1 and BRCA2 testing is considered standard medical treatment and covered by TeamCare. On the other hand, genetic testing for a diagnosis like opioid dependency, nausea, or hypertension, etc., would be considered experimental and not covered. It is important that your doctor checks with the PPO network to see if genetic testing is covered for your diagnosis.
Prenatal genetic testing is another area where your doctor needs to be sure treatment is covered by TeamCare.
- Clarify costs: Genetic testing can cost thousands of dollars. Keep in mind you will be responsible for any costs associated with genetic testing considered experimental and not medically necessary.
- Ask questions: What can we learn from results? How accurate is the test for my condition?
- Be your own champion: Be sure you understand why genetic testing is being recommended, and how those results affect your treatment plan.
- Direct-to-consumer genetic testing: Genetic tests like 23andMe or AncestryDNA are not covered by TeamCare for any diagnosis.
Genetic testing can provide only limited information about an inherited condition and can’t guarantee whether you will end up with a certain disease. Talking to your doctor about your family history, and what you can do to prevent disease, is always a smart and proactive approach to maintaining good health.