Insurance 101

Many people come into the office with questions about if their genetic testing will be covered by insurance. This is a great question to be asking! However, it is important to understand some insurance basics in order to appreciate the answer.

Terminology:

Premium– cost of a health insurance plan, often a monthly payment

Deductible– amount you have to pay out of pocket before your insurance plan starts to pay

Copayment– a flat fee you pay every time you receive a medical service

Coinsurance– a fixed percentage that you pay to the healthcare provider after you meet your deductible

Out of pocket maximum– maximum dollar amount you can pay during a year, after maximum is reached the insurance pays all covered expenses

Prior authorization– request to your insurance to cover testing/services, submitted before testing is completed

Insurance coverage of medical care is often based on evidence of medical necessity. Providers can provide documentation of medical necessity to your insurance. Insurance companies have medical directors in charge of deciding what is both important and cost effective for their patients to have. If your insurance denies coverage, there is an appeals process that allows you to make an argument for why you believe coverage should have been approved.

Remember, covered/approved ≠ free!

It is never our goal that you get a large bill. No system is perfect and there may be bumps along the way, but we assure you that we do our best to provide top quality care is affordable for everyone.