Do insurance companies cover the cost of more accurate tests, such as ultrasound or blood tests, if a patient can provide evidence that he/she has one or more cancer marker genes?
Dear Informed Patient,
The insurer will pay for medically necessary tests. So, if the doctor believes that the ultrasound or blood test is appropriate for you, he/she will order it. I have not heard of an insurer requiring prior approval for such tests, nor denying the claim as medically unnecessary. You can always have the doctor’s office contact your plan to confirm before you have the test done.
These tests may or may not qualify as “preventive” care, which would have no co-pay. For example, someone might be prescribed to have a colonoscopy every two years, based upon his own or his family’s cancer history. The guideline for screening colonoscopies is one every 10 years. This means that insurance will still cover the colonoscopies, but the plan’s deductible would apply.
The test for detecting cancer genes is a different story altogether; genetic testing is rarely covered by insurance, and then only under very specific circumstances. It sounds like you have already had that test, and have the results.