What is Genetic Counseling?
Genetic Counseling is the process by which you can learn about the inheritance of traits, conditions or diseases that may exist in your family. A genetic counselor is trained to elicit family history and interpret information about genetic disorders, explain patterns of inheritance, identify the most appropriate risk assessment tools and discuss risk information. After a session with a genetic counselor you will have information about genetic risk that your physician can use to determine your total risk and the best strategy for helping you to maintain your good health. Genetic counselors work in collaboration with physicians, providing to physicians and their patients -up-to-date and useful information about how genetic conditions can be inherited and how genetic testing is being used.
Your genetic risk and your ability to obtain genetic testing to clarify your risk is based on accurate family history information, which sometimes requires supporting medical records. We are experts in helping to determine which records are important and necessary, and in helping to locate them. Genetic testing approval is also based on insurance company policy, which can vary and which is based on consensus driven recommendations. These are ever changing and our up-to-date information can help you with insurance approval for the testing you seek. It has been shown that patients who seek genetic testing through genetic counselors are more likely to obtain greater coverage for the costs of genetic testing.
Can't my primary care physician answer my genetic questions?
Your doctor can answer many questions about heredity and health. However, your doctor will refer you to a genetic counselor or other specialist when he has determined that your question requires the greater expertise of a specialist. Genetic Counselors have experience in answering numerous questions about the hereditary basis of disease.
Genetic Counselors are familiar with the most up-to-date genetic testing information and are uniquely trained to help your physician to identify the most eligible patients for genetic testing of all types. The involvement of a genetic counselor usually assures that the most appropriate testing has been considered, that insurance coverage is satisfied and that patients have follow-up and interpretation for genetic testing.
Some individuals are concerned about their family health history, but have not been referred to a genetic specialist. We would advise that you make as detailed a list as possible of relatives with the health issues of concern, whether it be cancer, mental retardation or neurologic disease - and present this to your physician. Please call our office to discuss your case with us. Sometimes a genetic counseling appointment is necessary to assess your concern before we can assess your risk.
Who can provide Genetic Counseling?
Practitioners with expertise in Genetics include medical geneticists (MD's), genetic counselors, nurses or select health care providers with advanced training in Genetics, or physicians with expertise and/or credentialing in Genetics. From 1982-1990 the American Board of Medical Genetics (ABMG) certified genetic counselors. Since 1993, certification has been offered jointly by both the ABMG and the American Board of Genetic Counseling. Certification is valid for a maximum of 10 years, for those individuals who passed their exams in 1993 or later, although those individuals who certified before 1993 have unlimited certification. The National Society of Genetic Counselors (NSGC) represents genetic counselors. To date there are over 3500 genetic counselors in the United States. The International Society of Nurses in Genetics was established in 1988, and over 200 nurses in the United States are members. The American Board of Human Genetics offers a credentialing examination to physicians.
Physicians with interest or special training in genetics represent another component of genetic counseling services. Most insurers recognize and allow genetic counseling by in-plan physicians who have interest or experience in providing such service.
How does Genetic Counseling Services work?
We are different from most Genetic Counseling Services which are hospital or office based and offer in-person, face-to-face appointment from the start.
Genetic Counseling Services recognizes the growing role which many physicians prefer in managing genetic testing and the healthcare of their patients. We will work with you and your doctor to obtain the most pertinent family history information, insurance authorization and informed consent, all through private and convenient telephone consultation and correspondence, so that your physician can order the testing you need, which we will help to coordinate.
We are in the process of contracting with most insurers to bring this service to you. We are still working out the details with many insurers, so please Contact Us through any page of our website to find out the most current information about your insurance eligibility for Genetic Counseling Services.
What are the payment options for genetic counseling?Genetic Counseling is separate from genetic testing. The cost of genetic testing is also separate, and when applicable, we can assist you. There are two payment options: Self-Pay or Insurance Pay. We are in the process of contracting with a growing number of insurers and hospitals so that patients can obtain Genetic Counseling Services without cost to them, aside from deductibles and Co-payment costs. If we are contracted with your insurer, similar to an office visit, you will need to pay the amount of your co-payment, if you have one. For certain insurers, this may not be required at all. Until those details are in place, clients may contact us with their insurance company information so that we can consider your insurance in our contracting plans moving forward. In some cases we can try to obtain an out-of-plan authorization to provide genetic counseling to you. You may also call the Provider Services phone number on your medical insurance card to see where else your insurer is contracted for Genetic Counseling.
If we are not yet contracted with your insurance or hospital clinic, you may consider our self-pay option. Often the amount of your co-payment, lost work and travel time is not much more than the self-pay amount for a convenient, remote phone or web based genetic counseling appointment.
Who is eligible for genetic testing?
Many professional societies have issued statements to identify who is eligible for genetic testing of various types. Most medical insurers have also developed policies and criteria under which specific genetic testing can be approved. The two groups often differ and what is more, family history information does not always match up to the requirements of either group. A skilled and informed clinician is able to compile the most relevant information and is best able to make the most valid and reasonable argument for genetic testing. Genetic Counselors may be more likely to obtain insurance coverage for genetic testing for their patients.
Can I submit my bill from Genetic Counseling Services to my insurer and expect reimbursement?
If we are contracted with your insurer, we will submit your bill for you. Please contact us for the most up-to-date information about those insurers with whom we are directly contracted.
Some insurers request prior authorization for genetic counseling visits. Insurers may also require genetic counseling only through physicians or those providers with whom they are contracted. For that reason, you may want to verify your coverage for Genetic Services, by calling your insurer.
Because genetic counselors are not licensed in the state of New York, some genetic counseling services will choose to bill through physicians with whom they collaborate, unless direct contractual arrangements have been made otherwise. Genetic Counseling Services is not contracted with any physician, for billing purposes, but contracts directly with certain insurers for services.