Assessing Genetic Risks Implications for Health and Social Policy (1994) / Chapter Skim
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7 Financing of Genetic Testing and Screening Services
7 Financing of Genetic Testing and Screening Services
Pages 234-246
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From page 234... ...
The Ethical, Legal, and Social Implications Program (ELSI3 Task Force on Insurance and Genetic Testing (ELSI Insurance Task Force, 199312 has already submitted its concerns to President Clinton's health insurance reform committee. Health insurance reform proposals will need to be evaluated to determine whether they adequately protect genetic information and persons with genetic disorders from discrimination and other potential social, legal, and ethical harms related to health insurance and the use of genetic information (see Chapter 81.
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From page 235... ...
Even the casual conversation of medical personnel, human resources staff, and others about genetic information may affect insurance coverage if such information is reflected in medical records or in the personnel system of self-insured companies. To avoid such impact on insurability, some genetic counselors report that they routinely advise their counselees not to seek insurance reimbursement because of the potential risk to future health and life insurance coverage for them and their families (OTA, 1992c)
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From page 236... ...
Problems of underinsured and uninsured families, and financial support for genetics services, were ranked as among the top priority issues in their respective states by state genetics services coordinators who were asked about the most important issues in genetics services facing patients and families in a 1991 Council of Regional Networks for Genetic Services survey (CORN, 19911. Many genetics services have difficulty meeting traditional standards for reimbursement by third-party payers.
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From page 237... ...
Panney, Maryland Department of Health and Mental Hygiene, personal communication, 19931. There are a few sources of noninsurance funding for genetics services that will reimburse out-of-pocket costs for persons without health insurance or whose insurer will not reimburse for genetic testing and counseling.
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From page 238... ...
However, as discussed in Chapters 2 and 8, this may not be the ideal time for CF carrier testing. PRIVATE SOURCES OF PAYMENT FOR GENETICS SERVICES The majority of health insurance for the under-65 population in the United States is private health insurance, generally provided through employers (Fields and Shapiro, 19931.3 In the United States, private commercial health insurance is usually a private business enterprise, run on basic business principles of responsibility to shareholders to maintain profitability (Pokorsky, 19891.
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From page 239... ...
Where reimbursed, genetic tests may be subject to insurance company requirements for prior approval of procedures. Prenatal genetics services are more widely covered by third parties than other genetics services; many group health insurance plans and health maintenance organizations include coverage for prenatal diagnosis if recommended by the attending physician.
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From page 240... ...
PUBLIC SOURCES OF PAYMENT FOR GENETICS SERVICES In some instances, public financing for genetics services occurs through Medicaid, Medicare, or state genetics services programs. Medicare Medicare is primarily a program to reimburse medical expenses considered "medically necessary" for people over age 65 and certain categories of disabled persons.
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From page 241... ...
0 ( 0%) Genetic counseling?
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From page 242... ...
State Medicaid programs varied in whether they provided coverage of genetic counseling. As is common for many counseling services in a medical setting, genetic counseling might be covered if it were included in a general office visit code (either provided by the physician or provided by other professionals such as genetic counselors under the supervision of a physician)
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From page 243... ...
Some states provide limited genetics services directly; most states coordinate at least some genetics services, particularly with Medicaid, Medicare (which sets reimbursement rates used by state Medicaid programs) , and other possible funding sources (such as programs for persons with mental retardation or developmental disabilities, or for children with special needs)
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From page 244... ...
Several states specifically attempt to limit use of available state genetics services when the goal is selective abortion of affected fetuses. Minnesota and Missouri provide extensive genetic testing services, but almost no funding for abortion services; Tennessee's extensive prenatal diagnosis program is limited to conditions leading to treatment in the mother or the baby, but its legislation states that "use of this program to abort unborn children is against the public policy of the State of Tennessee" (Tennessee Code Annotated, 1991, §§ 68-5-501-505~.
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From page 245... ...
should be defined to include appropriate genetic testing and related education and counseling, and these genetics services be reimbursed under health insurance plans. Medical necessity can often be established by a family history of the disorder.
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From page 246... ...
1993. Genetic Information and Health Insurance.
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