Many insured cancer patients do not pay OOP costs for genetic counseling

Many insured cancer patients do not pay OOP costs for genetic counseling

Commercially insured cancer patients typically have low costs for genetic counseling, according to a research letter published online July 29 JAMA Health Forum.

Mya L. Roberson, Ph.D., of Vanderbilt University School of Medicine, in Nashville, Tennessee, and colleagues used data from the IBM Watson Health MarketScan database to identify 16,791 privately insured individuals patients with breast, prostate, endometrial, ovarian, colorectal or pancreatic cancerwho had at least one meeting for genetic counseling from 2013 to 2019.

The researchers found that the median net payments for genetic counseling encounters were $118 (range, $58 to $211). Most cancer patients paid $0 for genetic counseling, with a total median out-of-pocket cost of $0 (range, $0 to $16). Nearly one-third of patients (31.1 percent) had a co-payment greater than $0. Patients billed under code S0265 of current procedural terminology versus 96040 had a lower prevalence of out-of-pocket costs (adjusted prevalence ratio, 0.52 ). Prostate cancer patients had a higher prevalence of out-of-pocket genetic counseling costs (adjusted prevalence ratio, 1.28) vs. breast cancer patients.

“While the costs to patients were low because the Centers for Medicare & Medicaid Services do not recognize certified genetic counselors as a billable provider, genetic counseling costs could be shifted to health care practices,” the authors write.

An author revealed a job at Concert Genetics.

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