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Throwing the Brakes on Genetic Testing for Cancer


Some Insurance Companies See Genetic Testing as An Unnecessary Expense

Preventative medicine can go a long way to reducing costs of long-term care. Extended treatment for many diseases can go on for years and cost billions.

In 2011, The American Cancer Society estimated that direct medical costs (total of all health care costs) for cancer in the US in 2011 were $88.7 billion. (50% of this cost is for hospital outpatient or doctor office visits; 35% of this cost is for inpatient hospital stays; 11% of this cost is for prescription drugs).

Excerpt from ACS Economic Impact of Cancer

“And according to Cancer Facts & Figures 2015, ‘Uninsured patients and those from ethnic minorities are substantially more likely to be diagnosed with cancer at a later stage, when treatment can be more extensive, more costly, and less successful.’

“This year, about 589,430 US residents are expected to die of cancer – that’s more than 1,600 people a day. Cancer is the second most common cause of death in the US, exceeded only by heart disease. Cancer accounts for nearly 1 out of every 4 deaths in the United States.”

 The Rise In Awareness of & Desire for Genetic Testing

genetic testingWith this in mind, the recent news about genetic testing for certain types of cancer has drawn attention to the possibilities of using high-tech analysis for information that can help people make better choices about their health and future. The attention brought to the risks of ovarian cancer by Angelina Jolie’s announcement to take preventative measures from her double mastectomy in 2013 to the removal of her ovaries and fallopian tubes in 2015 has increased women’s desire to pursue genetic testing.

Insurance Companies Blink At Paying for Genetic Tests

Yet, with the increased costs and the desire for women to take control of their health, insurance companies are looking at genetic testing as a potentially unnecessary expense that they aren’t willing to cover.

Three major insurance companies: Cigna, Aetna and Anthem will not pay for the most current multi-gene panel tests. Refusing or delaying coverage for these genetic tests can put patients at risk. The new panel tests can analyze 20 or more genes at a time. A company in California just announced a cheaper way of conducting tests for breast cancer.

“The evaluation for getting these tests done should be at the discretion of the physician,” said Dr. Paul MacKoul, MD, The Center for Innovative GYN Care. “Patients need to know that only a small percentage of women actually have a family history of ovarian cancer, less than 10 percent. While testing should not be done randomly, women who have a family history of breast or ovarian cancer need to have these tests to identify their risks for this disease.”

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