As if this couldn't get any worse for genetic counselors, who BTW get paid next to nothing by insurers........ United Healthcare is now requiring Prior Authorization for BRCA testing. In their policy bulletin from May, Volume 31.......
The coverage determination made regarding BRCA testing for your patient will be based on the UnitedHealthcare medical policy for BRCA testing, which is based on the clinical evidence and is closely aligned with the criteria developed by the organizations listed above. This coverage determination will be conveyed to you promptly by either phone, or letter or both. Of course, adverse determinations are subject to all applicable appeal rights.
Add that to the list of scut work which the counselor will get stuck doing.... So much for same day testing in a timely fashion! At least you get an appeal!
My guess is that this set of patients will get the services they need, in a very, very delayed fashion. I sure hope we don't see a cancer develop in one of this patients while their testing is "awaiting approval"
A huge loss for cancer genetics, but also a stopgap from the misuse of testing which has been going on for a couple of years now, while Myriad has profited handsomely......MYGN...
Buttressed next to this claim is the fact that United will proved you with access to an "independent" genetic counselor..... How's that for lipstick on that pig.......which has me wondering, will that counselor be from DNADirect or Informed Medical Decisions.......DNADirect, BTW went from online test supplier to care provider........a sound business decision which I hope Navi will come to shortly.....
The Sherpa Says: Increasing barriers to prevent abuse is likely what will happen with healthcare reform....which is what shouldn't happen. What should is in the NYT Sunday....Hey, we do that!
Monday, June 8, 2009
Prior Authorization for a Medically Necessary Test?
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2 comments:
The large held belief was that there would be more demand for genetic counselors the more popular genetic tests become. This may not turn out to be the case. Besides being employed to do "scunt work" to save time for a "real" trained medical professional, the more mainstream genetic testing becomes, the fewer genetic counselors will be needed. The only way there will be that much more of a demand for genetic counselors is if clinic departments (cardio, ob/gyn, etc) are looking to hire a genetic counselor. I have done a lot of thinking about this and it actually costs a clinic department more money to hire a genetic counselor than it does having for the income brought in my ordering a genetic test.
You are spot on correct. I each field learns the "genetics" in their field it is way cheaper to have the doctors test AND do the counseling. What they say, on the other hand could prove risky......but departments won't know until they get sued. Or they could pull the bill for physician consults without ever seeing the patient scam.... Which happens all to often in NY, CT, MA..... Etc.
Tough times for counselors, you have to demonstrate value monetarily and that is very, very tough. Unless your Dept. Allows you break the law....
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