I scheduled my annual wellness checkup, did the usual blood work, and answered some questions. They suggested I get genetic cancer counseling because of my family history.
I asked, “Is this covered by insurance? How much will it cost?”
The answer was, “No idea. You’ll need to call the cancer center or your insurance.”
So, I called the cancer center. They told me I could ask my insurance or check with their finance department, but they only check costs after you book an appointment.
I then called my insurance, got transferred four times, and was told I needed to confirm if my doctor and the facility are in-network. I didn’t know how, so I asked them to check. After double-checking, they confirmed the cancer center is covered.
They then asked if my referral was for:
- Genetic Testing
- Non-routine Genetic Counseling
- Routine Genetic Counseling
I said I didn’t know the difference and offered to send my referral. She said she couldn’t explain the difference because I’m not medically trained. She told me routine, medically necessary testing is covered 100%, but genetic testing and non-routine counseling aren’t; they count toward my high deductible. But since we don’t know which one my appointment is for, I had to call the cancer center again.
I booked the appointment at the cancer center. They transferred me to the finance department to discuss costs. I asked for a price quote.
They said they couldn’t tell me if it was covered because they didn’t know what type of counseling I was getting. I currently have a new patient consult scheduled, not the test, so they can’t tell which test yet. They suggested I talk to my doctor. I told them my doctor referred me. Then they asked me to speak directly with the office where I have the appointment. I’m not sure what the finance department’s purpose is at this point.
I contacted the office and asked what’s covered by insurance. They checked my appointment and said coverage depends on my benefits, which they’ll run after the appointment. I said I’d like to know the price beforehand in case it’s very high. I didn’t get a clear answer. She mentioned it’s a standard consult visit, a specialist visit.
I asked if they knew if I was referred for genetic testing, non-routine genetic counseling, or routine genetic counseling. She said it’s “most likely” routine genetic counseling. I asked how we could confirm this. She said we’d only know the type of genetic testing after the visit. I asked how much the first counseling visit would cost out of pocket—$350. Follow-up visits are $150. But I won’t know what kind of genetic testing is needed (or if it’s covered) until after the counseling.
This process is frustrating. Why can’t the department that schedules appointments take your insurance and tell you the costs upfront? I still don’t know the total costs.