Many Insured Cancer Patients Pay No OOP Costs for Genetic Counseling

Out-of-pocket costs higher for commercially insured patients with prostate cancer versus breast cancer
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THURSDAY, Aug. 4, 2022 (HealthDay News) -- Commercially insured patients with cancer typically have low costs for genetic counseling, according to a research letter published online July 29 in JAMA Health Forum.

Mya L. Roberson, Ph.D., from the 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 patients with breast, prostate, endometrial, ovarian, colorectal, or pancreatic cancer, who had at least one encounter for genetic counseling from 2013 through 2019.

The researchers found that median net payments for genetic counseling encounters were $118 (range, $58 to $211). Most patients with cancer paid $0 for genetic counseling services, with an overall median out-of-pocket cost of $0 (range, $0 to $16). Almost one-third of patients (31.1 percent) had an out-of-pocket cost more than $0. Patients billed under Current Procedural Terminology code S0265 versus 96040 had a lower prevalence of out-of-pocket costs (adjusted prevalence ratio, 0.52). Patients with prostate cancer had a higher prevalence of experiencing out-of-pocket costs for genetic counseling (adjusted prevalence ratio, 1.28) versus breast cancer patients.

"Although costs for patients were low, because the Centers for Medicare & Medicaid Services does not recognize certified genetic counselors as a billable provider, genetic counseling costs may be shifted to health care practices," the authors write.

One author disclosed employment at Concert Genetics.

Abstract/Full Text

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