Thanks to a friend/client and loyal Tips reader for this week’s topic. ‘Beth’ asked if her health plan would cover BRCA gene testing.
Sometimes, I have to confess to being stumped.
BRCA 1 and BRCA 2 are genes. A woman’s risk of breast or ovarian cancer is higher if those genes change. There are blood tests now that can detect those changes. Mutations are infrequent, so testing is usually reserved for women with a family history of breast cancer. Interested? Click here.
Generally, insurers are covering BRCA testing but on a case by case basis. Pre-certification is required. Not a bad idea for many services these days.
Which leads to a larger point previously covered in these Tips, but worth repeating.
New tests, scans, drugs and surgeries come to market all the time. We want our health plans to cover medically necessary services. We also want our premiums to be lower.
The trick is to decide who determines medical necessity; you and your doc or your insurer.
Believe it or not, insurers make those decisions by consulting with informed medical directors,not their stockholders.