Genesurance Counseling: Genetic Counselors’ Roles and Responsibilities in Regards to Genetic Insurance and Financial Topics

Abstract

While traditional components of genetic counseling sessions are well recognized, less is known about insurance and financial discussions. This study sought to examine "genesurance counseling" which we defined as: that portion of a genetic counseling session, whether intentional or non-intentional, that is devoted to the topic of costs and insurance/third party coverage (particularly for genetic testing). Our objective was to assess genetic counselors' practices and perspective related to genesurance counseling. A survey link was sent by e-mail to members of the National Society of Genetic Counselors (approximately 3100 NSGC members). A total of 571 genetic counselors participated in the survey of which 550 identified as clinical genetic counselors. Survey data were used to investigate differences between specialties, impact on patient rapport, changes in practice dynamics, and devotion of clinic time. Overwhelmingly, 99% of participants acknowledged conducting genesurance counseling, 87% believed it to be part of their job description, and 85% viewed it as an important aspect of genetic counseling. On average, respondents estimated they devoted 10% of their session, or 6 min, to genesurance counseling. Of the surveyed participants, 95% reported genesurance counseling as having some form of influence in a patient's decision regarding genetic testing, and 74% stated that genesurance counseling concerns change the practice and dynamic of their clinic. "Genesurance counseling" is not a topic which has been studied to date. Our study highlights the changes in genetic counselors' roles and responsibilities regarding insurance and financial counseling.

Impacts of genesurance considerations on genetic counselors' practice and attitudes

“…Given that insurance and billing factors play a role in patient decision‐making, discussion of these issues is viewed by many clinicians as part of the informed consent process for genetic testing (Hooker et al., 2017; Riggs & Ubel, 2014), more recently referred to as ‘genesurance’. Genesurance counseling was first defined in the literature as the part of a genetic counseling session dedicated to discussing costs and insurance coverage of genetic testing (Brown et al., 2017). This same study focused on how genetic counselors perceived their role in regard to insurance and financial topics reported that 99% of genetic counselors discuss insurance and billing with their patients and 85% of genetic counselors viewed genesurance counseling as a part of their role (Brown et al., 2017).…”

“…Genesurance counseling was first defined in the literature as the part of a genetic counseling session dedicated to discussing costs and insurance coverage of genetic testing (Brown et al., 2017). This same study focused on how genetic counselors perceived their role in regard to insurance and financial topics reported that 99% of genetic counselors discuss insurance and billing with their patients and 85% of genetic counselors viewed genesurance counseling as a part of their role (Brown et al., 2017). A second study focusing on patient expectations reported that a majority of patients expect genesurance counseling during a genetic counseling session (Wagner et al., 2018).…”

“…Insurance coverage for genetic testing often varies between payers, plans, and testing indications, which leads to complications in healthcare navigation for both the genetic counselor and the patient (Lu et al., 2018; Prince, 2015). In addition, one study found that 74% of genetic counselors reported that insurance‐related issues directly changed their practice dynamics (Brown et al., 2017). The nature of these reported changes was not investigated at that time.…”

Financial constraints on genetic counseling and further risk‐management decisions among U.S. women at elevated breast cancer risk

“…The field of risk assessment and management is evolving quickly, and a high proportion of genetic counseling sessions include discussions about the costs of genetic testing and risk-management options, termed 'genesurance' (Brown et al, 2018). In fact, 85% of genetic counselors believe that genesurance is one of their job responsibilities, and they spend about 10% of their genetic counseling session time discussing financial aspects (Brown et al, 2018). Yet, our specific understanding of the impacts of financial constraints on cancer risk-reduction behavior remains limited.…”

Building an infrastructure to enable delivery of genomic medicine

“…By applying coverage rules to the type service provided, rather than the CPT codes used to bill for the test, consistency in coverage and payment can be achieved. Providers can determine, at the time of order whether a test will be covered and counsel their patients accordingly and briefly, focusing more of their conversations on the patient's clinical care, and less on complicated insurance processes (Brown et al, 2018).…”