Genetic tests have long been used to alert women to a heightened risk of breast cancer. Through genetic analysis, doctors are able to identify women who are extremely likely to get the disease, allowing the patients to opt for preventative measures, including a mastectomy.
Some OB-GYNs say it's relatively simple to identify women who should consider genetic testing, based on their family medical history. Women who have close relatives who have been diagnosed with breast cancer or ovarian cancer are often recommended for testing.
However, insurers are increasingly requiring patients interested in genetic testing to receive counseling before the procedure. They argue that the counseling will give them a better sense of whether the testing is actually necessary.
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Doctors oppose those types of requirements, saying that they are in a perfectly good position to advise patients themselves. Requiring counseling before, they argue, might simply delay the process of getting the tests done or prove cumbersome enough that the patient will simply drop out of the process completely.
UnitedHealthcare and Cigna insist that women consult with a genetic counselor before they can be approved for test that will examine whether they have one of two genetic mutations — BRCA1 and BRCA2 — that are associated with a heightened risk of breast and ovarian cancer.
"We had concerns that people were having testing ordered that didn't appear to need it and probably didn't understand it," Dr. Jeffrey Hankoff, a Cigna official, told Kaiser Health News. "Too often the wrong tests were being ordered."
In addition, genetic counselors argue that their trade is not something that can easily be performed by an OB-GYN. They are experts at gathering extensive family information that might not be recovered on a standard form a woman fills out during an annual physical.
The argument insurers are making will unlikely fall on entirely deaf ears among policymakers. Although the Affordable Care Act requires that insurers cover the entire cost of genetic tests and counseling associated with identifying a number of cancer risks, the Obama administration is also working mightily to reduce what it considers unnecessary medical tests and procedures.
Other types of cancer tests have come under enormous scrutiny in recent years. Medical officials are increasingly skeptical of tests for prostate cancer and colon cancer, particularly for men over the age of 65. And yet, studies have shown doctors regularly ordering up cancer tests for very elderly patients.
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