Navigating insurance coverage for healthcare costs can be difficult, especially when dealing with less common conditions and tests. We’ve compiled some tips and resources to help when it comes to ordering telomere length testing.
For physicians supporting patients through diagnosis, it can be a complicated and lengthy process, especially in the case of rare diseases. Having to consider insurance coverage when selecting which tests to order can be an additional concern. Here we aim to provide answers to common questions, as well as downloadable resources, to support the process.
Is telomere length testing covered by insurance?
This will vary depending on company and coverage type. However, telomere length analysis should be covered by insurance when used diagnostically in instances where it is the standard of care and is medically indicated. Most notably, telomere length testing should be covered for dyskeratosis congenita, telomere biology disorders and / or pulmonary fibrosis.
How does RepeatDx help?
To provide support, RepeatDx provides template letters that can be used to contact insurance companies clearly explaining:
- The need for a telomere length test in a particular situation (tailored to dyskeratosis congenita or pulmonary fibrosis)
- That telomere length analysis in these circumstances is standard of care and is medically indicated
- This testing is neither experimental nor investigational as it will directly impact the patient’s medical care
You can easily download these template insurance authorization letters from this page. They can be personalized and may be useful when contacting insurance companies for approval prior to testing.
Why is it difficult to agree coverage?
Insurance companies make decisions regarding what tests and treatments to approve for coverage, ensuring they are fulfilling the needs of all their customers to the best of their ability.
It is important for insurance companies to understand that telomere length testing is not for research, and is not investigational, but will directly impact patient care. These template letters help to make this clear.
Can RepeatDx bill insurance companies directly?
Unfortunately not yet. As telomere length analysis is a specialist test that is unlikely to be on a pre-approved list, insurance companies generally assess each request on a case-by-case basis. In order to do so, they usually request further information about the patient and their clinical history. Providing this information upfront to the insurer with the test pre-authorization request can help expedite insurance coverage approval.
As RepeatDx is not authorized to disclose this patient information, all communications with the insurance company need to be handled by the patient and their physician or care team directly. Test billing by RepeatDx is therefore sent to the medical institution requesting the test, or to the patient, who will claim with the insurance company.
We appreciate this process can be a significant concern for patients and families. We are hopeful that in time formal agreements can be reached between RepeatDx and insurance companies that will allow for direct billing.
On our website you can read more about RepeatDx and the telomere testing that we conduct for a range of medical conditions.
The template insurance authorization letters are available for download from our Order Test page (for dyskeratosis congenita and pulmonary fibrosis).
If you have any questions, or want to find out more, please do not hesitate to contact us.