Dataset Information

Insurance denials and diagnostic rates in a pediatric genomic research cohort.

ABSTRACT:

Purpose

This study aimed to assess the amount and types of clinical genetic testing denied by insurance and the rate of diagnostic and candidate genetic findings identified through research in patients who faced insurance denials.

Methods

Analysis consisted of review of insurance denials in 801 patients enrolled in a pediatric genomic research repository with either no previous genetic testing or previous negative genetic testing result identified through cross-referencing with insurance prior-authorizations in patient medical records. Patients and denials were also categorized by type of insurance coverage. Diagnostic findings and candidate genetic findings in these groups were determined through review of our internal variant database and patient charts.

Results

Of the 801 patients analyzed, 147 had insurance prior-authorization denials on record (18.3%). Exome sequencing and microarray were the most frequently denied genetic tests. Private insurance was significantly more likely to deny testing than public insurance (odds ratio = 2.03 [95% CI = 1.38-2.99] P = .0003). Of the 147 patients with insurance denials, 53.7% had at least 1 diagnostic or candidate finding and 10.9% specifically had a clinically diagnostic finding. Fifty percent of patients with clinically diagnostic results had immediate medical management changes (5.4% of all patients experiencing denials).

Conclusion

Many patients face a major barrier to genetic testing in the form of lack of insurance coverage. A number of these patients have clinically diagnostic findings with medical management implications that would not have been identified without access to research testing. These findings support re-evaluation of insurance carriers' coverage policies.

SUBMITTER: Zion TN

PROVIDER: S-EPMC10584034 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Insurance denials and diagnostic rates in a pediatric genomic research cohort.

Zion Tricia N TN Berrios Courtney D CD Cohen Ana S A ASA Bartik Lauren L Cross Laura A LA Engleman Kendra L KL Fleming Emily A EA Gadea Randi N RN Hughes Susan S SS Jenkins Janda L JL Kussmann Jennifer J Lawson Caitlin C Schwager Caitlin C Strenk Meghan E ME Welsh Holly H Rush Eric T ET Amudhavalli Shivarajan M SM Sullivan Bonnie R BR Zhou Dihong D Gannon Jennifer L JL Heese Bryce A BA Moore Riley R Boillat Emelia E Biswell Rebecca L RL Louiselle Daniel A DA Puckett Laura M B LMB Beyer Shanna S Neal Shelby H SH Sierant Victoria V McBeth Macy M Belden Bradley B Walter Adam M AM Gibson Margaret M Cheung Warren A WA Johnston Jeffrey J JJ Thiffault Isabelle I Farrow Emily G EG Grundberg Elin E Pastinen Tomi T

Genetics in medicine : official journal of the American College of Medical Genetics 20230128 5

<h4>Purpose</h4>This study aimed to assess the amount and types of clinical genetic testing denied by insurance and the rate of diagnostic and candidate genetic findings identified through research in patients who faced insurance denials.<h4>Methods</h4>Analysis consisted of review of insurance denials in 801 patients enrolled in a pediatric genomic research repository with either no previous genetic testing or previous negative genetic testing result identified through cross-referencing with in ...[more]

PMID: 36718845

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Dataset Information

Insurance denials and diagnostic rates in a pediatric genomic research cohort.

Purpose

Methods

Results

Conclusion

Publications

Insurance denials and diagnostic rates in a pediatric genomic research cohort.

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