With the introduction of genetic tests in recent years to assess for a wide variety of health conditions, non-genetics providers are facing increased pressure from patients as well as lab sales teams to adopt genetic testing as a part of their practice. Oftentimes, however, it can be difficult for a provider with little to no genetics background to determine which, if any, genetic test is the best one to order for their patient. That’s where genetic counselors can help! Genetic counselors take a detailed personal and family medical history, review applicable records, and use that information to determine what, if any, testing would be appropriate to offer a patient. Once those results are back, genetic counselors can also help to interpret those results and how they apply to the patient in the context of their personal and family history. Genetic counselors can also provide recommendations based on genetic test results, help patients address any psychosocial concerns that may arise, and determine what family members may also be at-risk and should consider genetic counseling and possible genetic testing.
As a small non-profit organization, our mission is to improve the quality of healthcare by providing up-to-date, objective genetic information to patients, providers, and healthcare organizations, supporting those in need of genetic services, and facilitating the adoption of best genetic practices. It has become increasingly common for genetic testing labs to offer genetic counseling services to providers, often free of charge. However, these services are part of the lab, which is a business whose goal is to make money. This presents an inherent conflict of interest when it comes to genetic counseling services. GSF is independent, meaning we do not have contracts or associations with any commercial genetics laboratory. We believe this allows us to remain free from any conflict of interest that may (oftentimes unintentionally) sway patients one way or the other when it comes to decisions about genetic testing.
The genetic counselors at GSF can see patients for a variety of indications, including discussions around prenatal or preconception testing options, personal or family history of cancer, personal or family history of cardiovascular disease, questions about newborn screening, questions about direct-to-consumer genetic test results, among others. If a patient is referred for an indication where it would be best for them to see another specialty provider, then we can help to provide feedback and to identify where it would be best for the patient to be seen.
Part of our genetic counseling process is to take a detailed personal and family health history. We can also request additional records for review (pathology reports, test reports, consultation notes, etc) to ensure that the full clinical picture is being appreciated. GSF genetic counselors then discuss with the patient their impressions and recommendations for possible follow-up, in some cases including genetic testing. We also draft a detailed consultation note that is sent back to the referring provider (as well as any other providers that the patient requests) that reviews the conversation with the patient, topics discussed, and the plan or any recommendations. If genetic testing is done, genetic counselors can meet with the patient to review the results in detail with them to ensure that the patient understands the results and what any next steps would be. Genetic counseling at GSF is primarily done via telehealth, although we do have an office in Olympia, WA, where we can see patients who live locally and prefer to see a provider in person.
To refer a patient to be seen at GSF, please fax relevant medical records, patient demographic information, and insurance information to 844.813.3892. If the patient’s insurance requires a prior authorization for the genetic counseling visit, the referring provider’s office is responsible for requesting that from the insurance. We’ll then contact the patient to schedule an appointment. After the visit, a thorough note documenting the appointment as well as the plan moving forward will be sent to your office. If genetic testing is recommended, we’ll ensure that the most appropriate testing is being ordered. Once the results are back, we’ll contact the patient to review those results, and your office will get a results summary as well as recommended next steps.
There are a number of ways that a provider, clinic, or hospital can utilize GSF’s genetic counseling services. For offices with a more steady or consistent volume of patients that could benefit from genetic counseling, a contract where GSF provides that clinic with a set number of hours per week can be helpful. In situations where there isn’t necessarily a weekly need, a more per diem contract can be arranged where GSF would provide genetic counseling services to your office on an as needed basis. Others prefer to refer patients to GSF as a third party service rather than bringing genetic counseling services directly into their office. We are happy to work with you to come up with an arrangement that best suits your and your patient’s needs.
Many insurances cover genetic counseling services, including those provided by telehealth, but coverage varies by state and by insurance plan. Insurances may only cover genetic counseling visits for certain indications, may not cover telehealth genetic counseling, or may not cover genetic counseling services at all. Out of pocket costs are dependent on plan details, including deductibles, copays, and whether or not GSF is in-network with the insurance. Of note, Washington state has a parity law that dictates that telehealth encounters should be reimbursed at the same rate as in-person encounters (RCW 74.09.325). One current notable exception to coverage for genetic counseling services is Medicare. Unfortunately at this time, Medicare does not recognize genetic counselors as providers, and thus does not reimburse for genetic counseling services (although that hopefully will change in the near future). Patients are responsible for any costs associated with the visit that are not covered by their insurance.
If a patient is referred to be seen at GSF, we will collect their insurance information and attempt to bill their insurance for the visit. Any cost not covered by the insurance will be the patient’s responsibility. GSF does have a financial assistance program for those who qualify. For offices that contract to have GSF provide services directly with their facility, the facility would be responsible for submitting reimbursement claims to the patient’s insurance. In these situations, GSF can work with your office to ensure that there is a smooth process for billing.