Financing & Payment

One of the major challenges facing both providers and consumers of genetic services is payment. Families often have questions about insurance coverage, paying for genetic tests, or the cost of a clinic visit. Providers sometimes have to figure out a way to be reimbursed for the services they have provided. Many people wonder how genetic services can be improved in the state, and where the money will come from to do that. This page provides general information in regards to some of these issues.

Private Insurance
Many people have questions about what their health insurance will or will not cover. Every health insurance provider is different and will have different policies and procedures. It is always a good idea to check with your provider ahead of time to discuss coverage and what is required. Many health insurance providers will cover some or all of the cost of a clinic visit, especially if a referral from a physician is provided. Genetic testing, when medically indicated, is also often covered by health insurance. Sometimes, a health insurance provider may ask for a letter of medical necessity before or after an appointment, or before certain testing can take place. Such a letter is usually provided by a genetic counselor and/or a medical geneticist. Some people are nervous about scheduling a genetics appointment or having a genetic test performed because they are concerned about insurance or employer discrimination. There are both federal and state laws in place in regards to genetic discrimination (see the Policy and Law section) which are designed to protect citizens’ confidential genetic information. Privacy is a right, and genetic privacy is not an exception.

Medicaid
Medicaid is a federal and state health insurance program that pays health care providers to deliver essential health care services and long-term care to eligible citizens. Elderly people, individuals with disabilities, low-income families with dependent children, and other children and pregnant women may be eligible for services. Medicaid of Wisconsin includes programs such as Medical Assistance, BadgerCare, and SeniorCare. Each of these programs usually covers some or all of the cost of clinical genetics appointments and medically indicated genetic testing. The Wisconsin Medicaid Program is a source for questions about eligibility, enrollment, billing and reimbursement, and coverage issues related to genetic care.

State Funding
A significant percentage of genetics activities in the state are funded by a Federal Title V Maternal and Child Health Services Block Grant. Many different programs at the state level receive money as part of the block grant. A portion of the block grant is reserved for the Wisconsin Genetics System. The money from the grant is used to help finance different areas of importance in genetic services. This includes outreach clinic services to underserved populations, clinical services for uninsured or underinsured families and individuals, improved communication and collaboration among genetics professionals, and education for physicians and communities.

If you have questions about funding for genetic services, or need help paying for clinical services, contact the Statewide Genetics Coordinator at 608-267-7148.