Clinical OMICS

JAN-FEB 2019

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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34 Clinical OMICs January/February 2019 www.clinicalomics.com I am a genetic counselor (GC), trained to understand how my patients' genes influence their well-being, and I treat the genetic components of disease. I feel grateful to prac- tice at a time when knowledge is rapidly expanding. A newly discovered gene is discussed in the academic liter- ature nearly every week. Clinical laboratories incorporate these discoveries into tests that physicians use in delivering patient care. It's my job to be aware of the evolving field and, with physicians, bring the benefits of genetic medicine to patients. The greatest barrier I face are insurance compa- nies. My experience with private payers, and that of my col- leagues, shows how frustrating it is to encounter constant barriers and patients put at risk. This is due, in part, to prior authorization policies. Prior authorization has been around for a long time. These policies require providers, such as doctors or labora- tories, to get permission from an insurance company before providing a service like genetic testing. It is a good idea to have a review process because we are concerned about the cost of healthcare in America. But these policies can be abused so that insurance companies don't pay for medically indicated tests or procedures. As a result, patients, and in the case of medical genetics, their families, get hurt. One of my colleagues had an experience recently with a payer 's benefit management subsidiary that was a nightmare of bureaucratic runaround and a potential disas- ter for the patient who was denied access to genetic testing. My colleague, a highly skilled genetic counselor, has a patient with hypertrophic cardiomyopathy (HCM), a com- mon inherited heart diseases that causes the walls to thicken and the heart to malfunction. When we read tragic stories about healthy young athletes dying suddenly on the field, it is often because they have undiagnosed HCM. There is a genetic test for HCM that is very effective, and there are guidelines for testing and treatment of this dis- ease from the American College of Cardiology (ACC). One By Scott M. Weissman, Certified Genetic Counselor My Patients Cannot Get the Tests They Need "A reasonable person would assume that anyone who met the ACC guidelines would be able to get the test." poba / E+ / Getty Images CO M M E N TA RY

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