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Lab Test, Will Insurance Pay?

bincongo

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bincongo Contributor
bincongo
Posted

My daughter has decided to go for gene testing and I gave her the information for using Mayo Clinic labs but I am wondering if her insurance will pay for it. Does she need to contact her insurance company in order to have part of it payed for and to see which lab they use? I don't know what insurance company she has. When the doctor orders it is there a certain code he should use based on the fact that I, her mother has Celiac?

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adab8ca Enthusiast
adab8ca
Posted

My daughter has decided to go for gene testing and I gave her the information for using Mayo Clinic labs but I am wondering if her insurance will pay for it. Does she need to contact her insurance company in order to have part of it payed for and to see which lab they use? I don't know what insurance company she has. When the doctor orders it is there a certain code he should use based on the fact that I, her mother has Celiac?

She should contact her insurance company. In Canada, I know it is not covered and even the regular Celiac blood tests are not covered by insurance (although the biopsy is).

Has she had other testing done that is inconclusive? The gene test will not tell you if you have Celiac, just that you have the genes to get it. I think lots of people have the genetic markers and only a small fraction ever get the disease.

bincongo Contributor
bincongo
Posted
  • Author

She should contact her insurance company. In Canada, I know it is not covered and even the regular Celiac blood tests are not covered by insurance (although the biopsy is).

Has she had other testing done that is inconclusive? The gene test will not tell you if you have Celiac, just that you have the genes to get it. I think lots of people have the genetic markers and only a small fraction ever get the disease.

She has not had any testing done. My sister has the gene and symptoms for Celiac so she is getting more testing done. I want my daughter to have gene testing done because I am a known Celiac. I think she needs to know if she has the gene first since she doesn't have symptoms that I know of. If insurance companies will only pay for the antibody testing then I need to know that. It seems backward though because if she is negative than it only means she doesn't have it now. I would think the gene testing is more worthwhile.

Skylark Collaborator
Skylark
Posted

The value of the testing depends on your view. Your daughter already has a "positive" genetic test, as a first-degree relative of a celiac. It is abundantly clear that the DQ2 and DQ8 tests do not tell the whole story anyway. What if those aren't the celiac genes in your family? What you really need to know is if there is intestinal damage that could hurt her absorption of nutrients for the baby, right?

There is no harm in the genetic tests, but your daughter really needs to have a celiac panel preferably with the new deamidated gliadin peptide test. It would be awful for her to get a false sense of security from genetic tests.

As far as insurance, it only covered my Mom after she had the negative normal celiac panel.

kareng Grand Master
kareng
Posted

The univ of Chicago Celiac Center sent me the stuff for genetic tests to be sent to Kimball labs. They are $395. Just a little FYI.

I think it would be better spent to get the celiac blood tests to see if she has active celiac. I think they were about $300 but our insurance paid for my kids to get them because I have it. It is a " family history" code. If she is having any symptoms, particullary GI ones, that would be an excellent primary code to justify the tests using the family history as a second or third or fourth.

kareng Grand Master
kareng
Posted

She has not had any testing done. My sister has the gene and symptoms for Celiac so she is getting more testing done. I want my daughter to have gene testing done because I am a known Celiac. I think she needs to know if she has the gene first since she doesn't have symptoms that I know of. If insurance companies will only pay for the antibody testing then I need to know that. It seems backward though because if she is negative than it only means she doesn't have it now. I would think the gene testing is more worthwhile.

Just re- read your post and saw she doesn't have symptoms. I choose not to get my boys gene tested because:

They are still researching the genes involved in this disease. I would hate to give them a false sense of " I can't have it" in case they come up with more info

I didn't want the positive genes on their medical records. The way insurance companies are, I don't want them denied insurance or denied coverage because it's a pre- existing condition.

I have been told that the military and perhaps other programs will not accept people with celiac disease. Having the gene doesn't mean you have celiac disease but I'm afraid they will decide that is a reason not to take them ( if they chose that).

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