What You Need to Know
- Insurers often classify whole genome sequencing as experimental.
- Insurers do cover whole genome sequencing for some critically ill NICU patients.
- One obstacle to "WGS" coverage is vague billing codes.
In the realm of genetic testing, insurance payers have been reluctant to recognize that there is a method of testing that gives physicians over 99% of the information that they need to solve current or even future medical puzzles related to genetics.
When evaluating insurance policies, it’s important to know that whole genome sequencing (WGS) offers the most comprehensive testing available providing granular, actionable data from an individual’s DNA to diagnose and effectively treat many inherited disorders, including inherited cancers.
How WGS Works
With WGS the individual’s entire DNA is scanned. Because upwards of 99% of the individual’s genetic information is available, physicians are able to comprehensively evaluate and effectively pinpoint and/or rule out the precise genetic cause of the patient’s disease. All as part of a single, once and done test that eliminates the prolonged “diagnostic odyssey” that often delays a definitive genetic diagnosis, sometimes as much as decades.
In addition, the data from WGS can be reused again and again, throughout an individual’s lifetime, any time a new medical situation presents. There’s no need to collect another sample for additional testing.
The Human Genome Project gave us the “transformative textbook of medicine” by mapping and categorizing the approximately 20,500 genes that make up the human “genome.”
WGS Coverage Gaps
You could reasonably conclude that the ability of WGS to provide access to an individual’s genetic blueprint throughout one’s entire life would be a rather good example of doing things right the first time and would, therefore, be an attractive addition to the medical benefits offered by insurance payers. Especially as the technology for conducting WGS has become so much less expensive in recent years. Yet, there are very few insurers that cover whole genome sequencing. Why is this?
One reason is that, in the United States, there is no uniform way that insurers are evaluating the types of sophisticated WGS testing technologies now available. When you look at corporate policies, even when carriers cover less comprehensive genetic tests, like whole exome, there’s little consistency in the way they make their decisions.