Key Takeaways
- Many patients meet their annual insurance deductibles near the end of the year, which may reduce or eliminate out-of-pocket costs for genetic testing.
- Exome and genome sequencing are recommended as first-line tests by several leading professional societies for conditions such as developmental delay, intellectual disability, and unexplained epilepsy.
- Discussing testing before benefits reset can help families move forward with testing sooner and shorten the diagnostic odyssey.
- GeneDx offers cost estimate support, financial assistance programs, and patient access solutions to help reduce barriers to testing.
Why Year-End Can Be an Ideal Time for Genetic Testing
As we near the end of the year, many patients have met their yearly health insurance deductibles.
That makes it a particularly good time to help your patients find answers—especially given that the timing of insurance utilization can affect whether families choose to pursue testing.
When patients have met their deductible, they may be more likely to proceed with recommended genetic testing, as the barrier of out-of-pocket costs is reduced or eliminated.
Exome and Genome Sequencing Are First-Line Tools
Many professional societies recommend exome and genome sequencing as first-line tests that can be ordered as soon as symptoms or features are identified.
American Academy of Pediatrics
Recommends exome and genome testing as a first-tier test for:¹
- Global developmental delay
- Intellectual disability
American College of Medical Genetics and Genomics
Recommends exome or genome as a first-tier test for:²
- Developmental delay
- Intellectual disability
- Congenital anomalies
National Society of Genetic Counselors
Recommends exome or genome sequencing for individuals with:³
- Unexplained epilepsy
American Epilepsy Society
Endorses the NSGC guideline recommending exome or genome sequencing for individuals with:
- Unexplained epilepsy
International Precision Child Health Partnership
Recommends rapid exome or genome sequencing as a first-tier test for:⁴
- NICU patients with unexplained hypotonia
The Role Providers Play
If your patients were hesitant to get comprehensive genetic testing earlier this year due to concerns about out-of-pocket costs, their response may change if they’ve now met their annual deductible.
In addition to discussing how year-end can be a key window when insurance coverage may stretch further, you can also explain how comprehensive testing like exome and genome sequencing can help:
- Shorten the diagnostic odyssey
- Guide referrals
- Reduce unnecessary tests and treatments
- Connect patients with community
By raising this now, you help families make informed decisions before benefits reset.
Why Acting Before Benefits Reset Matters
For families with deductibles met, year-end can be an especially cost-effective time to act.
Even families that recognize the importance of genomic answers may choose to delay testing if cost is a concern.
Missing the key window this year could mean waiting a full year before considering testing again.
That’s a full year without answers.
GeneDx: Your Partner in Finding Answers
GeneDx is committed to helping patients identify the best billing option for their individual situation.
Our Patient Access Solutions are designed to reduce barriers to testing year-round.
Cost estimate support
For patients with contracted commercial insurance and Medicare Advantage plans, we can contact the patient’s health insurer to obtain a cost estimate based on their current benefits, including deductible and coinsurance.
Financial assistance
Our Financial Assistance Program can help reduce potential out-of-pocket costs associated with testing.
Epilepsy Partnership Program
This program expands access to exome testing for eligible patients by providing options if their health insurance denies a claim or if the patient is uninsured.
It’s Time for Another Conversation
The end of the year will be here soon.
Now is the time to talk with eligible patients about exome or genome sequencing.
Your guidance can make the difference.
Don’t delay. Samples must be in our lab before December 31 for testing to be billed to a patient’s 2025 benefits.
Have Questions?
Our team is here to help answer questions about prior authorizations, cost estimates, billing support, and more.
