Insurance denials and diagnostic rates in a pediatric genomic research cohort.

Autor:	Zion TN; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO. Electronic address: tnzion@cmh.edu., Berrios CD; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Cohen ASA; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Bartik L; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; University of Kansas Medical Center, School of Professional Health Sciences, Kansas City, MO., Cross LA; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Engleman KL; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Fleming EA; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Gadea RN; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Hughes SS; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Jenkins JL; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Kussmann J; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Lawson C; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Schwager C; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Strenk ME; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Welsh H; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Rush ET; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO., Amudhavalli SM; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Sullivan BR; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Zhou D; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Gannon JL; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Heese BA; Division of Clinical Genetics, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Moore R; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Boillat E; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Biswell RL; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Louiselle DA; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Puckett LMB; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Beyer S; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Neal SH; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Sierant V; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., McBeth M; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Belden B; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Walter AM; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Gibson M; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Cheung WA; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Johnston JJ; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Thiffault I; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Farrow EG; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Grundberg E; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO., Pastinen T; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO.
Jazyk:	angličtina
Zdroj:	Genetics in medicine : official journal of the American College of Medical Genetics [Genet Med] 2023 May; Vol. 25 (5), pp. 100020. Date of Electronic Publication: 2023 Jan 28.
DOI:	10.1016/j.gim.2023.100020
Abstrakt:	Purpose: This study aimed to assess the amount and types of clinical genetic testing denied by insurance and the rate of diagnostic and candidate genetic findings identified through research in patients who faced insurance denials. Methods: Analysis consisted of review of insurance denials in 801 patients enrolled in a pediatric genomic research repository with either no previous genetic testing or previous negative genetic testing result identified through cross-referencing with insurance prior-authorizations in patient medical records. Patients and denials were also categorized by type of insurance coverage. Diagnostic findings and candidate genetic findings in these groups were determined through review of our internal variant database and patient charts. Results: Of the 801 patients analyzed, 147 had insurance prior-authorization denials on record (18.3%). Exome sequencing and microarray were the most frequently denied genetic tests. Private insurance was significantly more likely to deny testing than public insurance (odds ratio = 2.03 [95% CI = 1.38-2.99] P = .0003). Of the 147 patients with insurance denials, 53.7% had at least 1 diagnostic or candidate finding and 10.9% specifically had a clinically diagnostic finding. Fifty percent of patients with clinically diagnostic results had immediate medical management changes (5.4% of all patients experiencing denials). Conclusion: Many patients face a major barrier to genetic testing in the form of lack of insurance coverage. A number of these patients have clinically diagnostic findings with medical management implications that would not have been identified without access to research testing. These findings support re-evaluation of insurance carriers' coverage policies. Competing Interests: Conflict of Interest The authors declare no conflicts of interest. (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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