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My Testing Options - Health Insurance Coverage Checklist
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Health Insurance Coverage Checklist

You may use this checklist as a guide when you verify coverage with your insurance company.

Reason for Test(s)
Discuss testing options with your health care provider.

No Family History (screening) ____ Known Carrier ____ Follow-up Test(s) __________

Family History (please explain) _________________________________________

___________________________________________________________________

Other (please explain) ________________________________________________

___________________________________________________________________

Your Health Insurance Information
See membership materials, e.g., member card, handbook, etc.

At the time of the test or tests, will you have health insurance coverage? Yes / No
(If No, please discuss with your health care provider.)

Name of Insured Person ________________________________________________
(For carrier testing, both mother and father should complete a health insurance coverage checklist.)

Member ID Number ____________________________________________________

Group Number ________________________________________________________

Employer Name ______________________________________________________

Health Insurance Coverage Type
HMO ____ PPO ____ Medicaid ____ Medicare ____ EPO ____ POS ____ HSA _____

Other________________________________________________________________

Health Insurance Program Name __________________________________________

Health Insurance Member Service Telephone Number _________________________

Prepare for Your Call
1. Gather any information provided by your healthcare provider (e.g., family history, initial test results).

2. Call your insurance company and ask for Member Service or Customer Service (see your membership materials for the appropriate department name).

3. Ask the following questions and discuss answers with your healthcare provider.

Questions to Ask Your Insurance Company

Yes

No

Do I have genetic screening benefits? (e.g., Cystic Fibrosis; Ashkenazi Jewish)

    

Does this testing require pre-authorization by the health plan?

    

Is this testing a covered benefit under my policy?

    

Is this testing covered as a routine screening, or are there any specific criteria that must be met (i.e., advanced maternal age, family history, etc.)?

    

Is this testing subject to a deductible?

    

Will this testing be covered at 100% or will I have a cost-share or co-insurance to pay?

    

Are there any plan limitations or medical policies in place that limit genetic testing services?

    

Telephone Call Details

Health Insurance Member Service Representative’s Name (who you talked to)

____________________________________________________________________

Date of Call __________________________________________________________

Call Confirmation Number _______________________________________________

Notes from the Call

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________