Instructions to call your insurance company

Prior to calling your insurance company, you should decide which medical center you are going to for your genetic counseling visit. Medical billing is very complicated and always involves procedure codes (CPT codes). Each medical office will have their own unique coding system so it is very important that you ask what their specific CPT codes are for preconception genetic counseling as well which doctor you will be seeing. Your coverage for genetic counseling may differ depending on who your provider is and how they bill.

To investigate your insurance coverage for genetic testing in the most thorough way, we recommend the following.

  1. Decide where you want to go for your genetic counseling/testing.
  2. Call that institution to set up an appointment. Tell them that you’d like to call your insurance company first to find out if your genetic counseling will be covered.
  3. Ask them for the following pieces of information:
    1. Which doctor will you be seeing?
    2. What CPT code will they use for billing for your appointment?

Once you have all of that information, you will be able to call your insurance company, using the instructions below:

  1. Call the number on the back of your health insurance card.
  2. Tell the insurance representative that you want to check if genetic counseling is covered under your plan.
  3. If they ask for a diagnosis code, tell them Z31.43 if you are female and Z31.44 if you are male. Not all insurance representatives will ask for this. This is the “indication” for your genetic counseling visit.
  4. If they ask for a procedure code, give them the CPT codes that you obtained from the doctor’s office.
  5. The insurance representative may take a few minutes to look into it and will come back with an answer for you
  6. Make sure to ask the following questions and keep a record of all the answers:
  • Is the provider in-network?
  • Do I have a co-insurance or unmet deductible?
  • Does my insurance plan have a policy statement regarding genetic counseling?
  • If so, this might give you more information regarding your specific coverage for genetic testing. Usually this is available on your insurance company’s website. You can request a copy of this policy as well.
  • What is the reference number for this call?
  • What is the name of the insurance representative you are speaking with?