Insurance FAQ – MyDevelopingChild

Frequently asked questions about genetic testing for children with developmental delay and/or autism

After nearly a decade, we have learned that health insurance often does not offer adequate coverage for genetic testing. MyDevelopingChild was created to give more families access to genetic testing for their child by offering a lower cost, self-pay testing option.

This option can also take significantly less time to get results than relying on health insurance for coverage. Below are a number of insurance related questions we often receive from parents.
Will my insurance cover genetic testing for my child?
Many health plans do offer coverage for diagnostic genetic testing, though most policies require that the child meet very specific requirements before considering coverage for testing. In most cases, diagnostic genetic testing will also require the deductible to be met before they will cover any of the cost.
Will genetic testing apply to my deductible if I use my insurance?
In many cases, diagnostic genetic testing will apply to your policy’s deductible which must be met before the plan will pay any of the cost. Many families have high deductible plans and could end up paying thousands of dollars out-of-pocket for testing depending on their specific deductible amounts.
Is a self-pay option right for my family?
Families with the following circumstances may benefit from self-pay genetic testing:

  • Families with high deductible health plans
  • Families who only have access to out-of-network genetic testing labs
  • Families who are uninsured, under-insured, or self-insured
  • Families facing a long wait time to see a specialist to receive genetic testing

If any of these circumstances apply to you and your family, you may be able to save time and money by opting to self-pay for your child’s genetic testing through MyDevelopingChild.
How much will I have to pay for my child’s genetic testing if my insurance covers it?
Diagnostic genetic testing is expensive and can cost thousands of dollars even with insurance coverage. If your health plan does offer coverage for diagnostic genetic testing, most policies have specific criteria that your child must meet before the plan will cover the test.

Many health plans also require a prior authorization before testing begins so they can evaluate whether your child meets the policy’s medical criteria for coverage, which is often very restrictive. The prior authorization process can take weeks for the plan to issue a coverage determination, which may end up in a denial of coverage if the policy’s medical criteria is not met.
How can self-pay testing cost less than what I would pay through my insurance?
The insurance billing process can be very lengthy and costly for a laboratory. By foregoing the insurance billing process, we can offer high-quality diagnostic genetic testing at a lower cost for families.
Can I use my FSA/HSA account for this testing?
Yes. The genetic testing through MyDevelopingChild is considered a qualified medical expense for FSA and HSA accounts because it is a diagnostic test ordered by a medical doctor.

Keep in Mind

Whether your health insurance covers the cost of diagnostic genetic testing depends on your individual policy. Some policies are more comprehensive than others, covering a wide range of genetic tests, while others may not cover genetic testing at all. Your out-of-pocket cost may vary based on your individual policy.

For more information about your individual coverage, please check with your health plan to verify your child’s specific deductible, coinsurance, co-pay amounts, prior authorization requirements, and whether the testing laboratory is in or out-of-network.

Get Started

Enter your email to receive educational articles, the latest news and exclusive deals as they come up.