The rapid growth of genetic testing is outpacing the ability of health plans to manage it effectively. With over 180,000 tests available, and more being introduced daily, current systems based on traditional CPT coding and routine benefit structures are proving inadequate. This mismatch is leading to administrative inefficiencies, inaccurate claims processing, increased potential for fraud and waste, and delayed access to appropriate care. 

In this InsuranceThoughtLeadership.com article, Avalon CEO Dr. Bill Kerr, MD, explores the drivers of these challenges and the critical need for specialized lab benefit management programs designed specifically for the genetic testing landscape that includes established evidence-based medical policies, clinically validated laboratory networks, advanced audit mechanisms, robust provider education, and compliance with evolving biomarker legislation. Implementing this level of infrastructure enables health plans to manage complexity, reduce variability, and support more consistent, clinically sound, and cost-effective decision-making across their populations.

Read the full article at InsuranceThoughtLeadership.com.