Today, Blue Shield announced that we are the first health plan in the U.S. to cover critically ill, eligible newborn babies in neonatal or pediatric intensive care units (NICU/PICU) for the Rady Children’s Institute for Genetic Medicine’s (RCIGM) standard and rapid Whole Genome Sequencing test.
This single genetic test can screen a blood sample for thousands of genetic anomalies and quickly identify the root causes of a child’s condition, equipping pediatricians and specialists with precise, child-specific, disease-specific information so they can make better, faster medical decisions.
Genetic testing is part of our Enhanced Clinical Programs and Medical Policy team. The team ensures that Blue Shield members, including those who are just a few days old, get the right care, at the right time, and at the right cost.
This type of test is typically funded by private philanthropy and research grants. We believe that expanding our coverage to include proven genetic testing is not only the right thing to do for our members, it will also influence other health plans to cover emerging diagnostic tools that will ultimately improve health and wellness overall.
Blue Shield members with Individual and Family Plans or employer-sponsored health plans who have a critically ill child, up to age 18, hospitalized in neonatal or pediatric intensive care at any location with an undiagnosed condition may be eligible.
RCIGM is the only lab in the country that can decode, analyze, interpret and deliver test results within three to seven days on the root cause of rare genetic disorders of babies in NICUs and PICUs. In extremely urgent cases, a diagnosis can be made in three days or less.
After the sequencing process, artificial intelligence (AI) analyses the data to look for a host of rare, genetic disorders in acutely ill infants. In 2018, RCIGM set a Guinness World Record for the fastest diagnosis through whole genome sequencing, with the fastest times averaging 19 hours.
Advances in genomic sequencing technology have made it possible for specialists to identify serious genetic conditions across a spectrum of possibilities at once, significantly reducing the costs and complexities of individual tests.