Getting Started with AT-GC

A what-to-expect-guide for your telehealth genetic counseling journey with Advanced Tele-Genetic Counseling

steps on the path to your genetic awareness

A comprehensive overview of the six steps of the genetic counseling journey with AT-GC

The Genetic Counseling Journey

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1. Initial genetic counseling

 

During initial genetic counseling, you’ll meet virtually an AT-GC genetic counselor to discuss personal and family history, the benefits and limitations for genetic testing options, and to discuss your specific genetic risk factors. 

 

2. genetic testing coordination

In some cases, your provider may have already ordered genetic testing for you. If you have not had genetic testing and are interested in pursuing it, AT-GC’s genetic counselors may help coordinate this on your behalf, often in conjunction with your local provider.

 

3. results genetic counseling 

When you’ve received your results, you may meet with your genetic counselor for a post-test review of the meaning of your genetic test report. You’ll discuss current research, implications for your health and family members, and discuss current guidelines for risk management.

 

4. continuity of care and risk management

 

With your permission, AT-GC’s genetic counselors will share your genetic risk and management information with your local provider or health team. Sharing this information helps your doctor know how to best care for you and keep you healthy. in light of your genetic findings.

 

5. personal empowerment through knowledge 

Gaining a clearer picture of the variation in your genetic cards can help you manage the hand you’ve been dealt.

The information discussed in your genetic counseling appointment can provide you greater clarity about risk management and help promote personal wellness.

6. we support you

 

As genetic counselors, we do our best to help you understand what the story of your DNA is telling us, and leave plenty of time for questions during our appointments; however, if you find you need a bit of clarification or remember a question in the future, you can check in with your AT-GC genetic counselor by phone or email if you need to follow up.

 

Comprehensive Genetic Counseling

Though genetic counselors sometimes see patients for only a pre-test appointment or a post-test appointment, the gold standard for genetic counseling involves the genetic counselor both at the initial phase (pre-test genetic counseling) and for interpretation of genetic counseling results (post-test genetic counseling). Here’s more about the two appointment types what to expect when meeting with your AT-GC genetic counselor. 

Initial (Pre-Test) Genetic Counseling

Genetic evaluations take place virtually by phone or video consultation. At AT-GC, all genetic counseling appointments are blocked for one hour to ensure sufficient time for you to cover all the questions you may have with your genetic counselor.  Prior to initial evaluation from AT-GC, you’ll be responsible for gathering personal and family genetic health history. Your genetic counselor will utilize the health information you provide, along with any clinical documentation shared by you or your doctor, to discuss hereditary information important for you to know and to help determine whether a particular genetic test may or may not be appropriate for you. In some instances, your doctor may have already ordered a genetic test for you. If you decide to move forward with a genetic test that has not been ordered, your genetic counselor will help coordinate this with you and involve your local provider, when possible. Often, samples may be submitted from your home via mail-in saliva, through mobile-phlebotomy services offered by some genetic testing laboratories, or through your physician’s office.

 

Results (Post-Test) Genetic Counseling

Genetic evaluations take place virtually by phone or video consultation. At AT-GC, all genetic counseling appointments are blocked for one hour to ensure sufficient time for you to cover all the questions you may have with your genetic counselor.  Prior to initial evaluation from AT-GC, you’ll be responsible for gathering personal and family genetic health history. Your genetic counselor will utilize the health information you provide, along with any clinical documentation shared by you or your doctor, to discuss hereditary information important for you to know and to help determine whether a particular genetic test may or may not be appropriate for you. In some instances, your doctor may have already ordered a genetic test for you. If you decide to move forward with a genetic test that has not been ordered, your genetic counselor will help coordinate this with you and involve your local provider, when possible. Often, samples may be submitted from your home via mail-in saliva, through mobile-phlebotomy services offered by some genetic testing laboratories, or through your physician’s office.

 

Frequent Questions

What questions are asked at a genetic counseling appointment?

In order to get a clear picture of your personal genetic risk factors, you will be asked to complete a personal and family health history prior to and/or during your meeting with the genetic counselor. Some of the detailed topics you will discuss include:

  • Which relatives have had symptoms that may indicate an underlying genetic condition?
  • How old were they when they developed these symptoms?
  • What type of symptoms did they have?
  • Has anyone in the family had a diagnosis of a genetic condition?
  • Have they had genetic testing? If so, what were the results?

What is the fee for genetic counseling?

When a patient is responsible for their own genetic counseling costs, AT-GC strives to maintain affordability with transparent and low-cost pricing. The fee per genetic counseling consultation is $119.

Payment is collected via verified credit card or HSA payment through the AT-GC Client Portal. Each appointment is blocked for one hour of time.

It is our goal to help make genetic counseling more accessible to individuals who need it. AT-GC offers financial assistance via a reduction in fees for patients who meet certain criteria and who are able to provide the required supporting documentation. You may request a copy of AT-GC’s Patient Assistance Application by emailing our  AT-GC Care Team Coordinators. To see if you may qualify, please consult the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2)

Will my insurance pay for telegenetic services? 

At this time, AT-GC is an out-of-network provider.  

 

Many commercial insurances do cover the cost of genetic counseling, and we are happy to provide you with a receipt if you wish to seek insurance reimbursement. 

 

Is AT-GC affiliated with a particular laboratory?

No. As an independent genetic counseling provider, AT-GC does not support any particular genetic testing laboratory. Instead, genetic counselors use the information discussed during the personal and family health history genetic counseling evaluation, when considering genetic testing. In all instances, it is an individual’s decision to pursue or decline any exploration of genetic testing.

 
What is the Genetic Information Non-Discrimination Act?

The Genetic Information Non-Discrimination Act (GINA) is a federal law passed in 2008. It and other state laws help protect most people undergoing genetic testing against health insurance discrimination and employment discrimination.

 

 

 What  are some family or personal health history scenarios that may mean genetic counseling should be considered?
  • Earlier disease onset than typical ages
  • Especially severe or exceptional disease presentation
  • Multiple diagnoses or  similar types of disease in the same person or in multiple family members on the same side of the family
  • Multiple congenital (present at birth) anomalies
  • Recurrent pregnancy loss
  • Sudden death
  • Developmental delays
  • Family history of a known inherited disorder

What is an inherited condition?

An inherited condition is a medical condition or a trait that can be passed down from parent to child. Genes are the instructions that our bodies use to grow and function. If one of these genes has a change in it, it cannot work correctly, which can put us at a higher risk for developing symptoms related to having a variation in that specific gene.

 

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How can genetic counseling help me?

Meeting with a genetic counselor can help you learn more about the specific genetic risk factors in your family.

Based on your genetic test results, your doctor may want to offer specialized screening or management options to keep you healthy.

You may want to consider ways to reduce the chance of developing symptoms related to specific genetic findings.

You could share information with your relatives so they can determine their own risk of developing certain genetic conditions and stay healthy.

at-gc supports all individuals seeking to know more about their genetic risks

An overview of some of the reasons people meet with an AT-GC genetic counselor

Proactive Wellness

Genetic counseling for all who want to understand more about the influence of their inherited genetic information and associated health risks   Genetic counseling for personal or family history of suspected genetic conditions   Genetic counseling for those experiencing symptoms and for healthy individuals who seek personalized preventive health information about their genetic risks

Cancer

1:10 of all cancers are related to genetics 

Genetic counseling for diagnostic or predisposition testing for personal or family history suspicious for hereditary  ovarian, pancreatic, breast,  colorectal, cutaneous melanoma, gastric, prostate, renal cell, uterine, and thyroid cancers, among other concerns

Family or personal history of similar or aggressive cancer types, bilateral primary cancers in paired organs, multiple cancer diagnoses, or cancers occurring more frequently or at younger ages than would be expected

Reproduction

Genetic counseling for any individual or couple planning a pregnancy or who are expecting who wish to know more about individualized reproductive risks for their family

Genetic counseling for advanced maternal (+35 years) or advanced paternal (+40 years) age 

Genetic counseling for carrier and diagnostic testing

Genetic counseling for 50% of infertility cases that are related to genetics

Genetic counseling for a history of miscarriages

Genetic counseling for newborn screening followup

Ocular

Genetic counseling for early-onset vision changes, such as blindness, glaucoma, macular degeneration, and in cases of retinal degeneration

Genetic counseling for 30% of cataract cases that are related to genetics

Genetic counseling for other conditions of the eye that are suspected to be genetic in nature

 

Pharmacogenomics 

Pharmacogenomic testing explores how an individual may respond to common drugs and can help prevent adverse reactions and provide efficacy information for dosage and type

Genetic counseling for physician support when considering certain FDA labels recommending pharmacogenomic testing for medication and treatment decisions to prevent severe, adverse drug reactions

Used for physician treatment decisions in oncology, heart and lung disease, and mental health

Cardiology

Genetic counseling for 30% of cases related to high blood pressure and cholesterol that run in families

Genetic counseling for personal or family history of aortopathies, arrhythmias, and cardiomyopathies

Genetic counseling for history of early heart attack, thoracic aneurysm, congenital heart disease, or sudden cardiac death

Surgery

Genetic counseling for patients undergoing surgery with a suspected or known family or personal history of genetic disease

Genetic counseling support for surgeons requiring assessment of genetic predisposition for pre-surgical and post-surgical decision-making and care

Neurology

Genetic counseling for 30-40% of epilepsies that are heritable

Genetic counseling for early-onset Alzheimer’s disease and dementia that run in families 

Genetic counseling for Huntington disease

Genetic counseling for hereditary ALS (amyotrophic lateral sclerosis)

Genetic counseling for hereditary Parkinson disease

Genetic counseling for neurodevelopmental delay or other neurodegenerative conditions

Family/Personal History

Genetic counseling for family history of similar conditions or symptoms that appear, especially in multiple family members, those on the same side of the family, and sometimes with more frequency, with severity, or at earlier-than-typical ages

Genetic counseling for symptoms that you or your provider are concerned about that appear to be genetic in nature

Guide for Providers

As a healthcare provider, you’re the expert. You want the best for your patient. You want to treat their cancer, help them understand the reason for their struggle with infertility, or simply order genetic testing to find out whether their symptoms are of hereditary concern.

You may wonder, 

 

When and why do my patients need to see a genetic counselor?

 

Do you know the common and less common genes,  beyond BRCA1/2, that predispose a person for breast cancer?  pancreatic cancer? ovarian cancer? Genetic tests are available for many indications, and as we learn more about the causes of certain diseases and the role genetic plays in that, it can be helpful to know the latest research. For example, when it comes to cardiac health 30% of heart disease is linked to heredity, as are 17% of  ALS  cases, and even when it comes to cataracts, 30% of cases are caused by genetic factors.  It can prove difficult to keep up with current genetic testing and management recommendations, which seem to change rapidly.

Do you know that there are  10+ genetic tests that enter the market every day and the average genetics appointment lasts about 45-minutes? Certain types of health insurance now commonly require genetic counseling and test ordering from a qualified genetic counselor before approval for the associated costs. The same is true for certain accreditation standards, such as the  Commission on Cancer and NAPBC, which may set the requirement of input from genetic counselors for participating centers.

Did you know that when reviewing genetic testing, genetic counselors will suggest alternative or expanded testing for 30% of patients for whom testing was already selected and that utilizing the expertise of certified genetic counselors can help reduce physician liabilitywhen it comes to choosing the current best tests for patients?  Knowing when and what type of genetic testing is warranted keeps patients from slipping through the cracks when the benefit of increased medical management could help, as determined from targeted genetic testing and knowledge of the current guidelines and regulations regarding their specific results.

 

Genetic counselors are specifically trained to help understand, interpret, and navigate complex genomic information and processes to support the best patient care. In fact, if there is one thing genetic counselors know, it’s genetics!

 

They are specifically trained to help you and your patients navigate the complex and rapidly expanding world of genomics. In common areas like oncology fertility, and medication management, to specialties in which we may not have previously considered routine genetic counseling care, such as cardiology, neurology, endocrinology, surgery, dermatology, and general practice, AT-GC’s genetic counselors provide expertise and help guide patients and providers through the personalized options and meanings related to all types of genetic indications and testing.

Genetic counselors are here to help as extensions of your team. When you utilize AT-GC as a referral source for your patients’ genetic counseling care, you’ll get to know our team of certified genetic counselors, who will correspond with you directly regarding your patients’ care. Whether you’d like to make sure the test you’ve selected is the best one for the patient, or would like the support of genetic counselors for your patients during the pre-test phase and to explain the meaning of complex genetics results to patients, we are here to support you. With each appointment blocked for an hour of time and all genetic counselors specifically trained in psychosocial counseling and genetics, enlisting the assistance of genetic counselors means that we will provide valuable feedback for overall patient wellness by explaining levels of increased risk as well as ongoing genetic management guidelines so that you can provide continued, expert follow-up to your patients whose genetic findings indicate the need for increased genomic support. 

 

Genetic counselors help patients and providers:

 

Know when genetic testing may be warranted

Understand current genetic screening/testing guidelines

Distinguish clinically useful and valid genetic tests 

Correctly interpret complex  genetic test results

Explain genetic risk, testing options, management guidelines, test results, and their implications  

 

 

Refer patients to genetics

 

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