Laboratory stewardship programs have demonstrated an improvement in the genetic testing process. The involvement of genetics experts in the review of genetic test orders reduces inappropriate orders and their associated costs. There are many stakeholders in the genetic testing process, including patients, providers, payers, healthcare systems, and laboratories. We present four cases that illustrate common pitfalls towards optimal testing and reimbursement. These cases demonstrate current challenges in genetic testing including confusion in test selection, patient-driven orders, coverage deficiencies, and prior authorization errors. We have developed a checklist that helps navigate challenging steps in genetic testing. Additional collaboration and communication among all stakeholders are needed to improve this process.