Won my Oncotype dx appeal!

Urbie

Won my Oncotype dx appeal!

Urbie

Good news to share.  The state of Virginia has ordered Anthem (Blue Cross Blue Sheild) to pay for the oncotype dx test.  Anthem had denied the claim, saying that the test was "experimental medicine". It won't do me a lot of good because they will bump it into the "out of network" category where I have a separtate $2,500 deductible, but Genomic Health says that I qualify for full financial assistance for whatever they don't pay.  The good thing is that with every appeal that is won, Anthem will have to start allowing and paying for this test.  Just wanted to share.....  

otter

Yes, Urbie, that is good news.  Too bad it takes a lawsuit to make them do what's right.

I had read that Blue Cross/Blue Shield of Michigan lost what amounted to a class action suit, I think last year, over the same issue.  BC/BS was claiming the Oncotype test was investigational, and they weren't paying the claims.  Yet, while the suit was underway, they quietly changed their own policy and began paying for the test ... but not retroactively.  In the meantime, a huge number of insurance companies in other states began paying for the test.  Once the clinical oncologists' professional organization and the National Comprehensive Cancer Network adopted Oncotype testing as a standard of care for early, node-negative, ER+ BC, there was no more excuse; and BC/BS lost the case.  I think Michigan forced them to pay retroactively, up to a certain date.

I received a letter from Genomic Health a few weeks ago, informing me that they were going to contact my insurance company about payment.  I haven't heard from them since then, but I haven't received a claims statement yet, either.  My insurance is supposed to be good; I sure hope they don't balk at this.

otter 

Harley44

Good news!  Well, my insurance flat out REFUSED to pay for the Oncotype test.  Genomic appealed ONCE, and TRICARE sent us both a letter saying that they WILL NOT PAY for the ONCOTYPE test and they will not allow any further appeals...  I didn't know they could do this.  

Anyway, the Genomic people also told me that I qualified for FULL ASSISTANCE, so when I got the letter, I called them, and they sent me an application, and I sent it in with a copy of our 2007 tax return page 1 or whatever, which showed our income for last year.  I haven't heard anything yet, and this was in late February, when I sent it in.  I guess no news is good news!

Harley

mthomp2020

I really don't understand why the insurance companies are balking at this.  In the long run, it could save them millions of dollars.  One chemo tx alone costs more then the test.  Wouldn't it be to their advantage to use the test and thus avoid paying for chemo?  Like large corporations, the insurance companies look at the short-term savings, not the big picture.  They're cutting off their nose to spite their face.