Oncotype DX Coverage

yasminv1

Just wondering if anyone had issues getting the Oncotype test covered by insurance. I have Anthem but got a call from Genomic Health letting me know that they did not have a contract with Anthem and that the insurance company may not cover the test. They said the test costs $3900 and they would appeal for me is Anthem denies to pay but in the end I would be responsible for paying. They asked if they should go forward with the test.  I said yes because my Doctor really wants me to get this test to see if I will benefit from Chemo. I felt like I had no choice but to say yes as I may always wonder what recurrence score is and if I would have benefited from chemo.

This sucks. I truly hope the insurance company pays for some of it or else I will have to charge that $3900 to a credit card because with all the other medical bills and living expenses..I just can't afford to pay that right now.

Gitane

Hi jasminv1,  I just thought I would mention that Genomic Health tries to reduce or eliminate their charges for people who cannot pay and who do not have insurance that will pay.  You may want to discuss this with them.

hollyann

I agree with Gitane..I was told by Genomic Health when I had my test that if I could not afford it or if insurance would not cover then they would work with me on payments or not even charge me depending on my income.......Good luck to you......

Makratz

Me too!  Although, my insurance company ended up paying for it!!  I had no idea if they would or not, but I needed to have the test done.  To me, even if I had to pay the 3900, it was worth it to know if I would really benefit from chemo or not.  Who would want to do that to their bodies if they really don't need to.  Best of luck to you!

Firni

I have Anthem BCBS and they did eventually pay for the test.  Genomic Health appealed the denial for me.  I had the test in Nov. and insurance finally paid in July.  I was also told that Genomic would reduce the charge and work with me on payments if insurance wouldn't pay.  

yasminv1

Thanks ladies..your replies make me feel better. I was afraid with my household income I would not qualify for financial assistamce if my insurance does not pay for the test but after getting more info from genomic health they should be able to help with some of the cost.

Daylily

My insurance co only paid an out-of-network rate of $2290 - and the Oncotype folks called me the other day to tell me I was going to owe them the balance of about $1500.  They offered a 5% discount for "prompt pay".  I'd like to know what other folks' insurance companies are actually paying according to the EOB's.... I don't know if my insurance co. is paying what the co. actually negotiates w/ others or if it's being stingy.  By the way, my score was 23; we went forward with chemo anyway....

hopeful4ever

I am a new reader to this site and just have to address this issue.  When I first heard of the Oncotype Dx, I had no idea how/when/where or by whom the test would be performed, but I knew there was no option.. it had to be done.  To be honest, at that point in time, I wasn't thinking about participating vs. non-participating providers...  I was depending on my doctor and his office staff to know all about the insurance end of things. 

Even though Genomic Health was first identified by BCBS (federal plan) as a non-participating provider, once they were able to obtain the necessary documentation, they paid $3,252.40 of the $3,820.00 charge.  By the time the claim was processed I had met my catastrophic maximum for 2009 and wasn't responsible for the difference.  I stayed in touch with BCBS, Genomic, and my physician's office because the necessary paperwork had to come from several different locations and this was going on between the Christmas and New Year holidays.

I hope this will be helpful to someone before falling in head first.  You may have to spend a lot of time making phone calls and doing leg work, but if it pays, then it's worth it.  Best of Luck.

Firni

My insurance, BCBS, paid the entire bill of $3800.00.  All I had to do was sign a waiver allowing Genomic Health to appeal on my behalf.  No phone calls to anyone.