BRCA test

don23

Has anyone had their insurance deny coverage to get the BRCA 1 & 2 test? Mine did. I can't believe it. The insurance company said they do not cover any genetic testing. How crazy is that? The cost of the test is $3120 and I would have to pay out of pocket if I still want it done. The insurance administrator said that I could appeal this but has anyone done that and won?  I have three daughters and I really would like to know if this is genetic or not. I do have a sister that had bc at age of 49 and also ovarian cancer at age 55. She has not done the testing but I fear it is genetic. Any advise would be greatly appreciated. I am 51 years old.

smithlme

I am so sorry your insurance has denied your request. Is your sister willing to be tested? If so, does her insurance cover the cost? If she's willing and her insurance covers it, have her get the initial testing done, which is the most expensive one. (full sequence testing) If she tests positive, future family testing is in the $300.00 range, since the gene is known where to be located. www.facingourrisk.org is a website dedicated to BRCA 1 & 2 genetic breast and ovarian cancer. Best of luck to you and your family...

Linda

don23

Smithlme - thanks for your input. My sister has been dragging her heels for the last few years on this genetic test. That is why I decided, since I know had breast cancer, that I would go ahead and do it. I have been talking to her about it and she says that she is going to do it but never does. Maybe her insurance won't cover it either. I don't know. I'll have to keep bugging her because I really need to know!

kira66715

I used to work for an insurance company and the benefit guideline for genetic testing was that the test had to be important for the person tested--make a difference in their clinical management--not just to predict risk for future generations.

As the BRCA test would definitely change how you were medically managed, they're just plain wrong.

You should appeal their decision, and speak to the whoever in your local government oversees insurance--and let them know that.

I know the insurance company I worked for was very afraid of bad public opinion--one woman's attorney threatened to go public with a denial, and they caved.

A blanket "no genetic testing" is not the industry norm. I would ask to see the benefit guideline. They have one.

Good luck. Often the first thing you get is a denial, with the hope that you'll go away. I found that some less informed people, with little authority would use that technique.

This is important to you, in so many ways.

The company that does the BRCA in Utah isn't as friendly as the folks who do Oncotype dx in California--they'll push the insurance company.

One last thing--medical necessity is the buzz word--a letter from your doctor supporting the medical necessity of this test goes a long way.

Good luck.

Kira

(who got the test on advice of my oncologist--it was negative, but my husband's family is really the high risk one, and I have two daughters in their 20's) 

don23

Kira - thanks for your input. I'm not sure yet what I am going to do but at least I know there are ways to go about trying to get it approved. Thanks for your help!

Emily2008

Appeal, appeal, appeal! 

My insurance covered my BRCA test, but I was dx at age 35, so perhaps that was why they allowed it.  I think a bc dx when you're under 50 is one of the indicators of a genetic risk.

I agree that they're probably hoping you'll give up and go away.  Don't let them discourage you; keep fighting!