INSURANCE COVERING BRAC TEST

Veronica4808

INSURANCE COVERING BRAC TEST

Veronica4808

I have Blue Sheild & Blue Cross of Texas insurance and Im concerned they will not cover my test. I called Mydrid and the test is $3120.00.

Im 29 years old and I have a history of cancer on my mother side

My Aunt ( Mom's sister) was DX at 48 with BC in one breast had cemo then it came back in the other breast then it spread through out her body and she passed away at 50.

My Grandma( My Mom's mom) was DX at 65 had her breast removed she went into remission for 8 years then it came back in the other breast and she passed away at 75.

Im not 100% positive on this but my Mom's other sister I was told had the BRAC test and was positive but her Dr would not remove her breasts.. I will find out tomorrow after my Mom talks to her sister to see if she was for sure DX with the mutation.

My Mom wont get tested I have 2 half sisters from my Mom as well that would benifit from getting tested as well.

My father was DX with prostate cancer at the age of 56 and passed away at 60.  I have heard that prostate cancer runs in the same mutation or something like that.

Does anyone know if my insurance company will cover the BRAC test for me?

KatieMom

I have Anthem / Blue Cross and they are covering it.  I am waiting for results.  They covered the oncotype also.

Katie 

bcincolorado

Hi Veronica:

I am in CO but have a Blue Cross policy and they would do part of it but I hadn't met my yearlty deductible yet when I did it.  My BS had automatically ordered it.  I had to fill out some paperwork at the BS office to take to the lab first and give it to the lab.  Then when they drew the blood for the test, they sent in the paperwork and checked with the insurance.  I was told that I would be notified if my insurance would not pay for the test and then given a choice. 

My BS also gave me a video to watch all about the test and everything to help me also decide if I even wanted it run.

When the lab called me I would have had to pay about $1700.  I have no family history of breast cancer (colon and bladder only) and my daughter (in her 20's) said she would not want to know, which would have been my main motiviation for running the test.

Because of the cost involved, I opted not to do the test.  My insurace covered all of my OncoDX testing though after my first lumpectomy though, which I thought was much more important for me.

If you have an insurance agent (I'm personally self-insured) and can ask questions through my agent (and did a ton when I was first diagnosed) you might want to try to go through your agent since they know all the ins and outs of your policy and can put it in plain talk for you.

If you don't, I would just call the customer service number on your insurance card and ask them.  Your BS office also might be able to find out for you too like mine did.

I wish you all the best!

My insurance

AnacortesGirl

I let the doc's office work this out for me.  Since I'm already dx'ed with cancer it was my onc who made the referral.  Your referral would probably come from your primary care physcian.  I got a letter in the mail from UW genetics department saying they had recieved the referral and to give them a call to set up an appointment.  When I made that phone call I asked about the ins coverage.  They checked and confirmed that the inital visit with the genetics counselor was covered and they said the coverage on the actual test would depend on the risk determined by the counselor.  But they assured me that if they decided to test me, before they sent the blood draw to Myriad they contact the ins company to get pre-approval.  If that hadn't happened then they would have contacted me to let me know what, if any, was being covered by ins so I could stop it if I didn't want to pay.  Moot point since Regence paid everything.

Get the referral so you can talk with the genetics office and let them check on the coverage.

scrapmom40

Veronica - I had the BRCA test done when I was diagnosed.  They way it works (at least as far as my doctor told me) is they draw your blood and send it out to Myriad.  Myriad then contacts your insurance agency to see how much of the cost of the test they will cover.  Then you will get a phone call stating your insurance is going to pay for the whole test with no cost to you, they are only going to pay half and you pay the other half, etc. etc.  Once they call you and tell you how much you have to pay out-of-pocket then you tell them either to continue with the test, or don't continue with the test (say if insurance isn't going to cover it at all and you can't afford to pay the $3,000+ yourself).   We just covered this topic with a Doctor this week at my BC Support Group.  If you come back positive, then any other family members that need to be tested can be tested for a few hundred dollars (instead of the full amount) because then they only have to look at the specific gene.  (And yes you are correct about prostate cancer also having to do with the BRCA 1 and BRCA 2 gene).

I would assume if you meet with a genetic counselor they would agree that you are a good candidate to be tested based on your family history and they could write it up in such a way to get you the most coverage possible for the test.

Good luck!  I hope you are able to be tested and that insurance covers you 100%. 

Karen

Veronica4808

Thanks for your info.  I found out from my Mom this morning that my Aunt never had the BRAC test her ono said for not to since with insurance will throw up a red flag:(

I dont know if blue cross blue shields would cover it or not I looked at there guidelines and since I dont have 3 1st or 2nd degree realtives they wont cover it.  I havent put in the fact that my Dad died of prostate cancer at 60 but noone that I know of on his side ever had prostate cancer but they are all passed away so how to really go back any generations.

tweekerbeeker

Veronica, if you do further research, usually 3 1st or 2nd degree relatives is not the only requirement. I have BC/BS and they did pay for my testing. That is not a guarantee for you, however. But they seem to be very reasonable about it.

Please consider genetic counseling with a Certified Genetics Counselor. They are the experts in this field. (Their business card should say "C.G.C., M.S. Genetic Counseling) A counseling session should help you find out how high your risk is, and if the test might be right for you. If the CGC determines that it is appropriate for you, and you want to have it, she will send the insurance a letter of medical necessity. Myriad will call and let you know your share of the cost(as Karen described). In my case, they said I would have to paty about $400, but they never billed me.

AnacortesGirl

It may be helpful to look at your Dad's side also.  Although my Mom is where I got the gene mutation from, it was her father that passed it on to her. Her dad died from prostrate cancer.

How long ago was your aunt told not to do the test because it would throw up a red flag on her insurance?  In May 2009, the GINA (Genetic Information Nondiscrimination Act ) went into effect.  This prohibits medical insurers from using genetic testing as a pre-existing condition or denying coverage.  It does not cover long-term care, life, or disability insurance.

There's a good article on Medscape that you could read. You need to create a free account to access the article:

http://www.medscape.com/viewarticle/704508

travelgal6979

I live in CT and have Blue Cross BS and they picked up the cost except $850.  I figured it was worth it especially since I have a 19 year old daughter and also two sisters who have daughters.  Hope this helps.

travelgal6979

I do recall the genetic counselor saying that coverage is based on risk assessment of family history.  I believe my test was covered because my dad was an only child (smaller family means less information which can be accessed) and my mom was an identical twin whose twin had BC.  Identical twins had same DNA so that increases the genetic risk. 

thegoodfight

I also had the BRCA tests done when I was first diagnosed and they were fully covered  by my insurance.  I think the key is the genetics counselor.  My oncologist referred me and after a long meeting, many questions, a genetics family tree diagram, etc. , it was determined I was high risk.   I was under the impression that once a genetics counselor certified your risk, insurance would cover it.  Of all my tests, this is the one that meant the most to me.  I have two daughters (and a son) and my tests were negative for the gene.  What this meant to me is that my children do not have the gene.  My sister inquired if she should have the test and she was told no.

Ezscriiibe

thegodfight, my insurance covered mine as well, after a risk assessment by a genetic counselor.

However, even though mine was negative, my sister was still recommended to get it, or else have my mom get it -- and if positive, my sister should, if negative there is no need.

My daughter, on the other hand, will NOT need to get one since there is no way for her to have inherited the mutation if my test was negative.

My sister, however, still has a 50/50 chance of it being positive, so, if my mom doesn't get it, she will need to.

My mom's is being paid for by medicare, so that is the way we are going.

Again, if mom's is negative for the mutation, my sister will not need the test; if my mom is positive, she will absolutely need the test.

cassou1

have blue shields hmo-since i only have to tested for the brca1-(my sister took the whole test:brca1 and for brca2)came back positive for the brca1 and so did i. insurace covered it.

gale1525

I have and HMO and they covered the test, but I have family history.