Insurance denied my BRCA testing!

april485

My BS and my MO both wanted me to be tested for the gene because my grandmother died of ovarian cancer in her 50's and 3 of her children died of cancer (3 different types - 1 colon, 1 liver and 1 pancreatic) all in their 50's! Colon and pancreatic are loosely tied to the BC gene the genetic counselor told me, but the ovarian cancer worried her enough to think I should have this!

I am thinking of appealing it. What are the odds that Cigna will give in and pay for this? I don't care so much about me, but I want to know for my kids and for my cousins! I also had a cousin on the other side die of liver cancer at the age of 3! He was likely born with this they said.

Ugh..another thing to worry about!

MelissaDallas

April, here are their coverage guidelines:



https://my.cigna.com/teamsite/health/provider/medical/procedural/coverage_positions/medical/mm_0001_coveragepositioncriteria_genetic_testing_for_breast_and_ovarian_cancer.pdf

april485

Melissa, I swear you are the resident BCO angel...always there with information or a kind word. Thank you so much for posting this. I just received my rejection letter from cigna a few minutes ago in the mail with the same information but it is nice to have it in electronic form (I am an online person) as well! Thanks a bunch!

wenweb

April, It sounds like you should be covered because of your grandmother  Perhaps that information was not included with the request to Cigna.  Good-Luck!!

MelissaDallas

Thanks April.



Your history sounds more like mine. Both my Dad's mom & sister had colon cancer, but not at young ages. All three of his aunts on one side had breast cancer. I had ovarian cancer. They were actually more concerned about me having Lynch Syndrome than BRCA. They tested me for CHEK2, PTEN and BRCA & I was negative for all three.



I think they are going to find a lot more genetic things in the future that we still don't know about.

april485

We talked about Lynch too. They said they were testing all of the genes you cited as well due to the other cancers but it was all denied. I will appeal it and see what happens. Sometimes they do let it through I heard. Also, I have cervical cancer in my 20's so it is not my first cancer (also in-situ and very early so I am one lucky person with catching my cancers really early I guess!) so we shall see...

noellech

I have always read that at first level appeal, insurance company will reverse decision about half the time. Then there is a second level appeal in which another half will be reversed. It pays to appeal. You should try.