Breast Cancer Index/Biotheranostics letter: ethical?

TriplePositiveP

My oncologist ordered BCI in January and said I would hear from Biotheranostics and could decide whether or not to proceed after learning the cost.

It turns out my insurance (BCBS/FEP) considers it experimental except in limited situations that don't fit my profile.

We talked to a rep about Jan 19 and my out-of-pocket would be over $1000 so I said I would have to think about it. I was shocked to receive a letter (attached) yesterday saying that since significant time had passed, they were going ahead with the test unless they hear from me by Feb 5th!

I was shocked that a company considers it reasonable that it can take a year to process insurance claims, but I have less than a month to make a decision, with the default being charging me for a test without my express permission.

This letter causes me to question the company and their test. I wanted to get more recent data on the utility of the test in decision-making for triple-positive grade 3 tumors before making a decision.

I can't find any data related to BCI for her2+ more recent than 2015 where it stated that only 13% of her2+ get "low risk" results for stopping anti-estrogen therapy.

Is it standard procedure for companies to proceed with tests they know are not covered by the patient's insurance and send letters that are clearly intended to cover themselves legally for doing so?

ThreeTree

Sorry that I have no experience with the BCI test or anything like this with insurance, etc., but all I can say is, WOW, it sure doesn't sound right to me. You'd think if they hadn't heard from you and thought enough time had passed, they would just drop the matter if nothing else (not that that would be OK either), but not charge you!