BRCA testing/costs/MYRIAD lab

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samiam40
samiam40 Member Posts: 416
edited June 2014 in High Risk for Breast Cancer

I was told when I elected to get genetic testing that Myriad would call me if my liability was over a certain amount and get my consent to go forward with the testing ($375 seems to be what I remember.)  Well the BRCA testing was done (negative) and I received no communication from Myriad other than my test results. 

Yesterday I got an explanation of benefits in the mail from my insurance company BCBS which said they paid around $2600 and my co-insurance portion was $575.  Now this is not a bill, so I haven't actually been asked to pay anything yet, but was wondering if anyone else had encountered this.  Am I expected to pay the $575 even though I was supposed to consent to that?

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  • Emily2008
    Emily2008 Member Posts: 605
    edited February 2009

    Hmmm, good question.  I had my BRCA done in Nov (pos, unfortunately), and was told the same thing re: the $375.  I think you won't be held liable for the balance since Myraid's policy is to call to receive the consent for anything over $375.  I would wait and see what your bill is and if there's any discrepancy get on the phone with your genetic counselor.  I'll bet you don't get billed for the balance, though. 

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  • 1Cathi
    1Cathi Member Posts: 1,957
    edited February 2009

    I was told the same thing when I had my testing done, my genetic counselor told me however max out of pocket would be $300 however and they would call if insurance refused or I did have a co-pay. I never received a call just the results I had BCBS at the time and they paid 100%.

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  • campbell
    campbell Member Posts: 2
    edited February 2009

    we just got a call from myriad saying that BCBS (we have a PPO plan) won't pay for it????? not 1 dime?????? and we're supposed to pay 3125$ out of pocket....................any insight to this?

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  • campbell
    campbell Member Posts: 2
    edited February 2009

    Has anyone sent their blood to the UK for testing???? Cancer Research UK apparently got the patent first there... before Myriad/???

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  • samiam40
    samiam40 Member Posts: 416
    edited February 2009

    Campbell, please have your doctor's office call Myriad and discuss it with them further.  Your doctor should have an insurance department that will run interference for you and with your insurance company and also help you with the appeal process. 

    When I had my blood drawn for BRCA, the nurse said the more boxes they could check (i.e., reasons you need the test) the more likely BCBS would pay.  So, we went over the application twice and made sure all my relatives with bc were listed, that I had abnormal hyperplasia, that I was of Ashkenazi decent, etc., etc.

    As I posted above, I'm not sure BCBS will pay for all of mine, but they have paid almost all and I am glad.

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  • mom_of_2
    mom_of_2 Member Posts: 347
    edited February 2009

    Myriad is the only lab in the US that runs BRCA testing according to my doctors. If insurance denies - YOU MUST APPEAL! In my case there was no family history or reason for test other than my diagnosis. My insurance was pre-certified but genetic testing facility said we should fight if denied and they help with letters and clinical. I had 3 gene marker tested ($400) first and since it was negative went ahead with comprehensive reading ($2725). Another thing my genetic counselor told me is on the off chance insurance won't pay...Myriad cuts deals for payment and should talk to you prior to running test.

    Good Luck 

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  • 1Cathi
    1Cathi Member Posts: 1,957
    edited February 2009

    Hi Campbell,

    Yes call your DR back and ask them to run interference for  you Ihad BCBS and they paid 100%, but as Sami said the better the request is filled out the more apt you are to be approved. 

    I had no documented family history of BC however my mom died of Liver Cancer (unknown primary) and my Grandmother (moms mom) had Lukemia that info was noted, also because I was pre- 50 my genetic counselor made large note of that, if you have any family history of cancer it should be noted. 

    GOOD LUCK -

    FYI- my test was run less than one year ago

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  • nobleanna007
    nobleanna007 Member Posts: 641
    edited February 2009

    I am unfournatly running into the same problem but what is weird is that they will pay for me to see the Gentic counsoler which I did due to my BS feels I am highly at risk cause I was so highly positive in my BC. My problem is I was told by someone who works for the State That I should apply for The BreastCancer Treatment act. Due to the mounting med bills and high insurance premium since my DH is self employed.And unfournatly I had so may issues I had to give up my job. So We applied and I got accepted and we dropped me off my insurance in Dec.08 Never expectig and I had kind of put it out of my mind until I saw BC Surgeon who reminded me, and she got me a appointment. Called the State they said yes its covered. My GEN. Dr. said yes they pay for you to see me but not the test. What the heck! Then why should I have even bothered going if they are not going to pay for the test. I am at high Risk and have 2 children one girl one boy so I need to get this for their sakes and my own. I have had the bilateral but she strongly suggests I get my overies and fallopian tubes removed. Now I am scared I have not had a period since chemo in March08 and they are surpressing it now with tamoixfen. I just don't know what to do I have a Diep coming up in the spring so maybe after all Tx is finished and surgeries I will go back on insurance. But as you all know my deductiable is as High.

    So any suggestions would be great! 

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  • 1Cathi
    1Cathi Member Posts: 1,957
    edited February 2009

    Hi Noble,

    I am not familiar with the Breast Cancer Treatment act you speak of, just wondering though is it a HIPPA Eligable program that will allow you to pick up another insurance.  The laws from State to stae do vary some, but do check into futur Insurance ASAP, have your ducks in a row.

    I left my almost 9/yr job about a Yr into DX, working for a company that does not provide Insurance, I opted for COBRA within the allowed 63days, I had COBRA for 18/MO, then had another 63 days to elect a HIPPA eligable policy , here in Fla, not a whole lot of choices, my policy now is no where as good as what I had through BCBS, the deductibles and premiums are quite high.

    GOOD LUCK WITH EVERYTHING.

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  • nobleanna007
    nobleanna007 Member Posts: 641
    edited February 2009

    1Cathie,

        Thanks for responding, I think the Breast Treatment act is State wide not positive on that but I have read other ladies on it. The downfall to it is it does cover you for 5yrs if you qualify. Rest of your life if you have recurrence. Downside you have to have no other insurance. I myself was on a State program with my family that is for self employed people here in Maine. I could and can still have the that insurance but it is based on your income and we were still paying $1400.00 a month for it and it does not have good prescription coverage and of course all your copays ect.I am due to have reconstruction soon out of state and have been approved for a Diep so I really want to stay on this program, We are just so in debt with all the Med bills. Of course I did not know about this program until I had reached my Max out of pocket. So we are really trying to get them paid down and not add any others. When I can go back to work hopefully I can put money aside for this test. I also hear on Force boards that you can appy for assistance so I may try that. I know how crazy insurance issues can be. It seems like every surgery I have happens in Dec. so I have to start from scratch again.This has been a godsend for me. This is what stinks is once your diagnoised know one wants to insure you. The one I had will at anytime I am very lucky that way. But with all the cutbacks we are hoping it does not get cut. Living is tough right now everything costs so darn much. And its going to get worse before it get better I am afraid.

                                       Thanks again for replying!!!!!

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  • Flygirlx3
    Flygirlx3 Member Posts: 1
    edited February 2009

    I have BCBS - but am battling to try to get them to cover the 440.00 bill - am going thru 2nd appeal now.  I have a strong family history of breast cancer and ovarian cancer, my aunt, dad, and cousin have all had positive results for BRCA 1 gene defect, had my test run in November, and it was negative.  NOW BCBS is saying that it was not medically necessary - HELLO???  I am writing letters, Myriad sent an appeal letter, and have lots of copies of articles trying to prove that it is in fact necessary!  Not sure why they are kicking their feet as it would be much more expensive for them to pay for medical coverage of trying to cure a cancer!

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  • hugglez924
    hugglez924 Member Posts: 1
    edited August 2009

    My BCBS insurance paid 100% as well.  And that was after I was informed that I may have to pay $375, which I didnt mind.  I felt that was a small price to pay to see if my mom (16 year breast cancer survivor who died from ovarian cancer last October) had passed on the mutated gene to me (yep, I tested positive). I had the expanders put in and then the implants (2 weeks ago).  All is going fine and I couldnt be more relieved.  And the insurance has been great (so far) about it all. I wish everyone had that luck.

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  • SelenaRG
    SelenaRG Member Posts: 18
    edited October 2009

    Just told today that I needed to have the BRCA testing through MYRIAD lab. But my insurance is Medicare primary and Aetna secondary. Anyone had any dealings through Medicare as primary carrier?

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