Oncotype Dx Test Anyone?

MsPharoah · March 2014

Mmtagirl, definitely put up a stink with your insurance company and make sure you get your MO in your corner. Sometimes the drs can have more impact. And if that doesn't work, Genomics will reduce the price to something you can afford. They do that all the time. I'm betting your insurance co will cover, though on reconsideration.

MsP

juneping · March 2014

you could say now you have a low score that you're not doing chemo which save them A LOT of money. so they should be thanking you for doing the test.

and the oncotype does include node positive prediction. so your insurance company need to update their knowledge about coverage.

GL!!

mmtagirl · March 2014

Thanks MsP and Juneping, I am going to fight this one! Appreciate your help and response.

MsPharoah · March 2014

Go get 'Em!

Lenn13ka · March 2014

mmtagirl- insurance does cover node positive for the Oncotype. I had it and had 1 node positive.

Go fight it.

edwards750 · March 2014

mmtagirl...absolutely fight it. Actually Genomic Labs called BCBS for me before they even agreed to do the test and they agreed to pay for it and then reneged. According to GL insurance companies do it all the time. They told me they were going to take it up with BCBS and for me not to worry. They did. I had a micromet in my SN which according to GL is like being node-negative. My BS' office said BCBS have to know that chemo is more expensive than RADS and because of my low score on the test I had RADS. They need to look at the BIG picture. Also, Genomic Labs will work with you on a sliding scale if your insurance company won't budge. Good luck. Diane

rettemich · March 2014

When do they do this after surgery? Do I need to ask for this? Ok, I'm new and Very confused still. My little brain can't absorb all that is going on. I want to have this test as I am on the bubble about the HT will be having Rads no chemo. Plus hoping to reduce the chance by having a reduction proving my margins come back clear. If they do should be doing it within a few weeks after lumpectomy, on 3-25 . I too have BCBS

DCIS Stage 0 6cm

juneping · March 2014

rettemich - i don't think you need the oncotype done since you got DCIS which you don't need chemo anyway. i haven't heard of BCBS...what is it?

coraleliz · March 2014

Let Genomic health fight this for you. They do it all the time. I have BCBS & they often authorize tests in advance but then deny payment. It makes me angry & wish I had done chemo & expensive reconstruction, so then they'd really have to pay & pay!!!! Then they pay but not until they get more records.......

Before my MO ordered the test, I called Genomic health to see if they were contracted with my insurance & they were.

After Genomic health received my samples, I received a call from them stating that it would not be covered by my insurance BUT I would not have to pay anything because they were contracted with my insurance(huh!). They also sent me a letter stating this. It makes no sense to me. In the end my insurance paid all of it(huh!!!)

mmtagirl · March 2014

You gals have given me some great advice. I can't thank you enough. GH did call me before running the labs and told me that the test was approved so it was very surprising when I got the letter from Aetna. I will follow up with GH tomorrow. Overall GH customer service has been excellent so I have faith this can be settled.

edwards750 · March 2014

juneping...BCBS is Blue Cross/Blue Shield insurance

Lojo · March 2014

I also had an epic battle with BCBS. Genomic Health called me and said, good news, I'd met my out of pocket and the test would be covered at 100% by my insurance. Then a wait...and a wait...and my MO's office said they hadn't received the results. I called GH and they said, um...problem with BCBS. I called BCBS and talked to the most unsympathetic nurse in history who was my case manager. She said it was denied because the tumor was over 4cm, which was their cut off (otherwise i met criteria of node negative, er/pr +). I called my MO and he said he would have to do an expert panel with the insurance company docs to convince them it was necessary. In the end they had my surgeon do the consult (he's meaner!) and BCBS relented and paid (and they didn't have to pay for chemo as a result!). The only thing that slipped through the cracks was the hospital's pathology bill for processing the sample-- which was $100, and i decided not to fight that one.

Lojo · March 2014

I should also say that I got the weirdest letter from BCBS afterwards regarding the approval for the test. It was ONE time only! They were making a HUGE exception for me. My MO shouldn't get it in his head that other patients of his would be approved. Clearly not a form letter and certainly written by an actual human that had looked at the case.

BigDBeatingBigC · March 2014

I am sorry you had to deal with that Lojo. The important thing is to never take no for an answer and to get help with the appeal. I have had to fight insurance companies in the past and most of the time they will reverse it. But I never do it myself. I get a third-party involved, whether it is the doctor or the dentist, or the company who administers our health plan. It is worth the time and effort. I am glad your test was paid for.

rettemich · March 2014

What's the justification for denying over 4cm, anyone know? Just curious. I believe my DCIS is over 6cm. But it's calcification so far, and not an actual tumor.

BigDBeatingBigC · March 2014

I am taking a guess here, rette, and someone else may know the right answer, but I think because of the size of the area, whether it be tumor or whatever, there must be a cut-off in the insurance company's determination of whether the test should be administered. For example, my MO suggested that we absolutely do the test because my tumor size was 2.2 and there was an area of DCIS next to it. Where I am treated they generally cut off the determination of whether or not you should have chemo at 2 cm's. Just to be on the safe side. My grade was low, but the onco test result was the determining factor of whether or not I should have the chemo. Both the MO and RO felt the result would probably be low based on the path report, but they also said it was just a guess on their part and the score could be high. I did not want to always wonder if I had made the right decision to not have the chemo so I insisted on having the test done. When the score came back as 12, we all knew that chemo would be of no benefit to me. I can tell you that even if I had had to pay for that test myself, it was worth having it done for peace of mind. If I had had a tumor size of 4 cm, my doctors would have insisted on chemo no matter what.

edwards750 · March 2014

Totally agree BigD. All they can do is keep saying no and I for one don't give up until the last person says no. I won a battle with Met Life over a dental procedure. They claimed if was cosmetic; it wasn't. It took 6 months but God love my dentist he persisted. Rads are less expensive than chemo so you would think they would approve the test on that basis alone. For me, I would have going a way to pay for that test no matter what. Diane

rettemich · March 2014

Ok, that makes sense. I understand more now. Thank You BigD and edwards for taking the time to explain it to me.

LidzyWidzy · March 2014

I met with the medical
oncologist on Friday to discuss the results of the Oncotype score of 14 that I
received. He advised me that with a 9% recurrence rate there was, at best, only
a tiny percentage possible benefit
from chemotherapy and that this must be weighed again the well-established risks of chemotherapy. He also stated that the Oncotype result
presumes a regimen of tamoxifen and that the AI I’ll be taking (Femara) might
gain me another 2%. In addition, the Zometa injections – for bone density loss
– can be considered as another 1-1.5% protection against future recurrence, at
least in the bones. He concluded that it would be irresponsible on his part to
have me follow a course of chemo. I found his reasoning sound and am, at long
last, comfortable with this decision. I get there in the long run . . . it just
takes me a little time and understanding . . . thanks for all of your help!

Voraciousreader – thanks
for all the evidence – that was exactly what I needed last week. I can’t
believe I had not looked at the NCCN guidelines before – Duh! Thx for leading
me there.

Farmerlucy – I so
appreciate your words: “If it comes back it comes back. I will not let that
fear steal any more time from me.” I wrote that into the FBC diary I am keeping
– you know what the F stands for – and have referred to it more than once as I
try to get used to keeping this fear at bay.

MsP – yes, I agree – the
key tomoving forward is engaging with the things that are in my control and
make me feel better in any case – exercise, healthy habits, and moderation in
everything. I’ll meeti with the “survivor specialist” over at the hospital
tomorrow to discuss these kinds of things – kind of a creepy name and she was a
ibt upbeat/cheery for me but I’m ready to hear what she has to say.

Y’all are the best help
a girl could want at a trying time like this.

MsPharoah · March 2014

LidzyWidzy....doesn't it feel good to have your plan? You are definitely on your way and all the best to you. Hugs.

MsP

farmerlucy · March 2014

lidzy - Thanks so much for letting us know. Your onc's confirmation of AI's reducing it even more, plus Zometa, is wonderful information to hear!

LidzyWidzy · March 2014

Yes - a Plan is so much better than Uncertainty, any day! You sisters are great to stay on board and help us newbies navigate.

Lenn13ka · March 2014

Good Luck as you move forward LidzyWidzy.

Jojo0529 · January 2016

Hello Warrior,

My Ki-67 of 25 also does not fit with my profile. It makes no sense to have a miototic count of 1and a low Onco, but high ki-67?

Oncotype Dx Test Anyone?

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