The true cost of Mammaprint

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Lisey
Lisey Member Posts: 1,053
edited July 2016 in Diagnosed and Waiting for Test Results

So Kaiser has been great about paying for the oncotype and DNA / Brca testing. I'm in the grey area for oncotypedx, so my oncologist wants me to do a mammaprint to give a yeah or nah to Chemo. She submitted it to Kaiser and they will not pay for it. I've heard the test is $4200... which is a lot of out of pocket money. Does anyone know if they'll work with people individually or have had experiences with insurance not paying for this test. I really want that test as I would like a clearer picture being in the grey onco.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited July 2016

    I had this test in 2010 and my insurance did not cover it as it was deemed "experimental" by them at that time. This test was relatively recently FDA approved and some insurance companies use their discretion in covering it, particularly if they cover Oncotype Dx. Insurance may see Mammaprint as a duplicate test, and thus not cover it. They may be relying on your oncologist to factor in your clinical status with your Oncotype Dx Recurrence Score and come up with a treatment plan based on those factors. You are correct about the cost - when I had it done it was over $5,000, but Agendia (the lab that does Mammaprint and other assorted genetic assay tests for breast cancer)) does have some patient assistance programs available. This is from their site:

    "Agendia is a compassionate company offering a wide range of financial assistance programs based on individual financial status. Agendia offers the following programs to meet your financial needs:

    Interest free payment plans
    Underinsured patient assistance
    Uninsured patient assistance
    Indigent patient assistance

    For more information, or to speak with a Patient Advocate Representative, call us at 888-363-7868."

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  • Lisey
    Lisey Member Posts: 1,053
    edited July 2016

    I've read that if you work with them they drop it down to $500 for the individual, but I've just heard this via phone, nothing in writing. Wondering about the true cost to our family if I ask for it. 5K plus 3K in cold caps is quite a chunk out of pocket plus the 2K deductable

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited July 2016

    You might inquire about an appeal to your insurance company, citing your intermediate grouping on OncotypeDx, or having your MO do a peer to peer review with your insurance so that her viewpoint on ordering Mammaprint can be understood. Not sure how Kaiser handles that. The type of insurance plan I have requires pre-approval and a referral for each provider and action, and I pay only a co-pay, no deductible and no co-insurance percentage. My breast surgeon's office failed to obtain a referral to have the Mammaprint done - if they had, they would have known in advance it would not be covered. I did not sign anything saying I would be responsible for payment to Agendia if insurance did not honor the claim. I had no out of pocket obligation at that point and Agendia accepted the shipping charge paid by insurance as payment in full with my signed AOB form.

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  • edwards750
    edwards750 Member Posts: 3,761
    edited July 2016

    I had the Oncotype test in 2011. It was 5k. Genomic Labs conducts the test. We have BCBS. Has to be pre-approved by BC. They approved initially and then back pedaled. Genomic labs told me they do that all the time. The lady with Genomic said they were going to appeal. They also offered a sliding scale just in case. My BS was furious. He said BC should look at the cost savings as in my not doing chemo versus Rads which was the purpose of the test to begin with.

    Happy ending. They paid for the test and the results which was a low score allowed me to dodge chemo.

    Recently a friend who has aggressive BC had the test done to see if she needed to continue taking Arimidex for 10 years. Her insurance co refused to pay for it. Her husband raised cain and persisted. They eventually paid for it.

    It's outrageous we have to fight to have these needed tests done but a lady I know who has worked in insurance in a doctor's office said persistence usually pays off.

    I can only surmise your insurance co doesn't want to pay for another test since you had the oncotype test done. Maybe your doctor could put the squeeze on them. Sometimes that works too. One of my doctors changed the coding and insurance paid for the test.

    Diane

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