Oncotype 28

Rdh and Alice~ I do plan on raising a little heck. Don't know if I will be successful or not but I will try.

edwards~ I haven't actually received Genomic Labs' bill yet but when I do, I will be inquiring about a payment plan if my appeal with the insurance company gets me nowhere. Also, I think Genomic Labs is the ONLY company that does the Oncotype, which is the reason I think the out-of-network classification is stupid. There isn't another option in-network.

MLAnne, that's terrible! And yes, they are the only lab that does this test.

Hi,

I'm an insurance broker/consultant to employers. The problem may be how the benefit schedule is set up. Is this PPO Plan? If you get your medical insurance through an employer, they may be able to change the plan design. I think I read the carrier is saying they consider it medically necessary, but Genomics doesn't have provider contract with them.

I'm guessing the Oncotype and Mammaprint companies are not likely in-network for many insurance carriers on a PPO plan - so what the employer can do is amend their benefit plan so as to cover genomic testing as in-network because there are no other providers that can do this important and cost saving test. An employer probably has no idea their plan was set up this way, and it would cost next to nothing to tell their medical plans to cover it at in-network benefit level. Explain to them why it actually saves money and saves putting people through unnecessary treatment. It isn't an exception just for you - don't let them tell you it's discriminatory - you are suggesting they change the plan for everyone in this situation. They can change the plan any time.

The insurance companies have likely approached Genomics and Mammaprint providers to negotiate a price to be an in-network provider, and were told no because those companies know they are the only game in town and they have a monopoly. Total guess on my part.

If you get your insurance through somewhere else - like an individual medical plan on your own or through an exchange...you're not going to be able to get them to change the plan. In which case lean HARD on the insurance companies and call your State Dept. of Insurance to complain. If you are in an HMO, appeal to your Primary Care medical group - they should pay for the test if they referred you there. The Dept. of Insurance will investigate and perhaps rattle some cages. Keep asking - what preferred providers do you have that do this test? Because if you don't, then your network is not adequate for breast cancer patients!O

PS - do you have any money in your flexible spending account, HSA or HRA plans? I know it's your money, but it's pre-tax and would save about 30% on the bill. This is an eligible claims for any of those plans.

We were told by BC that since an OON facility was the only one that could perform my husband’s test his doctor could contact them for an exception. She fumbled the ball and didn’t do itso we appealed the OON charge and won the appeal.

Diane