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Oncotype DX Test and Insurance

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Posted 1/8/2006 7:29 AM (GMT 0)
Thanks Pattie. I wish you luck with your third appeal.

There is a lot of stuff out there from December 2005 you may want to include with your appeal. E-mail me if you have any questions.

Marianne
Posted 1/11/2006 6:42 AM (GMT 0)
Jean,

Sorry, it's seems I missed the post where you stated your insurance paid for your OncotypeDx test.  Congratulations!!!  I would have been jumping for joy with you had I not missed that post.  But we can still jump, right?

Seems I'm following in your footsteps, I'm where you were a few months back.  My insurance has decided to pay 70% of the cost which put a big smile on my face.  An even bigger smile will emerge on my face if I get word they paid the whole thing.

Again, congratulations on the good news and on a job well done.

Marianne

Posted 1/11/2006 6:48 AM (GMT 0)
Laure',

Thanks! I sure hope that I helped in some way so other women will have an easier time of getting this test covered by their insurance companies.

Happy New Year!

Marianne
Posted 1/13/2006 12:31 AM (GMT 0)
 Hi everyone,

I just got a really great phone call from Genomic lab....I am an excellent canidate for the Oncotype DX test and  (drum roll please...) my insurance Avmed will pay for it!!!! I am sooo happy right now. The lady at Genomic labs said that Avmed starting pay for this test as of Nov 1st  For those of you still battling the insurance red tape, keep on fighting!!!! We B/C sisters are stong and will fight until the end!!!!!!!

Love & prayers

                           Meg

Posted 1/13/2006 12:52 AM (GMT 0)
Hi Meg,

That really is great news.  Congratulations on both counts. 

Marianne

Posted 1/16/2006 4:21 PM (GMT 0)
Hi All,

 

I haven't been on here in a while (again) but got on here to research something completely different (my first mammogram after the cancer) and had to participate in this discusssion.

 

Some of you might remember that I had the oncotype DX test early last year to determine if I should have chemo in addition to rads. Well my onc. office did the leg work to see if my insurance company would cover it and they contacted me (the onc. office) and told me United Healthcare said yes.  I had the test, scored a 3 and went on with rads to be followed by tam. Sometime last summer I was notified that United Healthcare denied the claim!  I was furious and baffled at how this happened.  My onc. office suddenly doesn't have the documentation to back up the clearance from UH.  ????  I've been battling with appeals to no avail.  So it is encouraging to hear Marianne's news.

 

Could any of you that have battled this please keep me up to date on what course I should take now.  I thought the appeals process was exhausted, how long can you continue to appeal this?  And what methods should I use; any template for a letter would be helpful.  I am returning to work (finally) tomorrow and my time will be limited until I get adjusted to this.

 

Thank you all for giving so much of your time to keep us all up to date.  I've been terrible about that lately. Sorry.

 

 

Posted 1/16/2006 4:32 PM (GMT 0)
Here's an interesting article.  I'm sure many others will follow suit.

 

[If you tried the  link to this article before, it didn't work. I am changing it]

http://sev.prnewswire.com/health-care-hospitals/20060113/SFF01813012006-1.html

Also, don't forget to check out the Breast Cancer News blog my DH runs called Keeping Abreast. It is at:

http://www.jbryant.org/bc/blog_bcnews

Mia

Posted 2/14/2006 1:08 AM (GMT 0)
Marianne -- I had the EXACT same pathology report as you did, which I received 2 weeks ago.  My surgery was on January 19th.  I am waiting for the results of the Oncotype dx test -- should come in any day now, in order to determine whether I should add chemo to the recommendation that I have tamoxifen with lupron (for ovarian suppression).  I am also 48 years old.  How did you reach the treatment decisions that you made?  What did the oncologists recommend?  Thanks!  Susan

Posted 2/17/2006 7:49 AM (GMT 0)

Hi Susan,

So we have twin tumors.  LOL!  Can't wait to hear your OncotypeDx test score.  Please post it when it comes in. 

Following standard protocol, my oncologist first recommended chemo but said the decision was ultimately mine.  He gave me the "chemo talk" but seemed to be talking me out of it at the same time.  I left the office a bit confused.  Seems the reason for the chemo talk was because of 2 millimeters, other prognostic indicators were good.  Honestly, I did not want to do chemo.   We talked about the Oncotype test and I agreed to do it.  I was the first one at this hospital to have it done. 

In the meantime, I did a lot of research and talked to as many women who had been through breast cancer as I could.  And I read through so many posts on the breast cancer websites.  Although I didn't want chemo, I also didn't want to be stupid and not have an open mind.

The OncotypeDX score validated my decision not to do chemo. The day the results came in, my oncologist called and said no chemo.  I let out a big YIPPEE!

Each situation is unique and everyone looks at the benefit/risk ratio of chemo differently.  The few percentage points it gave me wasn't worth the risks to me.  Will I regret my decision if the bc comes back?  Absolutely not!  I know there are no guarantees no matter what you do. 

Here's hoping your score is a low one.

Marianne

I feel like I should put a disclaimer on this post stating I'm not advocating not doing chemo for everyone with Stage 1 breast cancer.  The decision needs to be based on pathology, age, and so many other factors.

Posted 2/17/2006 8:04 AM (GMT 0)
Susan,

Now I'm curious about your pathology.  We really have the EXACT same pathology report?  Here's mine again.  I had a lumpectomy and SNB, did you?

1.2 cm. IDC, Stage 1, Grade 2; Nottingham Score of 6 (mitotic count - 1; nuclear pleomorphism - 2; and tubule formation - 3)

highly ER/PR + 90% for both

HER2 -

low s-phase  (I believe mine was 2%)

Ki-67 showed low proliferation rate

diploid tumor

no necrosis, no vascular, no perineural and no lymphatic invasion

node negative 

Marianne

 

Posted 2/17/2006 11:18 AM (GMT 0)
Hi Marianne -- the only difference is that my Estrogen receptor is positive 95, other than that, it is an exact match, including the grade and our age.  Still waiting for the results of the oncotype dx test.  I've seen two oncologists -- very prominent in their field -- one from Hackensack Hospital, in NJ -- known for agressive treatment....pushing four founds of AC together with ovarian removal and arimidex -- and one who only specialized in breast cancer from NY Presbyterian....she favors only hormonal therapy with ovarian suppression. (starting with tamoxifen).  The oncotype dx test will be the great decider........

Posted 2/17/2006 10:39 PM (GMT 0)
Susan,

Please keep me posted on your Oncotype score and what you decide to do.  I'm interested on how different such similar tumors might be. 

This is such a difficult time when so much is being thrown your way and there are so many decisions to make.  I was diagnosed last Valentine's Day and it really does get easier as time goes by. 

Marianne

Posted 2/17/2006 10:57 PM (GMT 0)
Thanks, Marianne, I will certainly let you know.  I am assuming your score was low, and that you chose not to do chemo.  Right?  My doctors are recommending ovararian suppression with tamoxifen -- is that the therapy course you are doing?

Posted 2/26/2006 2:18 AM (GMT 0)

:-)   Hello everyone,

I havent posted in awhile but just wanted to update everyone. I got the results of the Oncotype DX test and I scored very low... No chemo!!!!!!!!!. YEAH!!!!!  I just have to do radiation. I have already done the simulation and should start Rads next week. I almost qualified for the excelarated rads where you go 2x per days for 5 days but the tumor bed is too close to my chest wall and lung and onc did not want to take a chance at damaging them.

I do have a questions about rad... how do you handle the not being able to shave? Will the rads stop the hair growth? I also worry alot about getting tired during treatment. I need to work in order to keep up with the bills and cant afford to go on disability pay. Does Rads make you tired like chemo does? Also, how burned and swollen will my breast get? I am very fair skinned. Thank you for any answers you can provide for me

        Meg

Posted 2/26/2006 6:43 AM (GMT 0)
Meg,

Great news.  Congratulations on the low score!  If you don't mind me asking, how low of a score was it and what was your pathology.  I like asking this question because it shows how very similar tumors can be so different.

Rads wasn't too bad at all.  I did get tired but more towards the end of treatment.  It's a cumulative effect so it catches up with you in the end.  Everyone I know who went through it had no problems continuing to work.  My guess is you'll find yourself going to bed a bit earlier as time goes on.  As far as the burn, everyone handles it differently.  I didn't burn til the end.  Just do what they tell you do.  In my case, they had me using fresh aloe (peeled and then put into a blender to make it liquify it).  I was also told not to use deoderant or scented soaps.  As far as not shaving, that part was difficult for me but you just sort of grin and get used to it.  I did not lose my underarm hair. 

Good luck on the final leg of the journey.  I'm sure things are going to be just fine.  Keep us posted.

Marianne

Posted 2/26/2006 6:54 AM (GMT 0)
Susan,

Sorry I missed your last post. 

You're correct, I chose not to do chemo because of my OncotypeDx score.  I am doing the Tamoxifen but not the ovarian supression.  The oncologist mentioned the latter to me but never pushed very hard for me to do it.

Keeping my fingers crossed that all goes well.

Did you get your Oncotype results yet? 

Marianne

 

Posted 2/26/2006 2:04 PM (GMT 0)
Great news, Meg! What a relief! Good news is always very welcoming!!!!!

Laure'
Posted 2/27/2006 4:30 AM (GMT 0)
Hi Marianne -- Believe it or not I STILL haven't received my Oncotype results yet....and it's been 4 weeks.  Not because the testing is slow, but I found out on Thursday that my breast surgeon had NOT submitted the correct paperwork for the test.  As you can imagine I was livid to find out that she had received three phone calls from the pathology department advising her that the paperwork needed to be resubmitted, but she did not respond to their repeated requests.  When I confronted her with this information, she said that even though I had signed the consent forms in her office, it was my oncologists responsibility to send through the paperwork to inititate the test.  A classic case of "he said, she said" -- and I'm the one who is suffering!  I now must wait ANOTHER 10 days to get the results, and I can't begin treatment of either radiation or chemo until the results are in -- seven weeks after my surgery.  I am so angry!  And to add insult to injury, she was completely unapologic and unsympathetic to the situation, taking a very defensive position that it was not her fault!  So, I wait.....  What was your number?  Does it matter what the number is, as long as it falls into the low or intermediate range?  Thanks!  Susan
Posted 2/27/2006 7:53 AM (GMT 0)

Hi Susan,

That is terrible news!  What your surgeon says doesn't quite make sense to me.  If it was the oncologist's responsibility as she claims, then why did she get involved in the first place.  Seems she should have let the oncologist handle all of the details.   I can see why she was defensive considering they recommend starting treatment within a certain time period after surgery.  By the sound of it you still fall within the time frame but still, her actions are totally unacceptable.

The recurrence score range is 0-100.  Each score correlates to an average rate of distant recurrence at 10 years (given as a percentage).  For example, my score was 17 and the average rate of distant recurrence at 10 years is 11%.  I was hoping for a lower score but am happy I fell into the low range.

I'm sorry you had to go through this ordeal.  Hopefully, the next ten days will fly by.

Hang in there,

Marianne

Posted 2/27/2006 12:53 PM (GMT 0)
Thanks, Marianne -- I will let you know about my results when they finally come! The waiting is so difficult -- I am ready to begin my treatment! Thanks for your support! Susan
Posted 3/8/2006 6:21 AM (GMT 0)
Hi Susan,

Waiting is difficult but it should almost be over.  You should be getting the results any day now.

Marianne

Posted 3/8/2006 6:31 AM (GMT 0)

Hi Marianne -- thank you so much for your continued interest and concern.  I am in Dallas now speaking at an industry conference, and I just received the results as the plane was pulling away from the gate!  The score was 19, and my very conservative onclologist is now advising that I can skip Chemo and go directly to radiation and hormonal therapy -- and add ovarian removal.  That should do it!  I'm so thankful that I don't need to undergo the stress of chemo!  Thanks again for your support!  Susan

Posted 3/8/2006 7:59 AM (GMT 0)
Susan,

So glad you finally got your results.  I'm breathing a big sigh of relief right along side you.  Seems our very similar tumors got similar oncotype scores as well.  I was a 17.

Good luck with the rest of your treatment.  Radiation isn't so bad just time consuming.  And remember, if you have any questions or just want to talk let me know. 

Marianne

Posted 3/8/2006 5:50 PM (GMT 0)
Susan

Great news on your Oncotype DX test !!!!!! I scored 18 on mine. Radiation is not bad at all. I am in my 2nd week of radiation and so far so good. It only takes about 10 minutes in total time and everyone is great at the hopital where I go. I am also on Femara and have had no side effects. Keep me posted on your progress and keep your chin up. The time will pass quickly..

Meg

Posted 3/9/2006 2:12 AM (GMT 0)
Like MK, I am an old timer and didn't have that battle to fight because the test didn't exist. However, I did decide to have genetic testing done a couple of years back, and insurance only needed a letter from onc saying she thought the test was medically necessary. Even though it was out of network, I got the insurance co. to pay in-network price because the test was not avialable in-network.

I asked for a pre-cert on the test and fought my battles before I got the test, so that made it a bit easier. Guess you don't really have that option here.

Good luck, and hope you get good results.

Hugs...
BEV
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