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Oncotype DX Test and Insurance

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Posted 7/6/2006 4:12 AM (GMT 0)
Hi Everyone,
I have not posted in awhile and wanted to update everyone. Well the good news is that I finished rads in April and I am feeling pretty good. I am getting my energy back and have had no side effect from the Femara.
Remember when I was sooo happy about Avmed paying for the Oncotype DX test??? .... well I got a denial letter from Avmed saying they will not pay for the test because it is classified as "experimental". Gemomic Labs is appealing for me so please keep your fingers crossed for me. I will mentioned that United Healthcare and Premera Blue Cross have paid for the tests (thank you Jean and MiaB) and maybe that will help. If anyone else has had the test paid by insurance or have any advise on the appeals process please let me know. I will keep you posted on my saga.
Hugs to everyone
Meg
Posted 7/6/2006 4:59 AM (GMT 0)

Hi Meg,

I have United Healthcare (Florida) and they covered 70% of the cost of the OncotypeDx test as an out of network provider.  Mind you that was after all the appeals.  Genomic Health appealed United's decision not to cover the test and I made my own appeal as well.  One thing that seemed to help was a letter from my doc stating the importance of the test for my situation.  It takes time but don't give up.

Good luck!

Marianne

Posted 7/6/2006 9:59 PM (GMT 0)
Marianne,
Thanks for the information. I see the onc on 8/23 and will ask him about writing a letter for me. He should have some pull since he is on the Cancer Center Board of Directors at Memorial Hospital in Hollywood,FL. I have not heard anything back from Avmed about my 1st Level appeal so hopefully "No news is good news!! " I have googled Oncotype DX and found serveral articles which I will include in my personal letter to Avmed. I really hope Avmed pays it all but even if Avmed agrees to pay a percentage, I would be happy. If I was older and on Medicare I would be home free because Medicare I heard pay for the test but I am only 47 so I'll just have to fight it. I am Irish and us Irish know how to fight!!!!!! I will keep you posted. Thank you again for the information.
Meg
Posted 7/7/2006 2:33 AM (GMT 0)
Meg,

Again, good luck!  Persistence pays off when dealing with the insurance companies.  BTW, I'm in Ft. Lauderdale.  We're almost neighbors.

Marianne

Posted 1/28/2007 5:04 AM (GMT 0)

I finally got my wife's insurer (Regence Blue Cross of Oregon) to pay for her Oncotype test, but only after going through three appeals (the last to an Independent Review Organization).  Regence said it was excluded as experimental or investigational.  The IRO reversed the insurer, relying heavily upon the fact that the TailorX study essentially takes as a given the fact that Oncotype has been shown to predict the lack of benefit of chemo for those with RS less than 11.  The link to a NIH document discussing TailorX and the validity of the Oncotype test is here: 

http://www.nih.gov/news/pr/may2006/nci-23.htm.

The brief I submitted in my appeal to the insurer didn't mention TailorX, but bolstered the findings of the IRO.  My brief is too long to post, but if you want a copy email me at [email protected] and I will send it to you.

Good luck, and don't them run you over! 

Posted 1/28/2007 7:49 AM (GMT 0)
Thanks for sharing the great news  Your persistence paid off.  I'm sure your info will help many others.

 

Posted 1/28/2007 1:36 PM (GMT 0)
In case you hadn't heard, Aetna and United Healthcare have both now agreed to pay for the test. OncoType's stock jumped quite a bit on that news, but most importantly, it gives women definitive test to be sure chemo will be worthwhile. Now that the big insurers are jumping in, so to speak, others will surely follow!

Lauré
Posted 2/5/2007 9:49 PM (GMT 0)

Hi,

I just had the OncotypeDX test in late December and did not ask my insurance company if they would pay for it.  My Blue Cross Blue Shield of IL did however pay 60% of it without question.  I'm not concerned about the other 40% because I had agreed to be part of a research study prior to the test and they said the Oncotype would be free of charge for participating.  I'm glad the insurance company paid some to help continue with the research.  BTW, i got a 9 on my test so NO CHEMO FOR ME!  I just finished my 19th rad and look like a lobster and feel like scrathing all the time.  After that I have 7 years of hormone pills.  It beats the alternative however.  Hope everyone is doing well.

NancyJean

Posted 8/22/2008 9:27 AM (GMT 0)
My Aunt had suffered from Breast Cancer. She had four operations in her breast but also there is no use of that. Because Now she was no more. I don't think breast cancer is a curable disease because i lost my aunt.. Its a Big Loss for us.
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rosesmith

Alaska Drug Addiction
Posted 11/25/2008 12:39 AM (GMT 0)
Well, despite that cheery August reply, I just wanted to say thank you to the rest of you for your ideas regarding how to get the insurance company to pay for the test.  Blue Cross/Blue Shield of Illinois has only paid a small portion of the cost, saying that I used an out of network provider.  I don't understand their logic, since to the best of my knowledge, Genomic Health is the only provider of the Oncotype DX test.
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