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Decipher Test Cost - What Can I Expect?

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Posted 9/2/2022 12:18 AM (GMT 0)
My doctor ordered a Decipher test post-RALP. My insurance is going to deny this -- what can I expect? What's the latest with the Decipher folks -- are they going to try to skin me alive? Anyone else have good luck negotiating with them?
Posted 9/2/2022 12:27 AM (GMT 0)
How do you know it will be denied? Did you have a pre determination through your doctor? If not, why not? Call decipher and ask them. Why would you consent to a test if you don’t know the cost you might be responsible for?
Posted 9/2/2022 12:34 AM (GMT 0)

JNF said...
How do you know it will be denied? Did you have a pre determination through your doctor? If not, why not? Call decipher and ask them. Why would you consent to a test if you don’t know the cost you might be responsible for?

The doctor did discuss it with me in advance, and I'm aware that the bill for this could be in the thousands. What he told me, however, was that the company has a history of negotiating with patients whose insurance will not cover it. I'm aware that Medicare covers it -- but I'm not quite there yet. I looked it up in my health plan's brochure and it's not covered. I agreed to the test because I felt it was an important part of my treatment plan.
Posted 9/2/2022 3:14 AM (GMT 0)
You should call the company and discuss what the out-of-pocket fee would be. When insurance is denied, a reasonable, fairly small fee can be negotiated. It doesn't hurt to call. Your carrier should have specific guidelines for Decipher test coverage.

If you decide to hold off, the Decipher test may well be covered if at some point your PSA shows signs of BCR. Personally, while it would be nice to know your met-risk category now, I don't think you are looking at a therapy decision right now anyway. The test result would IMO be helpful if your PSA rises and you want to know the exact PSA level that would trigger further treatment (e.g. 0.1 vs. 0.2 or higher).

Djin

Post Edited (DjinTonic) : 9/1/2022 8:18:45 PM (GMT-7)

Posted 9/2/2022 3:25 AM (GMT 0)

DjinTonic said...
You should call the company and discuss what the out-of-pocket fee would be. When insurance is denied, a reasonable, fairly small fee can be negotiated. It doesn't hurt to call. Your carrier should have specific guidelines for Decipher test coverage.

If you decide to hold off, the Decipher test may well be covered if at some point your PSA shows signs of BCR. Personally, while it would be nice to know your met-risk category now, I don't think you are looking at a therapy decision right now anyway. The test result would IMO be helpful if your PSA rises and you want to know the exact PSA level that would trigger further treatment (e.g. 0.1 vs. 0.2 or higher).

Djin

The Decipher test was already ordered (weeks ago) and may have been done by now -- but the results aren't in yet. I have good insurance (retired federal employee), and can always try to call and push back. However, the documentation specifically says that these sort of tests aren't covered. Mainly, I'm curious what others have done. The doctor did tell me that the Decipher folks will negotiate substantially.
Posted 9/2/2022 4:08 AM (GMT 0)
https://decipherbio.com/wp-content/uploads/2021/09/final-what-to-expect-brochure.pdf

Might point you in the right direction
Posted 9/6/2022 8:10 PM (GMT 0)
I consulted with Nathan, direct line to Decipher at the time, 858-322-6122. I never received a bill, so I guess insurance must have paid it. Or it was built into URO billing. Process was done back in February. My risk factor was 0.28, and helped make my decision to go SBRT after MRI fusion biopsy and bone scan, both with contrast, to determine if it metastasized.
You need to go their website, create an account and submit your personal information which will help them determine the assistance factor.
Nathan I believe is in Marketing, they wear multiple hats there, and he answers the phone, or will return your call, and real nice guy.
Good Luck

Post Edited (DBozz) : 9/6/2022 1:40:02 PM (GMT-7)

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