Was your Oncotype test covered by insurance?

BioAdoptMom
BioAdoptMom Member Posts: 358
in Breast Cancer #1
Just wondering if your oncotype testing was covered by insurance? It is likely that my onco will suggest this (stage 1, grade 3, hormone receptor+, HER2-). So, if you don't mind sharing, please tell me the type of insurance you have (or had) and whether or not it was covered, also was it covered completely or partially?

Thanks!

Nancy

Comments

  • tigger99
    tigger99 Member Posts: 44
    #2
    I have Blue Cross Blue
    I have Blue Cross Blue Shield and the type of plan we had covered 0 out-of-network costs and they considered Genomic Health (the company that holds the patent for does the test) to be out of network. So initially they would not cover the test but after a letter-writing campaign by my doctors, my employer's benefits department, and me, they agreed to cover it in full.

    My oncologist gave us copies of medical journal articles showing that the Oncotype test is and has been a "standard of care" for years. The letter writing appeals process was well worth it.
  • csr771
    csr771 Member Posts: 117
    #3
    Insurance
    I have the UPMC Health Plan. I don't know if this is national insurance or local. I live in Pittsburgh, PA. The Oncotype DX test had to be pre-authorized by my health plan and was completely covered.
  • disneyfan2008
    disneyfan2008 Member Posts: 6,583 Member
    #4
    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise
  • padee6339
    padee6339 Member Posts: 763
    #5
    tigger99 said:

    I have Blue Cross Blue
    I have Blue Cross Blue Shield and the type of plan we had covered 0 out-of-network costs and they considered Genomic Health (the company that holds the patent for does the test) to be out of network. So initially they would not cover the test but after a letter-writing campaign by my doctors, my employer's benefits department, and me, they agreed to cover it in full.

    My oncologist gave us copies of medical journal articles showing that the Oncotype test is and has been a "standard of care" for years. The letter writing appeals process was well worth it.

    Not covered......
    Mine was not covered by my insurance (United Healthcare), but the lab itself picked up the entire cost of the test. It floored me as the test (back in 2008) was over $3,000.
  • laughs_a_lot
    laughs_a_lot Member Posts: 1,368 Member
    #6
    coverage
    So far I have not gotten a bill from Mayo clinic for the FISH test for Her2. I did get a bill from radiology for those tests. I had a high dedutible and was within $80 of meeting it the day I went in for my lumpectomy. I have Priority Health which is a regional insurance in the state of Michigan. This is supposed to be good insurance but the company keeps dumbing down our coverage each year to keep the employees from having a fit over the premium. However then we end up with higher decuctibles and co pays.
  • roseann4
    roseann4 Member Posts: 992 Member
    #7
    disneyfan2008 said:

    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise

    Mine was covered as out of network.
    There is only one lab in the country that does that test and it does not have an in network relationship with my carrier. I have Anthem. At first they only paid 1,000 of the charge but the lab contested it for me and I only had to pay 800 of the cost. I think it costs 3,000. The people at the lab will help you by making payment arrangements for your cost if any. They also have payment assistance if someone can't afford it.

    Roseann
  • csr771
    csr771 Member Posts: 117
    #8
    disneyfan2008 said:

    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise

    Oncotype Testing
    The oncotype DX test uses a sampling of the removed breast tissue to provide scores which predict the likelihood of a recurrence of cancer as well as the benefit of chemo therapy as a therapy. Oncotype tests are generally suggested for stage 1 or stage 2 IDC that is hormone receptive with no node involvement.
  • csr771
    csr771 Member Posts: 117
    #9
    disneyfan2008 said:

    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise

    Oncotype Testing
    The oncotype DX test uses a sampling of the removed breast tissue to provide scores which predict the likelihood of a recurrence of cancer as well as the benefit of chemo therapy as a therapy. Oncotype tests are generally suggested for stage 1 or stage 2 IDC that is hormone receptive with no node involvement.
  • csr771
    csr771 Member Posts: 117
    #10
    disneyfan2008 said:

    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise

    Oncotype Testing
    The oncotype DX test uses a sampling of the removed breast tissue to provide scores which predict the likelihood of a recurrence of cancer as well as the benefit of chemo therapy as a therapy. Oncotype tests are generally suggested for stage 1 or stage 2 IDC that is hormone receptive with no node involvement.
  • csr771
    csr771 Member Posts: 117
    #11
    disneyfan2008 said:

    oncotype testing? unsure what that is!
    So far I have only paid co pays for check ups in office...never for tests or exrays, surgery etc..but UNsure what type of test you are talking about..

    I have empire blue cross in NYS

    Denise

    Oncotype Testing
    The oncotype DX test uses a sampling of the removed breast tissue to provide scores which predict the likelihood of a recurrence of cancer as well as the benefit of chemo therapy as a treatment. Oncotype tests are generally suggested for stage 1 or stage 2 IDC that is hormone receptive with no node involvement.
  • Double Whammy
    Double Whammy Member Posts: 2,832 Member
    #12
    laughs_a_lot said:

    coverage
    So far I have not gotten a bill from Mayo clinic for the FISH test for Her2. I did get a bill from radiology for those tests. I had a high dedutible and was within $80 of meeting it the day I went in for my lumpectomy. I have Priority Health which is a regional insurance in the state of Michigan. This is supposed to be good insurance but the company keeps dumbing down our coverage each year to keep the employees from having a fit over the premium. However then we end up with higher decuctibles and co pays.

    Mine was covered
    and I'm glad it was because I was really on the fence about chemo and I don't think my oncologist was expecting me to be in the high risk range for recurrence.

    Suzanne
  • cindycflynn
    cindycflynn Member Posts: 1,132 Member
    #13
    Mine was covered
    I have Anthem Blue Cross/Blue Shield coverage in CA.

    They did deny the claim at first, but the lab took care of providing additional information and it was then covered.
  • lori1961
    lori1961 Member Posts: 56
    #14
    Hi Nancy, I have military
    Hi Nancy, I have military insurance and the Oncotype test was not covered. They called me and told me it was not after they drew my blood and told me it was a $4,000.00 test. They were very nice and said that they would submit my claim thru my insurance and would rebut it if it came back not approved. They also stated that they have a finanacial assistance program and they will send you paperwork to fill out on how much you make and if you make under $110.thousand dollars a year, they should pay for it. I am still waiting to hear if I qualify but hopefully it has been taken care of. Hope that helps.
    Lori
  • sbmly53
    sbmly53 Member Posts: 1,522
    #15
    Yes, mine was covered
    My husband works in a local school, his ins covered me. PM me if you want to know his insurance. The Onco people offered help if we weren't covered. Because of my low score, I opted out of chemo. I know that many would not have.

    Sue
  • lizzie17
    lizzie17 Member Posts: 548
    #16
    yes
    covered, and Humana
  • kya911
    kya911 Member Posts: 157
    #17
    lizzie17 said:

    yes
    covered, and Humana

    Athem Blue Cross Preferred (HMO)
    The told me they would cover it but after it was done they would not pay $4,000 it cost.
    The company doing the test is in letter stage.Oncotype people told me not to worry as I would not be charged a dime.
  • survivorbc09
    survivorbc09 Member Posts: 4,374 Member
    #18
    roseann4 said:

    Mine was covered as out of network.
    There is only one lab in the country that does that test and it does not have an in network relationship with my carrier. I have Anthem. At first they only paid 1,000 of the charge but the lab contested it for me and I only had to pay 800 of the cost. I think it costs 3,000. The people at the lab will help you by making payment arrangements for your cost if any. They also have payment assistance if someone can't afford it.

    Roseann

    My insurance would have paid
    My insurance would have paid for it if I would have wanted it, but, I declined to have it done. Roseann is right, contact Anthem and see what type of arrangements you can make. They may even cut the cost for you.


    Jan
  • BioAdoptMom
    BioAdoptMom Member Posts: 358
    #19
    Thanks everyone for the
    Thanks everyone for the helpful responses and great advice!

    Nancy

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