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insurance won't pay for assay

froggy1
Posts: 208
Joined: Nov 2008

I recently had an assay done from surgical tissue. My insurance has denied coverage. It is a large sum of money. Has anybody else experienced this? I am wondering if this has any worth at all, after reading some of the info on the internet.

2timothy1 7's picture
2timothy1 7
Posts: 331
Joined: Jan 2012

I recently got a letter saying my insurance (BCBS) is denying my test as well. It is being appealed. Any ideas on the cost? My letter did not say.

jazzy1's picture
jazzy1
Posts: 1387
Joined: Mar 2010

I had this procedure done, which at time had no clue it was even completed during surgery. I received a bill from an "unknown" company for something like $6K....I flipped out. Called both my radiologist and OB oncologist, and found the oncologist office said to wait it'll usually get paid. After receiving one more bill, that was the end of it.

I'd suggest calling your oncologist as possibly they can direct you. Almost as if my doc knows magic and it simply disappears????? Wishful thinking, but all I can figure out. Just happy I didn't have to pay that big bill, and yes it's so worth getting this testing.

Good luck my friend~
Jan

kayandok
Posts: 1223
Joined: Jun 2008

I had 2 chemo essays after my last surgery, I had in August of 2011. I have no insurance in the US and was covered by ?????? and the other I paid $250. In any case, I agree with Jan, call your onc, or beter yet his secretary. The two labs were Precision (came back right away and covered mostly chemo and hormon stuff- short and sweet). The second one, covered hundreds of stuff, and although nice to read, I only needed chemo, hormon and VEFG (determines whether avastin is helpful or not). It took about a month, which was way too long. But, they did it for no charge - someone must have to suck this up, I don't know who......

The first surgery, in 2007, I was billed for $10,000 by a company no longer in business! I ended up negotiating it down to $5000, and only paid $2000 or so. (To my luck, the business was bought out, the new owner never sent us a bill, go figure.....)

Hope it gets resolved soon, Froggy!
kathleen

froggy1
Posts: 208
Joined: Nov 2008

Thanks for all the replies. My insurance denied 2500. I haven't started to appeal it yet. In the rush of the moment, my docs office had me sign a blank form, saying I would pay for it if my insurance didn't. It is interesting how different the stories are about payment.
I have read a lot of negative about these tests and wonder if they are really worth it.

kayandok
Posts: 1223
Joined: Jun 2008

Did the onc order it or did you? Did they let you know how much the cost would be that you would have to cover? That form is can't be a legallly binding thing if there is no cost on it. Are you back in the US?
K❤

froggy1
Posts: 208
Joined: Nov 2008

The Doc took the specimens during surgery, but held the processing until I signed the form saying the cost could be from 0-4500.
I was under a lot of stress and should have asked more questions. It seemed highly unethical to me.....I am in the US

jazzy1's picture
jazzy1
Posts: 1387
Joined: Mar 2010

Just found the billing sheet from my insurance and company charged me $6000 and kicker, out of network...yikes! My notes from calling my oncologist "don't worry, I won't be billed" and may receive a check from this company. Never did receive a thing in mail in form of check, just the statement. Company they used is "PRECISION THERAPUTIC INC", noted -- SERVICE DENIED.

Surely don't like idea that you signed something with no clue what it was about...not fair! They'll try to use that one against you. File a claim...keep trying as eventually you'll get lucky and stumble upon some area that holds success for you.

Sorry you're going thru this...
Jan

froggy1
Posts: 208
Joined: Nov 2008

Thanks for the reply. It is the same company. I'm not sure who to approach first. My Doc's office just seems more interested in money these days than cancer, sad....

garden gal
Posts: 212
Joined: Nov 2010

for this assay.Called my insurance and Dr and was told it was submitted wrong, went through the insurance again- paid in full. Kathy

whiterose
Posts: 89
Joined: Jan 2012

My insurance company denied this test as well. I didn't even know what it was for at the time, but have since researched it. Someone from the assay company called me and sent me a form for them to re-submit the bill to the insurance company. Seems the bill was for about $4-5,000. Haven't heard anything since, it's been several months. They also told me that they would charge me a "compassionate rate", not the full amount, if the insurance company didn't pay. This is a good test, since it tells the oncologists what chemos are likely to work for you. However, many feel it's still in the experimental stage, which is why the insurance co.'s sometimes balk at paying for it. Keep re-submitting!

gdpawel's picture
gdpawel
Posts: 545
Joined: May 2001

For those wanting to appeal their insurance denial, there is a gracious woman on the Inspire ovarian cancer board (Tibet) who may be able to help you out. Her private insurance company denied her assay test reimbursement. I gave her what information I had and she personalized an appeal presentation. She was so good, on the way home from the appeal with about a dozen people (a lot were doctors), she received a cell phone call. They unanimously approved her reimbursement. They couldn't understand why this testing wasn't used and used widely. She has volunteered her services to anyone who would ask. You may want to make a Friends Request to her.

froggy1
Posts: 208
Joined: Nov 2008

Thank you Greg for the info. I am waiting on an appeal to the insurance company from Precision. My charge was $2500.00. I'm not
sure the information was worth it.....

gdpawel's picture
gdpawel
Posts: 545
Joined: May 2001

Froggy

I can understand. There are two conceptual weaknesses about the ChemoFx assay. The fact that they are amplifying cells outside of the body, results in a subpopulation selection. The other is 2D (two-dimensional) analysis. They plate cells in monolayers, then grow them to confluence (stop growing), and then add the drugs. It's a better assay to be used for the purpose of drug "de-selection" and not for drug "selection."

I think a better way is to get an ice could tumor (fresh), straight from the patient (just as good as an ice cold kidney, straight from the patient). And then isolate 3D (three-dimensional) cell clusters, straight from the tumor, exactly as they are in the patient, add the drugs shortly after the tumor is re-warmed to body temperature, and then measure whether the drugs kill the tumor, in comparison with extensive databases of tumors with similar characteristics ("apples to apples" comparisons). It's not that ChemoFx is wrong, it's just that it is not as "accurate" as 3D analysis.

If you do not get a favorable appeal, still contact Tibet on the Inspire ovarian website. She used to work for those guys and she knows ways to get around the bureaucratic red-tape.

Greg

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