BRAC Analysis Insurance Trouble

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nicmarie75
nicmarie75 Member Posts: 57 Member
I am attempting to have this Genetic testing done and am running into trouble with insurance. Currently my request in "under review" to see if I meet the "requirements" which they cannot tell me what those requirments are. SO frustrating...I initially called United Health Care and they informed very emphatically that this WAS covered and covered 100% as a preventitive item. So I called my OBGYN who ordered gave me the lab work request, I then went to the network lab I use and he said they didn't do this testing. I then went to the non network lab down the hall that said my Dr. had to request the kit from the ONLY Lab that handles this Myriad. So she requested it and I went to the lab at the hosiptal and had my blood drawn which I paid out of pocket for (40% discount if I did this, was pretty sure UHC would not cover this) Myriad Lab gets my kit and as of last Friday says they were told by Insurance that I did not meet the initial requirements and that they needed a pre authorization request. I have a feeling they are going to deny my lab work and I cannot afford the test out of pocket (my understanding is it is thousands for the full comprehensive, which I need since no family member has had this done) I am trying to be proactive, I understand that if I have the gene I won't positively get BC but Cancer is rampant through my family and I am trying to have all my pieces in place with knowledge of my body. Here is my family history:

Mother ~ DX Metastic Kidney Cancer 41 (died within 4 mo)
Maternal Grandfather ~ DX Parotid Gland Cancer 61 (died within a year)
Maternal Grandmother ~ DX Lung Cancer 69 (early stages, radiation and living, now 76)
Paternal Grandmother ~ DX 49 Breast Cancer (early stages, masectomy only treatment, affected breast only caught early, still living and 80)

Father and Paternal grandfather have Vascular / Heart Disease issues....

Tons of extended family with all different types of Cancer.

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  • linny b
    linny b Member Posts: 25
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    BRAC testing
    Hello, I was also denied twice by my insurance company for BRAC testing, even thou my mother had breast cancer, and I've had it twice and a mastectomy. They said I didn't meet their requirements because I would need two relatives with breast cancer, and my mother was diagnosed at age 69, if she was diagnosed earlier then I might qualify. I could pay for it myself, which would have cost over $500.00, and I just didn't have the money, with all the medical bills I had. Insurance companys will drive you crazy.
  • nicmarie75
    nicmarie75 Member Posts: 57 Member
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    linny b said:

    BRAC testing
    Hello, I was also denied twice by my insurance company for BRAC testing, even thou my mother had breast cancer, and I've had it twice and a mastectomy. They said I didn't meet their requirements because I would need two relatives with breast cancer, and my mother was diagnosed at age 69, if she was diagnosed earlier then I might qualify. I could pay for it myself, which would have cost over $500.00, and I just didn't have the money, with all the medical bills I had. Insurance companys will drive you crazy.

    So sorry
    You would think that your mom having it alone would qualify someone....personally I think that everyone should be allowed this regardless of their family history or age. Look at all the women with BC who have NO family history, or are diagnosed with BC in their 20's or 30's. There are no rules when it comes to cancer. My mom had Stage 4 Metastatic Kidney cancer at 41! With no kidney cancer symptoms. From what I have read that is something for men and in their 60's if you go by the guidelines.
  • mamolady
    mamolady Member Posts: 796 Member
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    Typically to consider cancer
    Typically to consider cancer to be genetic they look for diagnosis prior to 50. It is really tough to get the insurance to cover the test because of the cost. I had the testing and it came back negative even with 3 generations so it wasn't really any help for my kids.

    If you do not have cancer and no one in your family has tested positive, they typically will not do the test. I forget exactly why. The genetic councilor explained it but I was still going through chemo and my brain was a little addled. Since I tested negative they will not test my sister even though she has 2 sisters with BC one at 30 and one at 47. Having the gene would only increase my sisters risk slightly over the strong family history anyway.

    Cindy
  • Gabe N Abby Mom
    Gabe N Abby Mom Member Posts: 2,413
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    The genetics counselor I saw
    The genetics counselor I saw explained that one company currently holds the patent on the test. I think she said the patent is due to expire in 2012. She thought that once that happens the test will become more widely available, less expensive, and shorter response times.

    She also explained that if you test positive, it's no guarantee that you will get cancer. If you test negative it's no guarantee that you won't get cancer. In fact, there are many here with strong family connections to breast cancer who got negative results for BCRA. There are likely other unidentified genetic factors that contribute to the incidence of cancer. (They made me take a class on all this stuff before they would let me do the test.)

    So, in my opinion, regular testing like mammos and pap smears are more important in a proactive approach to cancer than genetic testing. And monthly self exams that include a visual exam are critical.

    After a diagnosis of bc or ovarian cancer, the BCRA test becomes more valuable...again, my opinion.

    Hugs,

    Linda
  • mariam_11_09
    mariam_11_09 Member Posts: 691
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    The genetics counselor I saw
    The genetics counselor I saw explained that one company currently holds the patent on the test. I think she said the patent is due to expire in 2012. She thought that once that happens the test will become more widely available, less expensive, and shorter response times.

    She also explained that if you test positive, it's no guarantee that you will get cancer. If you test negative it's no guarantee that you won't get cancer. In fact, there are many here with strong family connections to breast cancer who got negative results for BCRA. There are likely other unidentified genetic factors that contribute to the incidence of cancer. (They made me take a class on all this stuff before they would let me do the test.)

    So, in my opinion, regular testing like mammos and pap smears are more important in a proactive approach to cancer than genetic testing. And monthly self exams that include a visual exam are critical.

    After a diagnosis of bc or ovarian cancer, the BCRA test becomes more valuable...again, my opinion.

    Hugs,

    Linda

    Thanks for the information.
    Thanks for the information. I am a little in the dark with regards to the BCRA test. I know I was tested and it came back negative. My Onc. said the reason I was tested was because I was under the age of 50 and there had been no family history of breast cancer. I am not sure I get the connection and wasn't in a place at that time to ask questions.

    Nether the less my 12 year old daughter was relieved, not that it means she won't get it but I guess me not having the gene is one less thing to be concerned about. Sad what our young daughters have to go through when we as mother's have breast cancer.
  • Hubby
    Hubby Member Posts: 325
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    If you can tell them that
    If you can tell them that you have Ashkenazi Jewish ancestors, they may be able to approve the testing. For my wife, I basically told them that we weren't sure of the heritage, and they may have been Jewish. This was a fact that I found out doing her family tree. That along with an aunt who passed from breast cancer was enough for them to approve the test.

    It's nice to hear that your grandmother is a 31 year survivor!!!
  • debi.18
    debi.18 Member Posts: 850 Member
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    Hubby said:

    If you can tell them that
    If you can tell them that you have Ashkenazi Jewish ancestors, they may be able to approve the testing. For my wife, I basically told them that we weren't sure of the heritage, and they may have been Jewish. This was a fact that I found out doing her family tree. That along with an aunt who passed from breast cancer was enough for them to approve the test.

    It's nice to hear that your grandmother is a 31 year survivor!!!

    United Health Care
    I have United Health Care and they covered my BRAC test. My maternal grandmother and aunt both had BC, my brother had brain cancer (all are healthy now). My aunt was diagnosed before age 50 which I think might have had something to do with it.

    Good luck!

    Hugs, Debi