Navdx and insurance issues

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goffrey
goffrey Member Posts: 41 Member
edited October 2023 in Head and Neck Cancer #1

I have United Health care as my primary insurance and they covered my first 3 Navdx tests with no questions, but the last one I had done in August they have denied. Apparently they have changed their stance on coverage for the test. Navdx is appealing the denial but has anyone else had issues with insurance coverage? Or has anyone used Navdx financial assistance program? I trust this test as my luck with Pet/Ct scans so far as been dismal. Too much artifact on CT scan part to get a clean picture and Pet scan always has uptake.

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  • ProustLover
    ProustLover Member Posts: 120 Member
    #2
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    Funny you should mention it...we just got denial paperwork in mail yesterday (Medicare Advantage Plan through Univera). Unfortunately, husband has had two NavDx tests...the denial was for the first test, (no doubt due to slowness of insurance paperwork pipeline), so second denial will be forthcoming as well. This will total around $3,600. Yikes!!! We'll be taking it up with doctor as first step, since they normally seek approvals before any procedures or tests.

  • goffrey
    goffrey Member Posts: 41 Member
    #3
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    From what I am reading many insurance companies are now balking at paying for this test because it is expensive but so are all the scans and they pay for those. It is so ridiculous when the data is there that shows how accurate this test is! The NIH just did their own study on the test and the results lined up with what NavDx has claimed about reliability and sensitivity.

  • Swoosh13
    Swoosh13 Member Posts: 74 Member
    #4
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    Just received the EOB from our Medicare Advantage plan for my husband’s NavDx in August at NW-Chicago and it was $2,200 and our plan paid all but $35 which is our normal fee for lab costs. I had no idea they were so expensive but grateful we had it done at a nominal cost.

  • Duggie88
    Duggie88 Member Posts: 760 Member
    #5
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    https://csn.cancer.org/discussion/327185/navdx-and-insurance-issues

    Goffrey

    I suggest you appeal their decision and ask your Doctor for a written statement why he wants the test. I was a Trustee on a Teramster Health and Welfare Fund and heard many appeals and we almost always reversed a decision or policy. The biggest problem I saw was health organizations taking advantage of insurance providers which always results in policy changes resulting in patient issues. Good luck in your quest.


    Jeff

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