Genetic Testing/Insurance

Hi Sandy,

I had the genetic testing and the insurance company covered it, BCBS of SC through USAirways. However, I did get it approved first. In order to have it approved, there was a number, a percent, that was created for my likelyhood of having inherited it. I have four daughters, and two granddaughters, and I worried for their safety. I, fortunately, did not carry the gene. I would die if they had sent me a 3000.00 bill. I would have to file bankruptcy or something. I am so sorry.

Jan

Sandy, you too may still benefit from this experience. Don't be bullied. Exercise every right you have first.

Since Myriad Labs said they'd checked with your insurance and that the testing WOULD be covered, I'd get a statement from them, in WRITING, to that effect. As detailed as possible: who called your ins., date, etc. and with whom they spoke at your insurance company. Anyone making such ins. verification calls should have recorded this info, either in your file or into the computer, so it shouldn't be difficult for them to provide this. If they refuse, note this in your letter, together with the person's name who told you they'd "checked".

It would appear that the bottom line, is that the lab people and/or your insurance people seriously screwed up and now they're asking you to pay for their error(s). I wouldn't pay a single penny without a fight.

Next, I'd write a letter, explaining what happened and attach a copy of the bill from the lab. I'd mail this, together with the written statement from the lab, to your State Insurance Commission. They should be able to help you get the bill greatly reduced or forgiven altogether.

You should be able to find your State Insurance Commission listed in the Government section of your phone book. When you call to get their mailing address, also speak with a representative and briefly explain the circumstances and the rep
will let you know if you need to send any additional documentation. Just to be on the safe side, send everything Certified Mail, return receipt requested. That way, you know they received it and when. Hold onto that receipt for your records.

These kinds of things SHOULDN'T happen and it doesn't seem that it should reasonably be your responsibility, on any level. All communication about this was between the lab and your ins. company and since they got sloppy and/or had a huge miscommunication about the details, it's not something you were involved with, so how can you be responsible for it? Since the lab says they got the testing "pre-approved" based upon medical necessity, then how can they now send you a $3,000 bill, with anything resembling sincerity?

You'll likely find the people at the Insurance Commission to be very helpful. Hang in there.
Don't panic. Just put your energy into doing all you can to get this rectified as soon as possible. Keep in mind that the Insurance Commission, as a State agency, can move a bit slowly, but there are guidelines as to how soon they must respond to you, etc.. In the meantime, they will most likely take action to "freeze" the account until it is resolved. Keep in mind that the State Insurance Commission is a powerful entity and they're there to help with just these kinds of unfair, unreasonable situations.

Good Luck!

Love, light and laughter,
Ink

sostendorf said:

I did file an appeal with my insurance company, which was denied. Apparently, I have to file the appeal within 180 days, but while I had Myriad Laboratories checking on the claim for me, the 180 days expired. Now my insurance company says I don't have the right for an appeal because I waited too long. I have sent a letter to the insurance commissioner asking for an external review. Hopefully they will be able to help me. I do have all supporting documents from Myriad Laboratories and from my oncologist. If we have negative results from the insurance commissioner, my husband and I have discussed hiring an attorney. Hopefully it won't come to that. It's just all very frustrating . . . grrrrr! The only good news out of all of this is that the results were negative--very good news for my daughter and four sisters. Although I have a problem trusting the results. I have a friend who has three sisters. All the sister (including my friend) plus their mother and aunt have had b/c. My friend and one of her sisters were tested. My friend's test came back positive, but her sister's came back negative. It seems to me it is blatently obvious that there is a genetic mutation in this family, so how could one be negative? Given the other problems I've had with Myriad Laboratories, I question whether this kind of incompetence occurs in the lab too! Thanks for the support!

Sandy

Sandy, I have also recently had the genetic testing for BRCA1 and BRCA2 through Myriad Labs. My insurance carrier is BC/BS of Michigan. Before having the testing, my doctor's office AND Myriad Labs confirmed with BC/BS that the testing was covered. Because of my medical bills last year, it was to be picked up 100%. Satisfied, I went through the testing. Imagine to my amazement three weeks later when I received a bill from Myriad Labs saying that BC/BS had denied the charges. After a prompt call to my doctor and Myriad, I was informed that it is very normal for BC/BS to deny the charges initially, only to have the claim resubmitted and then accepted for payment. I was informed not to worry about it, and that it would be taken care of...which it was. I'm hoping this is the instance in your case. I would fight the charges if they are now saying they aren't covered.

Like you, my results were negative for BRCA1 and BRCA2, which is most interesting because 7 out of 10 aunts/grandmother/great aunt have all had breast cancer. This just means that I am not a carrier of the gene. However, it was discussed in detail that the testing does not pick up mutations that have not yet been defined by medicine. There are so many different strings of mutations.

Good luck with the insurance...I hope that you find resolution quickly. And, I am thankful to hear that your results were good.

Kathy