Oncotype DX test billing

jakeca
jakeca Member Posts: 92
edited March 2014 in Breast Cancer #1
Anyone else out there who has had the Oncotype test and is having trouble with your insurance covering it? Anthem Blue Cross applied it to my Out of Network Deductible, but Genomic (the lab in California that did the test) claims they are the only lab in America that performs this test, so it should not be considered "Out of Network." It's all very confusing and I'm hoping that I don't get stuck with the bill for $3820.00!

Comments

  • JoyD
    JoyD Member Posts: 81
    #2
    Insurance
    Jakeca:

    Prior to doing the Oncotype test did you check with Anthem BC if Genomic is an In-Network provider? If Genomic is not a provider for Anthem BC, then, that is the reason why it will be paid out of network.

    You may want to call the 1-800 of Anthem and see if you they could lower the bill.

    Joy
  • Christmas Girl
    Christmas Girl Member Posts: 3,682 Member
    #3
    Geez...
    No experience. Just chiming in with general frustration...

    Certainly, I'll be hoping this will be resolved with as little $ coming out of your own pocket as possible.

    Frickin' insurance companies!

    Kind regards, Susan
  • Ltalcott
    Ltalcott Member Posts: 119
    #4
    Genomic is indeed the only
    Genomic is indeed the only lab in the country that does the test--if that qualifies for "in-network."

    I hope you can get it all taken care of--last thing anyone needs is an insurance company arguement.

    Lisa
  • cats_toy
    cats_toy Member Posts: 1,462 Member
    #5
    no experience
    I had no experience with that, but I do know you have to push for some of these things to be covered. Hope you can get it done, I also have Anthem Blue Cross and they do like to restrict some of the more pricey testing. Let us know how it works out.
    Cat
  • Kristin N
    Kristin N Member Posts: 1,968 Member
    #6
    cats_toy said:

    no experience
    I had no experience with that, but I do know you have to push for some of these things to be covered. Hope you can get it done, I also have Anthem Blue Cross and they do like to restrict some of the more pricey testing. Let us know how it works out.
    Cat

    What is that test for?

    What is that test for?
  • jakeca
    jakeca Member Posts: 92
    #7
    Kristin N said:

    What is that test for?

    What is that test for?

    test
    They send a sample of tissue from the tumor that is removed and have it analyzed to determine the aggressiveness of the cancer and to predict the chances of recurrence. It helps determine whether or not you should have chemotherapy. In my case, my tumor was of an aggressive nature and chances were good for recurrence so I did decide to do chemo.
  • chili
    chili Member Posts: 32
    #8
    jakeca said:

    test
    They send a sample of tissue from the tumor that is removed and have it analyzed to determine the aggressiveness of the cancer and to predict the chances of recurrence. It helps determine whether or not you should have chemotherapy. In my case, my tumor was of an aggressive nature and chances were good for recurrence so I did decide to do chemo.

    Insurance billing
    Insurance companies can be very frustrating. I was very lucky to have the test covered. I did get information from them that if I had trouble with my insurance, they would advocate for me and work with my insurance company. It may be worth a shot. Hugs and good luck.
  • mgm42
    mgm42 Member Posts: 491 Member
    #9
    jakeca said:

    test
    They send a sample of tissue from the tumor that is removed and have it analyzed to determine the aggressiveness of the cancer and to predict the chances of recurrence. It helps determine whether or not you should have chemotherapy. In my case, my tumor was of an aggressive nature and chances were good for recurrence so I did decide to do chemo.

    Oncotype Test
    I also had the oncotype test, but I did it as part of the trial which ensured the fact that it would be paid for via Medicare. However, when I worked in HR, the question of out-of-network and in-network was a common one. With the companies I used to insure our employees, all said that if there was no in-network provider available, then the out-of-network provider would be paid at in-network rates. It may be that the lab may not accept the discounted rate normally paid to an in-network provider. Pursue this with the insurance company. Speak to higher ups if necessary. Often times the claims analyst is only the first level for claims payment and settlement. Defnitely go up the ladder. Good luck. Marilynn
  • jakeca
    jakeca Member Posts: 92
    #10
    mgm42 said:

    Oncotype Test
    I also had the oncotype test, but I did it as part of the trial which ensured the fact that it would be paid for via Medicare. However, when I worked in HR, the question of out-of-network and in-network was a common one. With the companies I used to insure our employees, all said that if there was no in-network provider available, then the out-of-network provider would be paid at in-network rates. It may be that the lab may not accept the discounted rate normally paid to an in-network provider. Pursue this with the insurance company. Speak to higher ups if necessary. Often times the claims analyst is only the first level for claims payment and settlement. Defnitely go up the ladder. Good luck. Marilynn

    Good advice
    Thanks. I'm working on it.
  • djteach
    djteach Member Posts: 273
    #11
    Dear Jakeca,
    I hope you have
    Dear Jakeca,
    I hope you have the energy to fight them. How dare they not cover the only lab in the country that does the test! If I had the energy, I would help you fight. I do know that they hate to see their company on the evening news as the bad guy! If you live in Calif., call the Att. General, because they are going after health ins. co. If there is anything I can do, let me know.

    Love and gentle hugs,
    Donna
  • lynn1950
    lynn1950 Member Posts: 2,570
    #12
    BC covered my test
    Blue Cross Blue Shield covered my testing last summer. Lynn

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