This is my first post however I've been reading and learning since my IDC diagnosis in Oct 07. Since then I've had bilateral mastectomies with expanders followed by implants in March 08. I have been very fortunate to have had no problems throughout this ordeal except for my insurance company refusing to pay for the onco type dx.
My questions to all of you are:
1. If you had the test, did your insurance company pay for it?
2. If they did pay for it, was there a negotiated payment?
3. If there was a negotiated payment, would you share with me how much the insurance company paid?
My oncologist recommended chemo but after my onco type dx score came back at 9, we decided that is was not necessary. i think I saved the company a bundle by not having chemo but so far they've denied my appeals.
Thanks for your help!
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nash Joined: May 2007 Posts: 1197 |
May 16, 2008 02:07 pm
nash wrote:
Congrats on your low score--that's great! I looked at my EOB to see what my PPO paid for Oncotype, and realized that they denied the claim b/c Genomic Health didn't file the claim in a timely manner (had the test done in August, Genomic Health billed my insurance in February). I haven't heard anything from either the insurance or Genomic Health since then. I assume they're working on it between themselves, and I assume my PPO will eventually pay for it. They have paid on proprietary test provider claims before, and they just treat it as in-network and charge me 10% of a negotiated discounted amount after I've met my deductible. I realize that this info doesn't answer your questions, but I guess my point is that Genomic Health deosn't appear to be terribly anal about their billing. Have you talked to them about your appeals being denied by the insurance? Seems that they must be used to this sort of thing. Dx June 2007, age 38, Stage IIa 2.7 cm pleomorphic ILC, ER+/PR+ HER2-, CAFx6, rads, tamox
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wishiwere Joined: Dec 2007 Posts: 1467 |
May 16, 2008 02:58 pm
wishiwere wrote:
Mine paid for mine and there wasn't a cost. At the time (in oct/07), genome was saying that IF the insurance denied payment, they (genome) would appeal it and that regardless of the outcome, there would be NO amount owed by me. I think this has changed, b/c it seems more and more are finding they have to pay or have co-pays or so on. Maybe be/c recently insurances started to pay for it, they expect all too? Not sure. Have you called Genome? Did you do the Trial program, b/c it was in that paperwork also. wishiwere
Dx 9/21/2007, ILC, 1cm, Stage I, Grade 2, 0/4 nodes, ER+/PR+, HER2- |
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Harley44 Joined: Jul 2007 Posts: 2982 |
May 16, 2008 03:22 pm
Harley44 wrote:
srk60, I was very conflicted about the chemo decision, and I ended up going to see a second opinion onc., who contacted his rep from Genomic, and asked if they could help me, since the test is so expensive, and my insurance wouldn't pay. Here is the phone number for Genomic Health: 866-662-6897. Please let us know how it goes. Good Luck! Harley |
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srk60 Joined: May 2008 Posts: 2 |
May 18, 2008 09:49 am
srk60 wrote:
Thanks for all your comments. I have appealed and spoken to Genomic Health. I will have to pay the full cost of the test, which I will. However, it is my opinion that insurance companies should pay for tests that being used in a clinical setting and that physicians are using to make health care decisions. This test has saved my insurance company significant amounts of money because I did not have systemic chemo. The other issue is that an insurance company will negotiate with Genomic Health for a discounted rate and will pay a faction of the charge. As a self pay, I will pay the full cost. This happens every day in health care. Self payers always pay more than insured. |
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:18 pm, edited May 23, 2008 05:22 PM
by lynn2593
lynn2593 wrote:
This Post was deleted by lynn2593.
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:18 pm, edited May 23, 2008 05:24 PM
by lynn2593
lynn2593 wrote:
This Post was deleted by lynn2593.
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:19 pm, edited May 23, 2008 05:27 PM
by lynn2593
lynn2593 wrote:
hello ladies, just wanted to add that genomic health lab called me before they ran the test to inform me my hmo plan said they would pay 100%. i also had b/l mastectomies with immed reconstruction with skin expanders i have opted to finish my implants before chemo as i need to have closure for something my onco agreed i just had my implants put in yesterday and will start tch july as my ps wants to be sure i'm healed and no chance of infection. i am dcis/idc er+pr+her2+3 and -LN and 3rd generation with onco index 43. try speaking with health advocates they are often successful in getting claims overturned. good luck to you all |
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:19 pm, edited May 23, 2008 05:23 PM
by lynn2593
lynn2593 wrote:
This Post was deleted by lynn2593.
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:19 pm, edited May 23, 2008 05:22 PM
by lynn2593
lynn2593 wrote:
This Post was deleted by lynn2593.
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lynn2593 Joined: Mar 2008 Posts: 18 |
May 23, 2008 05:19 pm, edited May 23, 2008 05:23 PM
by lynn2593
lynn2593 wrote:
This Post was deleted by lynn2593.
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