Topic: Insurance and genetic testing

My insurance wouldnt pay for it....said that I didnt meet their criteria...I dont remember what that was and the report is at home, Im at work.....I do remember they had a list of 5 things that had to be met and I missed it by 1....I was 46 at dx instead of 45...

My insurance paid for it. The laboratory submitted it before they ran the test and I believe that they may have the right staff to pressure the insurance, you may want to check with your lab.

The counselor just establish the % of possible positive outcome and send everything out. It was below 10% but the insurance still approved it. Negative in my case and glad that I know. But since BRAC 1&2 are the only known mutations, there are probably more out there that they aren't testing for yet, they still told me that my daughters will have to get mammos starting at 30.

Good luck, it sucks that you have to deal with that after paying into it, I hope that this system will improve in the near future...

p.s. you may want to find out what they will do in the case it will come out positive, they are so ruthless.

My ins. covered it, as well.  My oncologist said with my history (3 consecutive generations) they shouldn't balk, BUT if they did "I'll go to bat for you against the insurance company - and I *always* win" - his exact words!  It seems like there should be an appeal process, and someone on your team should be willing to help you adovcate for your cause.

Good luck!

Mary

It was recommended to me that I go to a Genetic councelor, by my breast surgeon.(first visit was provided by the hospital at no charge to me)  She went over my history and recommended that I go for the testing.  I was told that her summary and my blood was sent to the lab, the lab in turn contacted my insurance, if there were any out of pocket expense (oop) to me the lab would call and tell me how much and I would have to option to go ahead with it or not.  If there was no oop to me, they would go ahead and do the testing with no calls to me, and then report back to the genetic counselor.  My insurance paid for it.

I am very interested in this conversation.  I am currently having radiation treatments for BC.  My radiation oncologist recommended having the BRAC testing, since my mom was 58 when diagnosed with Stage IV ovarian cancer.  I called my insurance company and they said they do not cover genetic testing.  I do not necessarily need the genetic counseling, just the testing.  Does anyone know the cost of the blood test for the BRAC1/2?  I believe most of the cost is tied to the genetic counselor costs, not the blood test.  I have heard the cost can be as high as $3000 for the counselor/testing. 

Think what this is like for people without heatlh insurance.  Remember that when you vote in november!

I met with a genetic counselor 4/30/08, she assessed my risk and advised I have the test done for BRCA1/2, that I met the national guidelines.  On 5/7/08 I received a call from Myriad saying my insurance has denied the test (I was told they would call if co-payment >300 dollars), they also told me the total cost of the test is $3,120.00.  If I chose to pay out of pocket, the insurance company would probably close any appeals that are pending on the case.  The genetic counselor will start the appeal.  The National guidelines are any woman with cancer diagnosed  =/<50yo and with a primary blood relative with breast/ovarian cancer =/<50.  The insurance company's says their guidelines include only women =/<40 at time of cancer diagnosis and the do not consider my sister as having breast cancer (she had bilateral mastectomies last summer for extensive LCIS in one breast and ADH, ALH, and small amt of DCIS in other breast).

Thanks for the info.  I met with my rad onc today after my treatment and we talked about the insurance coverage.  I told my rad onc that I will work it with my medical oncologist and see what happens.  My sister is a physician assistant and is paying for it out of her pocket ... does NOT want the insurance company to know she is having it done.  And she is a medical professional, how sad is that statement. And yes, remember when we vote in November.  I just wish all the people in Washington faced what the average person goes thru with this crap!

Hi to all,

Did get some good news today.  My genetic counselor spoke with the medical director of my insurance company and was able to get him to approve by BRCA testing.  The counselor focused on the fact my sister did have breast cancer, no matter how small the lesion was and she was 41yo when diagnosed.  The counselor also used the fact that my mother and her two sisters have all died early (35yo,52yo,&56yo) from causes that could have been complications of undiagnosed cancer.   Hope some of this info can help somebody else!

Andrea                             

Good luck to all who are waiting results.  I am definitely planning on fighting my denial from insurance company.  I am thinking of contacting my US Senators to see if there is any additional documentation that I can use to help my case.

Hang in there everyone!!!

Sorry your having a hard time with insurance.  I was denied at first, but my genetic counselor stepped right up with an appeal.  She called the medical director of my insurance carrier and argued my case with him over the phone.  In about a week she called me and told me the test had been approved on appeal and Myriad had started to run the test two days earlier.  I was so impressed with her!  You need to find someone on your medical team that has experience filing and fighting for appeals, the more denials that are over turned, the easier it will be for others to be approved.  Also if your employer heads the insurance program and has another company manage it for them (like Atnea, PHCS, Beech Street etc) You can appeal to your human resources department than handles the insurance.  If they approve it, they will tell the managing insurance company to pay for the test.  Hope this helps!

My mom was dx at age 59 with invasive bc, her sister died at age 37 of Ovarian cancer, she also has uncles with prostate cancer. My mom went to the genetic counselor and they recommended that she get the test. She was ready to pay for it out of pocket. The counselor called her insurance and at first said that it was denied because of mom's age. The counselor called back and told about the sister and uncles with cancer. The insurance then reversed their decision and paid 100% of her test. Make sure that you do have someone knowledgable and they know what to say to help get the coverage.

Mom was brca negative. After my dx, my surgeon (same one my mom had) asked about testing me (dx at age 46) but then asked about my mom's test - he did not have her chart- and since she was negative and no breast/ovarian in my father's side, I decided not to do the test.

Sheila

My Onc referred me to a genetic counselor and my insurance paid for the test. Last week I found out I am BRCA 2 positive. I am having a total hysterectomy on June 27 as I am now at high risk for ovarian cancer. I have a strong family and personal history of cancer. If I had these results last year when I had my first mastectomy, I wouldn't have had a second diagnosis and additional mastectomy. Hind sight is 20/20...

Linda

Andrea,

Great news on your result for the BRCA1 and it's good that they'll watch you closely on the variant.  If I may ask, who's your onc?  I'm in Hurst and go to Dr. Krekow in Bedford.  The reason I ask, I just had my blood drawn and would love to have someone go to bat for me like someone for you did, if my insurance company has issues.

Take Care,

Trish