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Topic: Direct Bill from Oncotype? Anyone?

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Aug 20, 2020 12:40PM

kathabus wrote:

Hi--Has anyone had this test denied through your insurance? And you just had to pay?

Curious how they direct billed this for others.

I haven't gotten a bill yet, but I would like to know what I'm looking at. Thanks.

43 Years Old, Oncotype DX 10 Dx 2/17/2020, IDC, Right, 2cm, Stage IB, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 3/23/2020 Lumpectomy; Lymph node removal Radiation Therapy 5/14/2020 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/20/2020 Prophylactic ovary removal Hormonal Therapy 8/20/2020 Femara (letrozole)
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Aug 20, 2020 02:42PM Hopeful82014 wrote:

Kathabus, your best approach is to simply call the company directly and speak with a patient assistance agent. Numerous companies have arrangements to write down the cost of their tests if insurers refuse to pay. My insurer is rather old school (still considers Oncotype "experimental" and thus wouldn't cover it) and quite rigid but in the end I've never paid out of pocket for those tests.

Don't feel awkward about calling - they deal with such questions all the time and are generally quite helpful.

Dx IDC
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Aug 20, 2020 08:24PM MinusTwo wrote:

The other thing to remember - sometimes things are denied because the billing code is wrong. Sometimes human error, sometimes medical code changes. Check back and make sure they got the correct diagnosis when ordering the test.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Aug 20, 2020 10:48PM kathabus wrote:

Thank you for the thought. Unfortunately it was really denied. My BS did a peer to peer evaluation with one of their doctors. I’ve gotten all the letters stating it was denied. I’ve appealed and gotten those denial letters. It’s been an ordeal. They felt I should have not gotten the oncotype and just did chemo. (I avoided chemo because of my result!) I think Genomic Health will fight it out with them now...I’m just trying to find someone who was direct billed in the event it gets to that. Just curious. That’s all.

43 Years Old, Oncotype DX 10 Dx 2/17/2020, IDC, Right, 2cm, Stage IB, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 3/23/2020 Lumpectomy; Lymph node removal Radiation Therapy 5/14/2020 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 7/20/2020 Prophylactic ovary removal Hormonal Therapy 8/20/2020 Femara (letrozole)

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