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dlaxague · 09-13-2007, 07:46 PM

This is a topic of interest to me right now. I'm in somewhat of a gray area regarding family history. I would like to do the testing (for our daughter's sake, and perhaps that of my ovaries), but insurance will not tell me if they will cover the test until AFTER I've done the test. They say that it's considered a "send out lab" and they do not pre-approve this class of test. So the only way for me to find out if they'll pay is to first do the test and incur the debt. I talked to the nurse at Myriad (the company that's marketing the test) and she said that BC/BS commonly handles it in this manner and that she doesn't know if they'll end up covering it, either.

'Just doesn't seem right. At least if insurance would say "no", I'd know where I stand.

How did those of you who saw a geneticist first go about getting that referral? I'm thinking maybe that should be my next step, as perhaps if the test is ordered by a geneticist (as opposed to my FP doc who is perfectly willing to order it), insurance might be more-likely to cover it? Or my appeal of their denial might be stronger, with geneticist backing.

Debbie Laxague

09-13-2007, 07:46 PM	#4
dlaxague Senior Member Join Date: May 2006 Posts: 221	This is a topic of interest to me right now. I'm in somewhat of a gray area regarding family history. I would like to do the testing (for our daughter's sake, and perhaps that of my ovaries), but insurance will not tell me if they will cover the test until AFTER I've done the test. They say that it's considered a "send out lab" and they do not pre-approve this class of test. So the only way for me to find out if they'll pay is to first do the test and incur the debt. I talked to the nurse at Myriad (the company that's marketing the test) and she said that BC/BS commonly handles it in this manner and that she doesn't know if they'll end up covering it, either. 'Just doesn't seem right. At least if insurance would say "no", I'd know where I stand. How did those of you who saw a geneticist first go about getting that referral? I'm thinking maybe that should be my next step, as perhaps if the test is ordered by a geneticist (as opposed to my FP doc who is perfectly willing to order it), insurance might be more-likely to cover it? Or my appeal of their denial might be stronger, with geneticist backing. Debbie Laxague __________________ 3/01 ~ Age 49, occult primary announced by large axillary node found by my husband. Multiple CBE's, mammogram, U/S could not find anything in the breast. Axillary node biopsy - pathology said + for "mets above diaphragm, probably breast". 4/01 ~ Bilateral mastectomies (LMRM, R simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA ERPR 5%/1% (re-done later at Baylor, both negative at zero). HER2neu positive by IHC and FISH (8.89). Lymphovascular invasion, grade 3, 8/9 modified SBR. TX: Control of arm of NSABP B-31's adjuvant Herceptin trial (no Herceptin): A/C x 4 and Taxol x 4 q3weeks, then rads. Arimidex for two years, stopped after second patholgy opinion.