Oncotype: Ins denial

harrie · 07-13-2007, 01:00 AM

For those of you who had the Oncotype DX testing done, could you tell me if your insurance paid for the test?

My insurance denied payment based on the rationale that there is no scientific evidence that the Oncotype Dx test improves health outcomes nor is it the standard of care. They said while the National Comprehensive Cancer Network has extensively researched the tx of bc, including the role of Oncotype dx testing in risk stratification and tx decision making for early-stage invasive bc, a definitive recommendation has not been made for its use in this clinical setting. They noted that medical literature reflects that further studies are required to determine the role that prognostic marker studies such as the Onco dx have in guiding tx decisions for pts with early-stage invasive bc. Therefore the test is considered investigational and not a covered benefit.

Maryanne

Becky · 07-13-2007, 05:12 AM

Keep pushing your insurance company and have the Oncotype DX company push too. There is NO ONE I have met who had this test have insurance cover it from the get go. But all eventually succeeded in getting it covered by their insurance via appealing. Insurance will try to not pay for such things (wigs included) but they eventually will.

Shell · 07-13-2007, 07:04 AM

Maryanne-

I hope insurnance pays for it for you - keep pushing!

But as I didn't have the test done, I was nost intrigued by Becky's answer about the wigs - I never pushed my ins. co. and ended up paying for it myself. My hair is rapidly thinning on abraxane, and am wondering if I should push the ins co to pay for a new wig...

Regards,

tousled1 · 07-13-2007, 07:57 AM

Regarding insurance not paying for wigs - this is the first time I've heard that. I thought that if your doctor wrote you a prescription for a cranial prothesis your insurance would pay for it under durable medical products. I would check your insurance coverage. I know my insurance pays for dural medical products but only 80%. This also applies to any sleeves required for lymphedema and breast prothesis. Most insurance companies have durable medical product coverage of some sort.

07-13-2007, 08:28 AM

I had a script for a wig and my insurance still rejected paying, but I really didn't mind, as aside from $750, it was the only other thing I paid for in my first year of treatment.
I wonder if I should have questioned the decision not to pay.

Becky · 07-13-2007, 04:27 PM

I questioned, questioned, questioned about my wig. I was even told by my insurance they covered it (at certain places) but since I lived over 150 miles from the closest "approved" place, I could go anywhere I wanted. I was smart enough to get the person's name. Then they denied they said this but the conversation was taped on their end. It took 8 months but I got my money. If this happened to 1000 other people who didn't push for what they were entitled to, the insurance company makes 500,000 dollars (and it goes right to their bottom line).

Push