Insurance denies genetic testing

My insurance company sent a letter initially denying genetic testing from foundation 1 saying it is experimental and that they need peer reviewed results showing benefit, to Men. I sent a letter to my Dr. asking for help in this matter. Has anyone else had experience with this kind of appeal for foundation 1 genetic testing? The only study I could find is this one. I am hoping to get it appealed as it is $5800 nejm.org/doi/full/10.1056/N...

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  • Hi

    My insurance denied it as well. I had not specifically requested the test nor did they call for pre authorization. When it got denied I called the lab they appealed it and got declined again. With a short phone call they waived the charge. Suspect you can have the same result. Hope this helps but I would not pay.

  • Thanks John, do you mean that foundation 1 waived the charge?

  • My understanding is that Foundation One will charge you but if you it is not covered they don't pursue payment from the patient. They are looking to the drug companies to absorb the cost.

    This is only what I have heard not my personal experience. I think Rick Davis (Ardee) knows how this works since he as an advocate has gotten this done for patients.

    Bill

  • I had a similar experience with the Decipher test. I didn't even know that my doctor had ordered it until after it had been done. My insurance company sent me a letter denying coverage so I called my health care provider's financial office. They said that they were appealing it and not to do anything unless I get a bill from them. That bill never came so someone waived the cost but i never found out who.

  • Thanks everyone, thanks to this forum I was able to get the charges waived, much appreciated John , Bill and Cfrees. I am a happy camper not to have to worry about that Bill.

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