Tumor gene testing rejected by Blue S... - Advanced Prostate...

Advanced Prostate Cancer

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Tumor gene testing rejected by Blue Shield

sammamish profile image

Does anyone have experience with cajoling Blue shield or other insurance companies to pay for this test? I am lined up for Oncoplex tumor testing at U.W. Ticket price is 4200.00. Blue shield says it is "experimental". Anyone have a strategy to overcome such a ridiculous argument for patients with high risk Pca and germ line defect? I am all ears here.

12 Replies

Where are you receiving your PCa treatment?

sammamish profile image
sammamish in reply to johngwilk

SCCA in Seattle

johngwilk profile image
johngwilk in reply to sammamish

Same here. Evan Yu is my oncologist. Last year, he asked if I'd participate in a small local study that would require a biopsy of one of my bone mets. As a side benefit, he had access to the Oncoplex report at no cost to me. It identified a CDK12 mutation that opens me to targeted therapies. If your insurer continues to resist, see if your onco doc knows of a local study that will produce an Oncoplex report for you.

sammamish profile image
sammamish in reply to johngwilk

Did you try the straight insurance approach with subsequent denial first before going down the study route?

johngwilk profile image
johngwilk in reply to sammamish

No. I was happy to volunteer to avoid all of that agita. ;)

Will they at least work as an advocate to negotiate a better rate. The usual or customary charge with their write down. Another thing you can do is move up the supervisor chain.

sammamish profile image
sammamish in reply to noirhole

Yes I will pursue that strategy, thank you

You say "Blue shield". I am curious, are you speaking of Regence Blue Shield in Seattle?

sammamish profile image
sammamish in reply to tkalaf

Yes sir

tkalaf profile image
tkalaf in reply to sammamish

I had a colonoscopy years back, covered under preventive care through Regence BS. When billed, the procedure was covered but anesthesiologist (~$500) was not. This seemed strange, so I called both provider and Regence. I got the typical run around. Provider - verified EPC code was correctly billed. Regence - checked that EPC code from provider was not covered in plan. I was dumbfounded, was I expected to have aa colonoscopy w/o anethesia? I called Regence a 2nd time, and asked them this. I was transferred to a customer support help desk supervisor. This is when Regence agreed to put this bill into review and gave me a case#. After review, they later came back and agreed to cover this bill. I was thinking if they hadn't, I may have had to "call Jesse"! ;)("Call Jesse" is a local reference in Seattle).

i took a new treatment dated in 2002 not sure if the price is for the first test or all three and it was 72,000 gross and i believe they paid 42,000 and it cost me 0. same with the lupron/eliguard shot is around 3,000 and i paid 0.zytiga is 10,000+ and i pay 0 like to find more of that,because it worked on lowering my psa

charlie

Go to the webpage of the testing company and look to see if they have a tab for patient assistance or insurance assistance. Call them up and ask for their help.

Joel

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