Tumor gene testing rejected by Blue Shield

[sammamish]

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.

[johngwilk]

Where are you receiving your PCa treatment?

[sammamish in reply to johngwilk]

SCCA in Seattle

[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 in reply to johngwilk]

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

[johngwilk in reply to sammamish]

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

[noirhole]

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 in reply to noirhole]

Yes I will pursue that strategy, thank you

[tkalaf]

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

[sammamish in reply to tkalaf]

Yes sir

[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).

[charlesmeyers1964]

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

[JoelT]

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