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Real members of MyBCTeam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

Does Anyone Have Experience With Insurance NOT Covering Onkotype In The Case Of A Lumpectomy And Clear Nodes And Margins?

A MyBCTeam Member asked a question 💭
Denver, CO

Insurance told me in this scenario, the test is considered investigational and not automatically covered. Anyone had to pay out of pocket for the test? I'm wondering if I really need it since I had clear nodes & margins with a grade 1 stage 1 HER2 negative pathology report?

February 2, 2015
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A MyBCTeam Member

Genomic Health called to tell me they talked with my insurance and they wouldn't cover the test. I was devastated. The representative asked if my adjusted gross income was under a certain dollar amount.

She asked if I'd like to tell her my salary, which I shared. Then asked if I had a mortgage, car payment, what my monthly health insurance premium was, dental & vision premiums, property taxes, other debt, school loans, kids in school, etc.As I was giving her numbers, she was calculating figures and would say, okay now I've got you down to owing X. Then she'd ask more questions until .....I'm at ZERO dollars and they're completely covering it with their patient assistance program!!!!!!!!!!

@A MyBCTeam Member - consider asking your Dr. to send the order to Genomic and ask them to first call you to discuss their assistance program before they proceed with any action. You may not owe anything. This was the case for JannieM as well. Then you can have the assurance about whether or not chemo would benefit you.

February 11, 2015
A MyBCTeam Member

I had bcbs in AZ and they paid.Maybe because my company was self insured.

February 4, 2015
A MyBCTeam Member

My BCBS is North Dakota

February 4, 2015
A MyBCTeam Member

I have Blue Cross/Blue Shield and 2015 is the first year they will cover the oncotype Assay DX test.

February 4, 2015
A MyBCTeam Member

My insurance paid. I was stage 1 grade 1 w lumpectomy. I am glad I had the test. My score was high enough to warrant chemo. If I had not had the test I would not have had chemo and my risk of getting Cancer again would have been higher. Fight with your insurance co.

February 3, 2015

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