Tests and Insurance

I've mentioned already that my surgeon and oncologist both recommended the Oncotype DX test to determine what help chemo would offer in my cancer treatment. Last week the oncologist submitted the paperwork to Genomic Health, the company that does the test. He mentioned that we are fortunate here because the closest testing facility is only about 40 miles away.

Yesterday, I received a call from a Patient Advocate at Genomic Health. She told me that Genomic does not have a contract with my insurance company, Blue Cross of California. I found this to be shocking because I knew about the Genomic facility here and because my husband's company had provided me with a printout of the Blue Cross of California policy statement on the Oncotype DX test. I explained this to the Advocate, and read to her the policy outline, including the section where Blue Cross sets out 10 criteria for coverage. She just told me to keep the policy, because we might need it later.

Because there is no contract with my insurance carrier, Genomics will submit the bills to Blue Cross, but the advocate warned that they may pay nothing. The test costs $3,500. Now, Genomics does have a program to help families pay for the test. If you meet income levels, which allow for deductions for mortgage, car payments, education and medical expenses, you will pay only $50 for the test. We don't meet the criteria. After a short talk with my husband, we decided to do the test anyway. It is too important to us.

The cost is huge for us, but that wasn't what really bothered me. My husband I both work, and we don't have a lot of debt, so we are lucky. We will figure it out.

What really bothered me is the insurance company not covering the test. Here's the thing. If the test shows I don't need chemo, which the insurance does cover, they save thousands and thousands of dollars. If it shows I do need chemo, then the expense means that the chemo is a necessary treatment and will reduce the risk that I'll have a recurrence which would cost more down the road. If my husband I decided we could not take the financial hit of the test on top of all of the other surgery, pathology and hospital co-pays and deductibles we have to pay this year, then I may likely have decided that not doing chemo was too high a risk, and the insurance would have covered the chemo treatments.

Again, I know I am lucky. There are so many people facing devastating health bills because they have no insurance or are under-insured. They don't have the option of making the choices I am making. I don't want to let this go. There are tests and treatments that are being developed to target cancer treatments in more effective ways than the traditional cut, burn and radiate methods. Companies like Genomics are doing a wonderful service by helping families who can't afford to choose a test in spite of their insurance company and I hope other companies are doing the same. As for Blue Cross of California, I'll be getting ready to fight them if I have to.