I guess I need to venture back over to the other thread. LOL!
First of all, congratulations on the eight years! No chemo, no tamoxifen . . . nothing? That is wonderful.
I am not going to give in to the insurance company easily, that's for sure. I do hope this thread attracts some new people willing to share their experience with their insurance company regarding the test.
I am a new survivor (received the diagnosis on March 14, 2005) and I had the test done in May 2005. My insurance company at first denied the test as not medically necessary. Genomic Health and my oncologist sent letters in to appeal. My insurance company then said they were denying the claim because the test appeared to be experimental
I have been trying to find documentation that the test is no longer experimental. According to Genomic Health, the test has been on the market for two years. I even tried contacting the American Cancer Society today (11/09/05) and was referred to Patient Advocate Foundation. I tried calling them and have not heard back yet. I even called my oncologist's office and found out my doctor is out of the office this week
I intend to do my appeal letter tonight and let my insurance company know that documentation should be forthcoming. I don't think I have an easy fight ahead - my insurance will have to foot the entire bill because I met my out-of-pocket maximum for the year in April.
Good luck on your fight!
I am still fighting the insurance company. My insurance company is saying the same things as yours. I'm not giving up yet though. My hope is someone else will respond with some great info we can use. If you happen to run across anything saying it is not experimental please let me know. I will do the same.
Good luck with your fight as well.
As you may remember, I had contacted my oncologist's office to obtain "reliable evidence" that the Oncotype Dx test is not experimental. When I got home last night, there was an envelope from that office. Guess what was inside? Two articles from the New England Journal of Medicine.
I haven't had time yet to read the articles, but I believe they will be what I need. After I review, I will be sending them to my insurance company. Would you like copies?
Best of luck!
I am still fighting with my insurance company over them paying for this test. They upheld their decision on second appeal - they even said The New England Journal of Medicine showed the test was experimental. Add to this the fact that my case was reviewed by a Nephrologist (kidney doctor) rather than an oncologist. You can imagine how angry and frustrated I am.
I am not giving up yet, though. I've already started working on the third appeal. After rereading some of the posts on this thread, I am considering contacting my Benefits person to see if they can help me. My insurance company is self-funded.
If this third appeal fails and I have no other recourse, the next thing my insurance company will hear from me will be through a lawyer. I hate to go that route, but . . .
Congratulations, Marianne, on getting your insurance to pay. I haven't sent in my third appeal yet - holidays, etc.
For those of you still fighting (like I am), I found something that might help. The National Cancer Institute (www.cancer.gov) produces a bulletin and I found a write-up on the Oncotype Dx test in the December 14, 2004, issue (vol. 1, Number 48).
I figure I've had enough time to "cool off", so I am going to go over the letter I wrote in early December and edit it. I plan on telling my insurance company that other insurances have paid (I will include names of companies), another copy of the articles I received, as well a copy of the NCI Bulletin. Hopefully, this will work.
I also contact my HR person back in December to see if they could help. I hadn't heard anything as of today, so I e-mailed them again - still waiting.