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New Member

Date Joined Oct 2008
Total Posts : 1
   Posted 10/28/2008 5:43 PM (GMT -7)   
I discovered in November of last year that I had breast cancer. I found a small lump in my left breast and got it checked out right away. I had a biopsy and then a mastectomy. My surgery was Dec. 17, 2008. I made a very quick recovery, got to go to my mom`s for Christmas, which really made me and everyone else feel good. My oncologist suggested that I have an Oncotype Recurrency Score done by a lab in California. She said that if my score was low, I would not need chemo. I would take Tamoxafin for several years, ect. This sounded great to me. The only drawback was that the test was very expensive. We decided to have it done and based on those results, I did not have chemo.
My insurance company will not pay for any part of the test. They said that it was not proven????????? As I understand, Medicare will even pay for this test.
I have read articles about this test, and it seems to be a standard test for certain types of tumors.
Is there anyone out there who has had this experience? What can I do about it. The California lab`s appeals have all failed.

Jean in WA
Regular Member

Date Joined Mar 2005
Total Posts : 43
   Posted 1/2/2009 11:54 AM (GMT -7)   
Hello...I have not gone to the HealingWell site for a couple of years, but now may have a recurrent problem and found this site to be so helpful. But, I saw your question and needed to let you know of my experience with the Oncotype DX test. I had it done nearly four years ago and had to "fight" my insurance company (Premera Blue Cross of Washington and Alaska) to pay for the test. At that time, the Breast Cancer Symposium in San Antonia had presentations by Kaiser Permanente and the New England Journal of Medicine validating the Oncotype DX testing. I did the homework and worked with my insurance company "nurse" who presented this information to their doctor panel who decides on payment of things like this. They finally agreed to pay for the test (and I did score in the low zone!). This was in April/May of 2005, and I was one of the first to have it paid by insurance, according to the Genomic Lab where the testing is done. So, FIGHT for your right to have the test paid for. And focus on the money the insurance company will save by the possibility of this test negating the need for chemo, which will cost them tens of times more than the Oncotype DX test. Good luck!
Jean in WA
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