When my 11 mm. tumor was discovered on Dec. 7, 2021, I asked my oncologist about having an oncotype. I had never had anyone with breast cancer among my family or friends. I was ignorant of anything involving b.c,, but I did have the genetic testing, which showed no sign of BRC 1 or BRC2. I accepted it when he said, "You don't need one" to my inquiry about an oncotype. If, as you say, insurance wants the tumor to be bigger to justify having one at all, perhaps that was his reasoning, but I can tell you, from my own experience, that it has been standard of care since 2013 and everyone seemed to have one but me. An oncotype is used to plan your treatment and it also gives an idea of what your odds for a reoccurrence are after surgery. I did not have chemo (because I did not have an onco score) but, after my lumpectomy, I was very apprehensive about a recurrence. My surgeon suggested I ask my oncologist for a ki67, which would have given me that information, but, I found out that my oncologist never wanted to order anything expensive "for fear he'd get dinged by Medicare." He also didn't do much homework on me as a patient, because I was in a clinical trial for osteoarthritis from 1997 to 2020 (the MOST study) and that, alone, should have indicated that A.I pills were going to put me into agony by inflaming my fragile joints (I have 2 that I injured in a bicycle and volleyball accident). I had terrible side effects from Anastrozole and, later, from Tamoxifen, and my left knee actually blew out from the Anastrozole and put me in a wheelchair for 6 months. You mention having dense breasts and anyone who has dense breasts, like me, should read this:
https://mydensitymatters.org/programs/my-story-matters/
I asked for and got an oncotype from my Texas doctor after I flunked a HerScan that I paid for out of pocket on the 1st anniversary of my lumpectomy (1/27/2023). I wish i had insisted on an oncotype at the outset, because my score was 29, where above 25 usually indicates cheno, but I did not have that because it took fom 2021 to 2023 to find a doctor who really paid attention to me and my side effects. When I told the Illinois doctor about the brain fog, teariness, mood swings, excruciating back and joint pain, insomnia and vivid violent nightmares, he simply said "Don't take it then" and walked out. When I asked about the ki67, he said, "I won't order that for you. You'll have to get someone else." I would recommend that you fight for the onco score so you will have the peace of mind that the % of recurrence gives you, In my case, I had to stop all of the adjuvant therapy drugs, even though my odds of recurrence are 36% because I cannot tolerate them and now, at 79, I want to enjoy the rest of my time on the planet.