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Adenocarcinoma - newly diagnosed
Lung Cancer | Last Active: Jul 17, 2023 | Replies (164)Comment receiving replies
Hello, a comment about molecular testing. I had 2 lung surgeries, different lungs. Caris did molecular testing on first tumor. Went to Mayo for second tumor removal, their labs did molecular testing on that tumor. I also had blood analysis early in my cancer journey (Guardant). Results completely impacted the next steps/options for my treatment (Tagrisso). My advice – BE SURE YOU UNDERSTAND WHAT YOUR INSURANCE COVERAGE WILL PAY! Mine denied all claims. Rationale given included, "There is not enough evidence found in the medical literature to show that this testing is effective for managing your condition. The health plan does not cover tests that are not considered to be medically necessary for your care." The denial states the exclusion in my benefit plan (provided by a nationally recognized insurance company – thru my employer, but they are also huge as a Medicare provider) "…the fact that an Experimental or Investigational or Unproven Service, treatment, device or pharmacological regimen is the only available treatment for a particular condition will not result in Benefits if the procedure is considered to be Experimental or Investigational or Unproven in the treatment of that particular condition."
This is just a heads up. I had assumed the information garnered from the tumor analysis to be vital and a standard of care. I was wrong and paying the price for my ignorance!
Replies to "Hello, a comment about molecular testing. I had 2 lung surgeries, different lungs. Caris did molecular..."
Thank you for the information. I hope things improve with this issue. Blessings to you.
@kkckkjm, Thanks for the reminder for others that may read this in the future! You note has prompted some good discussion.
While others have mentioned that the biomarker/molecular testing is 'standard of care' in the USA, many rural clinics and insurance companies are lagging behind. The testing really is lifesaving, my own life included. My original insurance company also denied my claim. The biomarker company (FoundationOne) fought for payment on my behalf. Many of us on targeted therapies will experience progression of our cancer in the future, at that time biomarker testing should be performed again in order to determine if the cancer has mutated into another form with a targetable mutation. Unfortunately, our fight for insurance payments may not be over.
We're starting to see state-by-state legislation that requires insurance companies to pay for these tests, but progress is slower than any of us would like, and a federal solution would be preferred. Here's where we stand: https://www.fightcancer.org/what-we-do/access-biomarker-testing
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Thanks @kkckkjm. Geeze, sorry you had to go through that. I have just changed my health insurance which will cover chemo and radiation. I did have a maximum out of pocket copay of around $3600. I have $1241 left which I will have as a copay until it's met... Once that is met, it will take care of my chemo and radiation.
Sadly, we have to go through so much, and when health insurance becomes a nightmare it just adds to our stress.