MammaPrint (prognostic/predictive diagnostic test) Insurance Coverage

Posted by lisman1408 @lisman1408, May 13 5:31pm

My Medical insurance has refused to cover my MammaPrint from Agendia testing service. Has anyone else had this problem? I was covered by Blue Cross/Blue Shied and they won’t cover it. It’s $4200.00, it is worth every penny to me because it helped determine that I did not need Chemo., and that radiation would suffice in my case. But the cost is also a bitter pill to swallow.

Hello @lisman1408, I'm sorry to hear that the test is not covered by your Blue Cross/Blue Shield plan. I did find some information on the Agendia website that mentions insurance and financial support/assistance if it's not covered by your health insurance: https://www.agendia.com/our-tests/insurance-and-financial-support/.

This 2017 article in California mentions it's covered but I'm guessing it's different for some states but I'm not sure why. Agendia’s MammaPrint Now Included in Blue Shield of California Coverage for Breast Cancer Patients:
https://www.agendia.com/news/agendias-mammaprint-now-included-in-blue-shield-of-california-coverage-for-breast-cancer-patients/

Have you called Blue Cross and asked them why they don't cover the MammaPrint test?

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Hello @lisman1408,

I agree with John, @johnbishop, about pursuing this matter with BC. It takes a great deal of persistence to change an insurance company's mind after they have rejected a claim, but if you persist you can often win. I believe that the amount of this claim makes it worth your while to call and pursue all the avenues possible.

Will you give it a try?

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John and Teresa, Thank you both for your response. It’s been nearly two years since I had breast cancer and a mammaprint test. Of course I’ve perused it with Blue Cross as much as possible in those two year’s time! At the time I was covered under my husband’s health insurance policy from his employment. I have since aged into Medicare, plus a supplement ( I chose a Medicare supplement with a company other than Blue Cross because of this issue.) I have pursued this mammaprint issue with Blue Cross for over a year. Each time I have persistently called, I get the run around from agent to agent, Several times my call has been ‘dropped‘ in transfers from agent to supervisor, so I have to start the calling all over again. The bottom line is always that “it’s not covered”. I wondered if others on these message boards have had the same problem. I am also hoping that other women here reading our posts will see my experience and hopefully prevent this problem for themselves.

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@lisman1408

John and Teresa, Thank you both for your response. It’s been nearly two years since I had breast cancer and a mammaprint test. Of course I’ve perused it with Blue Cross as much as possible in those two year’s time! At the time I was covered under my husband’s health insurance policy from his employment. I have since aged into Medicare, plus a supplement ( I chose a Medicare supplement with a company other than Blue Cross because of this issue.) I have pursued this mammaprint issue with Blue Cross for over a year. Each time I have persistently called, I get the run around from agent to agent, Several times my call has been ‘dropped‘ in transfers from agent to supervisor, so I have to start the calling all over again. The bottom line is always that “it’s not covered”. I wondered if others on these message boards have had the same problem. I am also hoping that other women here reading our posts will see my experience and hopefully prevent this problem for themselves.

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@lisman1408, I'm really sorry to hear it's been a struggle with the insurance company. Did they ever explain your rights when a claim is denied? You may want to look into your rights because they denied the claim. Here's some information on making a formal appeal from the American Cancer Society – https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/managing-health-insurance/if-your-health-insurance-claim-is-denied.html

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@lisman1408

John and Teresa, Thank you both for your response. It’s been nearly two years since I had breast cancer and a mammaprint test. Of course I’ve perused it with Blue Cross as much as possible in those two year’s time! At the time I was covered under my husband’s health insurance policy from his employment. I have since aged into Medicare, plus a supplement ( I chose a Medicare supplement with a company other than Blue Cross because of this issue.) I have pursued this mammaprint issue with Blue Cross for over a year. Each time I have persistently called, I get the run around from agent to agent, Several times my call has been ‘dropped‘ in transfers from agent to supervisor, so I have to start the calling all over again. The bottom line is always that “it’s not covered”. I wondered if others on these message boards have had the same problem. I am also hoping that other women here reading our posts will see my experience and hopefully prevent this problem for themselves.

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Hello again @lisman1408, When I first answered your post I didn't realize that you had been working on this matter for over a year. How very frustrating! John's suggestion of working through the cancer organization is a good one.

You have certainly provided a lot of people with education as you have shared your experience.

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Thank you both for your kindness. I have pursued this issue with insurance as much as I can tolerate. Ive been working on this for well over a year, and hitting a brick wall every way I turn. I will pay this debt off by making payments a little at a time until it’s done. My credit rating and good reputation of paying my bills is valuable to me. I posted here to see if others have had similar experiences. Plus a warning to other readers of what has happen to me in this situation. I am very grateful for the availability of mammaprint from Agendia. This test saved me from needing to go through the struggles of chemotherapy. Just because the hospitals and physicians we work with are within our preferred list with insurance, it doesn’t mean that lab work and other testing they prescribe is also covered. Nor is it necessarily the physicians responsibility to check each patients insurance coverage. We must ask questions and advocate for ourselves in medical procedures. But as I said in my original post, the cost is a bitter pill to swallow! Hoping my experience can be beneficial to others as they pursue the best treatments for themselves.

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