BRCA gene testing coverage

[VacationForever]

I guess your doctor was not too careful with writing up the referral to the lab for the test. My PCP always CYA by saying "This is very expensive and your insurance may not cover it." See if he can pull any strings with the lab.

 

[cp73]

I wanted to update you on the status of my $4909 bill. As I had mentioned Medicare and my supplement both denied it. Several calls to the Lab got me nowhere. I was told there was no negotiation and they had no further process for resolving. I would at some point be dealing with collection. In August I got a revised bill for $3500 approx. with no explanation why the adjustment. I decided I wasn't going to pay this and this just didn't feel right. So I went back and reviewed everything I had. My initial email requesting the lab work to my Dr. I had told him if there were any "issues" we could talk about it before he orders it. Well he just ordered it and we never had any conversation until after the test was done and insurance wouldn't cover it. I also did some research on how much this test should cost. I found out that not many labs do that test. I also found out for $200 I could have gotten my answer from testing provided by Ancestry.com, and a few other labs for around the same amount. I also found on the labs website they had a section about genetic testing and they stated that they always discuss with the customer and their doctor the cost of the genetic testing prior to any work being formed. This hadn't been done for me. So I sent off a letter on Monday (11/30/20) to this company, addressed to the CEO, Legal SVP, Chief Medical Officer SVP, the DR who did the lab test, and my doctor. I mailed 5 copies of this letter. On the one to the CEO I also sent his email because I found his email address. My letter was 2 pages long and I emphasized how I had never given permission for that lab to do the work (which I didn't because I didn't know my lab was sending it out to them), no one informed me of the cost of the procedure, and they didn't comply with their own procedures in my case. Within 36 hours of me sending that email I received a call from the lab company apoligizing how they dropped the ball and they were sorry for everything I had been through trying to resolve this. They also said they were dropping all the charges. I was very impressed at how quickly and efficiently they responded and I thanked them for taking the time to understand my incident.

 

[Brett]

I wanted to update you on the status of my $4909 bill. As I had mentioned Medicare and my supplement both denied it. Several calls to the Lab got me nowhere. I was told there was no negotiation and they had no further process for resolving. I would at some point be dealing with collection. In August I got a revised bill for $3500 approx. with no explanation why the adjustment. I decided I wasn't going to pay this and this just didn't feel right. So I went back and reviewed everything I had. My initial email requesting the lab work to my Dr. I had told him if there were any "issues" we could talk about it before he orders it. Well he just ordered it and we never had any conversation until after the test was done and insurance wouldn't cover it. I also did some research on how much this test should cost. I found out that not many labs do that test. I also found out for $200 I could have gotten my answer from testing provided by Ancestry.com, and a few other labs for around the same amount. I also found on the labs website they had a section about genetic testing and they stated that they always discuss with the customer and their doctor the cost of the genetic testing prior to any work being formed. This hadn't been done for me. So I sent off a letter on Monday (11/30/20) to this company, addressed to the CEO, Legal SVP, Chief Medical Officer SVP, the DR who did the lab test, and my doctor. I mailed 5 copies of this letter. On the one to the CEO I also sent his email because I found his email address. My letter was 2 pages long and I emphasized how I had never given permission for that lab to do the work (which I didn't because I didn't know my lab was sending it out to them), no one informed me of the cost of the procedure, and they didn't comply with their own procedures in my case. Within 36 hours of me sending that email I received a call from the lab company apoligizing how they dropped the ball and they were sorry for everything I had been through trying to resolve this. They also said they were dropping all the charges. I was very impressed at how quickly and efficiently they responded and I thanked them for taking the time to understand my incident.

Thanks for update on the Medicare insurance billing problem

 

[turkel]

Quite frankly I am surprised and consider you beyond lucky. You requested the test and completed the test and then refused to pay for the test.

Lesson learned I hope.

I wouldn’t want to fork out $4900 either. I am awaiting an ER bill. My insurance paid out 16k my portion will be $850. I had 2 EKG’s, a chest X-ray, a ct scan and a slew of lab work. Paying a large unexpected bill is never fun but it’s a bill I owe none the less.

Hope you didn’t have the BRCA gene.

 

[DrQ]

Quite frankly I am surprised and consider you beyond lucky. You requested the test and completed the test and then refused to pay for the test.

Lesson learned I hope.

Been there ... done that.

DD had to have minor surgery and I RESEARCHED to make sure the surgeon and the hospital was in network. The surgeon chose an anesthesiologist who was OUT of network. I'm pretty sure that this was a common practice. We went around and around on it and I said that since I had no voice in choosing the anesthesiologist, he could:

1. Accept the IN network payment
2. Ding my credit for the difference
3. Sue me

He chose #1 and #2. It did stay on my CR, but I dogged his office for 5 years disputing the charge before he finally did not respond and it dropped off the CR.

 

[turkel]

As a nurse I can tell you that your doctor probably got either 1) the best guy for the job or 2) the guy that was assigned the job that day. No conspiracy no common practice just to screw you.

 

[DrQ]

As a nurse I can tell you that your doctor probably got either 1) the best guy for the job or 2) the guy that was assigned the job that day. No conspiracy no common practice just to screw you.

If it is:

1. Why were we not INFORMED that an out of network anesthesiologist be used?
2. Why would an IN-Network hospital assign an OUT-of Network anesthesiologist?

All I ask is transparency.

ETA: It was #1 and the surgeon's reply was "I can choose whomever I WANT to be on MY team" and even though he was recommended, I wouldn't use THAT arrogant doctor again.

 

[DrQ]

Story #2

When DD#2 was going to be born, we did our research and found a highly recommended OBGYN for prenatal/delivery. My insurance at the time paid a fixed fee for prenatal/delivery.

All went well until this doctor announced that he was opening a birthing center in the medical plaza by the hospital. The chief of the OB department retaliated and kicked him out of the hospital. Our OBGYN had privileges at a hospital about 80 miles away and were told that DW would have to deliver there. We told him no and asked for an adjustment on our fees to find a new OBGYN and he refunded $300 of a $2500 fee, claiming that the majority of the cost was prenatal. Try getting an OBGYN to do a delivery for $300!

After getting laughed at by other OBGYN's for trying to get a delivery for the remainder of the fee (and rightly so), we plopped the whole mess on the doorstep of the chief of the department, who finally agreed to do the delivery for the remainder.

Question: Have you practiced in Texas?

 

[tlwmkw]

Most doctors don’t have any knowledge of your insurance- they rely on their business office to deal with that. If your doctor is more knowledgeable about the insurance than about medicine then you should worry that she is only in it for the $$$$.
Also it is very unusual for the doctor to pick the OR team- it is usually assigned by the operating room and not at the choice of the physician.
Bottom line- if something is not urgent/emergent you need to call insurance company yourself to see if it is covered.

 

[DrQ]

Most doctors don’t have any knowledge of your insurance- they rely on their business office to deal with that. If your doctor is more knowledgeable about the insurance than about medicine then you should worry that she is only in it for the $$$$.
Also it is very unusual for the doctor to pick the OR team- it is usually assigned by the operating room and not at the choice of the physician.
Bottom line- if something is not urgent/emergent you need to call insurance company yourself to see if it is covered.

This was a case where the surgeon operated out of an ENT practice of several doctors which ALSO had an anesthesiologist. The surgeon was IN-network the anesthesiologist was not. This was also 20+ years ago. There was an uproar on this so I don't know if this is still being done.

 

[turkel]

As a nurse I can tell you patients have asked me about insurance a 1000 times. My response is always the same. I treat all patients the same weather they have insurance or not you will need to call your insurance to check on your coverage.

Period. NOT MY JOB, and why you would expect it to be your doctors is beyond my comprehension.

I haven’t practiced in Texas but as a labor and delivery nurse I can tell you that when the hospital I worked for 21 years ago when I had my last baby got paid $2500 for my induction, c-section and 4 day stay I laughed. That wouldn’t even cover what the hospital had to pay the nurses who took care of me. And that was back when we made about $25/ hr.

People get so aggrieved about their doctors and $$$, just give me a good doctor who will save my life if needed that’s all I ask. He/She can even be an as..... just be good at what they do!

 

[DrQ]

As a nurse I can tell you patients have asked me about insurance a 1000 times. My response is always the same. I treat all patients the same weather they have insurance or not you will need to call your insurance to check on your coverage.

I don't ask the medical staff pricing, but I DO check to see if the doctors I CHOOSE are IN-Network, that's my job. If a practice sets up a situation to game the system, shame on them. It MAY be legal, but is it ETHICAL?

I haven’t practiced in Texas but as a labor and delivery nurse I can tell you that when the hospital I worked for 21 years ago when I had my last baby got paid $2500 for my induction, c-section and 4 day stay I laughed. That wouldn’t even cover what the hospital had to pay the nurses who took care of me. And that was back when we made about $25/ hr.

It was a lot longer than 21 years ago, inflation is a b***h.

Period. NOT MY JOB, and why you would expect it to be your doctors is beyond my comprehension.

While it may not be YOUR job, many doctors OWN partnerships of their practices. In addition to being doctors, many are also BUSINESS people that negotiate pricing with insurance companies or decide whether they will accept medicare or medicaid patients. They have to pay rents and salaries (yours). I may DEAL with administrators and clerks for billing, but make no mistake that the people in charge of a practice of doctors are DOCTORS.

 

[bogey21]

7 or 8 years ago when my Daughter was going to have her 3rd child by C Section she cut a deal with one of the Houston hospitals. She paid them X dollars (I can't remember the amount) up front. The hospital agreed to cover 100% of the cost regardless of what it turned out to be...

George

 

[cp73]

Quite frankly I am surprised and consider you beyond lucky. You requested the test and completed the test and then refused to pay for the test.

Lesson learned I hope.

I wouldn’t want to fork out $4900 either. I am awaiting an ER bill. My insurance paid out 16k my portion will be $850. I had 2 EKG’s, a chest X-ray, a ct scan and a slew of lab work. Paying a large unexpected bill is never fun but it’s a bill I owe none the less.

Hope you didn’t have the BRCA gene.

Yes I did learn my lesson. At the time I thought it was just a simple lab test. However, I requested my dr via email and said if any issues let me know. To me an issue would have been, oh the test is $4900 you will have to pay for it. My Dr had no idea how much it was. He later told me that he told me it wasn't covered. However I told him to go check his records as to how he got my request. He checked with me right in front and then saw I requested via email, what I had said, and his quick response after. After my visit I saw him go over to the nurses and discuss with them, as if they did something wrong. My unsupported guess is his nurse responded to my email after a quick question to him. Then the lab screwed up by not telling the DR how much and that insurance wont pay for it. The lab (which is a huge company) has on their web site how much they communicate with DR and patients and they always get approval regardless of the amount. In the end they are a good company and stand behind what they post and believe in.

I really do believe your doctor (or his admin staff) should know whats covered and whats not, except maybe for emergency. I would expect them to inquire about who's going to pay the bill. Yes there are lots of insurance companies and policies. However your DR doesn't take them all. I can't get my oil changed without signing off on an order. Why should you not get a quote for non emergency care, especially when you have to pay for part or all of it. I have been to a couple of specialist that were very clear up front who paid for what. I appreciated that. I am lucky that I have good health.

And I dont have the BRCA gene. Well I kind of dont have it. The results said I kind of didn't have it. I didn't have it based on what they know today. There were a couple of unidentified strains that they dont know what they mean.

 

[turkel]

Yes I did learn my lesson. At the time I thought it was just a simple lab test. However, I requested my dr via email and said if any issues let me know. To me an issue would have been, oh the test is $4900 you will have to pay for it. My Dr had no idea how much it was. He later told me that he told me it wasn't covered. However I told him to go check his records as to how he got my request. He checked with me right in front and then saw I requested via email, what I had said, and his quick response after. After my visit I saw him go over to the nurses and discuss with them, as if they did something wrong. My unsupported guess is his nurse responded to my email after a quick question to him. Then the lab screwed up by not telling the DR how much and that insurance wont pay for it. The lab (which is a huge company) has on their web site how much they communicate with DR and patients and they always get approval regardless of the amount. In the end they are a good company and stand behind what they post and believe in.

I really do believe your doctor (or his admin staff) should know whats covered and whats not, except maybe for emergency. I would expect them to inquire about who's going to pay the bill. Yes there are lots of insurance companies and policies. However your DR doesn't take them all. I can't get my oil changed without signing off on an order. Why should you not get a quote for non emergency care, especially when you have to pay for part or all of it. I have been to a couple of specialist that were very clear up front who paid for what. I appreciated that. I am lucky that I have good health.

And I dont have the BRCA gene. Well I kind of dont have it. The results said I kind of didn't have it. I didn't have it based on what they know today. There were a couple of unidentified strains that they dont know what they mean.

You could be correct that his nurse responded to your e mail and ordered the test after a conversation with your doctor.

I do see where your coming from I just don’t think it’s reasonable to think a doctor knows the cost of every test with every insurance plan.

Happy to hear your test was negative.

Be well.

 

[JudyH]

I was a mental health therapist in private practice for 25 years. I took all insurances and accepted usual and customary. I checked to see if people had mental health coverage and how much co pays should be, which were due at each visit. I had patients sign a form that I would do my part of billing but they were responsible for anything not covered by insurance. There was no way I could keep up with each persons insurance beyond this.

The practice of out of network anesthesiologists has been going on a long long time.

 

[geekette]

I'm surprised. I thought pretty much everyone knew this was a crazy-expensive test. Anyone working in cancer treatment should know. I was warned by several doctors and nurses, and even got a letter from my hospital recommending the test but cautioning on cost, and directing me to potential financial help for it (I didn't qualify as the family history did not indicate that I 'needed' the test). heck, I already had breast cancer, what good would a forecast do at that point?

I'm not sure any insurance covers it. I won't be finding out as I won't be getting the test.

I'm glad this worked out. I admit to being moderately curious as to why it is so expensive, but I'm going to guess that cost will come down in time, as whatever tools, technology, whatever, quit being so new, less labor intensive, etc.

 

[bogey21]

A number of years ago I had a 6 panel genetic test run while an out patient in the Genetic Testing Section of a major hospital. I was advised that Medicare wouldn't pay for it. I asked if I could pay for it myself and what would it cost. The Doctor told me it would be expensive but if she ordered it for me as part of her examination she could get it done for something like $600 or $800 (I don't remember which). She asked me if I wanted to do it and I said I did. She asked me for my Credit Card, dialed the lab somewhere in California. She told the lab a tube of blood would be on its way, told the lab what tests she wanted run and gave the lab my Credit Card Number. About two weeks later she forwarded me the in depth 20 or so page Report from the lab with her 2 page comment letter. Medicare paid for her services and my Credit Card was charged the $600 or $800...

George