FOUNDATION ONE TESTING

[hart2hart]

We were denied Coverage from our Insurance Co for Foundation One Testing (6K) because my ONC did not get
a pre-authorization! Shoot! I thought he got approval on this.

Anyone else have this trouble. Any suggestions? Would love any feedback especially if this has happend to you
and maybe got resolved????? Maybe have the ONC write a letter to the insurance company since Pete was Stage 4?
Help!! Not sure what would be the best route to take.......!

Thanks!


Julie and Pete
Stamford, CT

[midlifemom]

I don't know if this is absolutely true or not, but I believe providers offices are responsible for pre-authorization. If they don't do it, they are on the hook. Maybe call your insurance company to clarify.
I recall reading many other posts on this subject as to how others have dealt with it.

[Deb m]

I agree that in many cases, the provider/place that does the testing is responsible for pre-authorization. On one occasion, the hospital did not get pre- authorization for my husbands pet scan and the insurance denied payment. The hospital tried to bill us, but the insurance company stepped in and the hospital ended up having to eat it! Check with your insurance company and see who is responsible.

deb m

[skypup]

Julie, Medicare refused to pay mine and I guess no one got preauthorization; Medicare takes good care of patients and they refused to let the company bill me because I had not been informed that it would likely be denied. I never heard another word about it. I have been told by the research center that FoundationOne settles with clients for far less than the billed amount when they have encountered insurance issues in the past. If it came down to it, I'd make a lowball offer...

[ktwmn]

I had the same problem with my genetic testing and got socked with a $6K+ bill from Myriad. I complained to the onc who recommended the testing and went to the people in the billing office. I had prepared a good letter to the insurance company. But then the billing people told me that they (the provider) must file the complaint. We'll see what happens.

[MamaN]

Hi Julie

So sorry you have to deal with this . Butt I have something if you like to call them ., they were going to fight for me when my ct scans had been denied they are patient advocate foundation I have a phone number too! Let me know what you think? K

Hugs to you

[lpas]

My onc told me he's never had a patient get billed for Foundation One testing after insurance denies. They'll send you something in the mail asking permission to appeal on your behalf (this is exactly what they did with me). Sign the form and send it back. They'll fight it out themselves with the insurance company. If insurance doesn't pay, they write it off. It's supposedly all part of their business plan to get their testing incorporated into the standard of care. FWIW, my insurance ultimately paid. YMMV. Good luck!

[HoosierDaddy]

You might try and call the company that conducts the test directly and see if they have reduced rates or max out of pocket levels based on household income. I called Genomic Health directly after my insurance denied the ONCOdx test (would have cost me 4-5k) and the company has a very generous $0 out of pocket payment policy for patients that make less than a certain household income..