Amarie123 wrote:My testing was denied by my insurance company as well and my oncologist appealed. They actually denied the appeal and the hospital paid. He said MGH has a “fund” for such situations. I would ask if they can appeal and what, if any, other options exist for payment.
Jack&KatiesMommy wrote:My insurer denied the Foundation1 Testing that my oncologist ordered, stating that it was still experimental. My oncologist appealed (it was denied) and I appealed with lots of research and my appeal was likewise denied. However, my insurance DID approve off-label treatment with Keytruda even though I was MSS, so I cannot complain.
Cynthia
NHMike wrote:Amarie123 wrote:My testing was denied by my insurance company as well and my oncologist appealed. They actually denied the appeal and the hospital paid. He said MGH has a “fund” for such situations. I would ask if they can appeal and what, if any, other options exist for payment.
MGH does the testing on-site - they don't send it out. So they may have more flexibility. They did mine for free too.
Amarie123 wrote:NHMike wrote:Amarie123 wrote:My testing was denied by my insurance company as well and my oncologist appealed. They actually denied the appeal and the hospital paid. He said MGH has a “fund” for such situations. I would ask if they can appeal and what, if any, other options exist for payment.
MGH does the testing on-site - they don't send it out. So they may have more flexibility. They did mine for free too.
I did see results that were processed at MGH (which identified the KRAS mutation) but there was also Guardant360 genomic testing done which took about 3 weeks to come back. My onc warned me that the claim would likely be denied but said that they would handle it on their end if needed.
Either way, a larger hospital should have an obudsman (I think that’s what it’s called) to help advocate with insurance if the oncologist and their team don’t do this. It doesn’t make any sense for insurance to deny these claims.
NHMike wrote:
MGH does the testing on-site - they don't send it out. So they may have more flexibility. They did mine for free too.
jep wrote:Great news!! Apparently Yale went forward with the Oncomine testing despite the insurance denial!! They have the results and have shared them with my husband’s local oncologist....we meet with him Friday to discuss....we also head to Yale in 1 week to meet with the Phase 1 director there....Yale will deal with the insurance company! Yay! So happy right now....
Thank you everyone
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