Detailed genetic testing - did your insurance cover it? How much does it cost?

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Claudine
Posts: 746
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Detailed genetic testing - did your insurance cover it? How much does it cost?

Postby Claudine » Wed Nov 09, 2022 2:11 pm

DH's onc requested the "Providence Personalized Medicine Panel, Solid Tumor prov seq523" which tests for 523 mutations, but our insurance did not approve it. We can appeal (and will), but I'm curious to know how much is costs, if we can't get it covered and decide to pay for it from our own pocket?

https://www.ncbi.nlm.nih.gov/gtr/tests/556857/
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 vertebrae 04/18; left adrenal gland & small lung nodules 03/19;
rectum 02/22 (pT3 pN0 stage 2A); L3 vertebrae 09/22

Surgeries: intestinal resection 05/18 (no cancer - Crohn's); adrenalectomy 02/20;
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22;
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20;
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22

Nor Cal
Posts: 69
Joined: Sun Dec 06, 2020 8:18 pm

Re: Detailed genetic testing - did your insurance cover it? How much does it cost?

Postby Nor Cal » Fri Nov 11, 2022 1:48 pm

Not much to offer, but my Foundation One test was denied, and then approved upon appeal. I know that denial is common, and there are some financial resources available for payment assistance - I'd check with your cancer center's financial department and see if they know of any resources for help.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. CEA 120.
BRAF+ TMB 5% MSS TDL1-1%
July 2020 - Present: 37 cycles chemo (All the various 5-FU regimens)
December 2020 - February 2021 Y90 Radioembolization, Chemoembolization x2

Claudine
Posts: 746
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Detailed genetic testing - did your insurance cover it? How much does it cost?

Postby Claudine » Sun Nov 13, 2022 11:42 am

Thanks Nor Cal, it’s good to know that appeal could work! DH’s oncologist is looking into it.
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 vertebrae 04/18; left adrenal gland & small lung nodules 03/19;
rectum 02/22 (pT3 pN0 stage 2A); L3 vertebrae 09/22

Surgeries: intestinal resection 05/18 (no cancer - Crohn's); adrenalectomy 02/20;
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22;
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20;
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22

Bpaint
Posts: 40
Joined: Sun Oct 11, 2020 8:54 pm

Re: Detailed genetic testing - did your insurance cover it? How much does it cost?

Postby Bpaint » Sun Nov 13, 2022 3:12 pm

After our insurance denied it, FoundationOne covered all of the cost of my husband’s testing. His oncologist said that was common, or that FoundationOne would cover all but $100.
My husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes (25+)
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
CEA 113
Liver, colon and lymph node resection 4/21
New lung mets, Vectibix monotherapy started 6/21
Stop Vectibix
Start Folfiri + avastin January 2022

Claudine
Posts: 746
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Detailed genetic testing - did your insurance cover it? How much does it cost?

Postby Claudine » Mon Nov 14, 2022 1:02 pm

Oh that’s great, thanks Bpaint! In Portland all week while DH receives SBRT at OHSU, but I’ll check back in with his onc when we get back home.
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 vertebrae 04/18; left adrenal gland & small lung nodules 03/19;
rectum 02/22 (pT3 pN0 stage 2A); L3 vertebrae 09/22

Surgeries: intestinal resection 05/18 (no cancer - Crohn's); adrenalectomy 02/20;
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22;
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20;
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22


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