It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • Decipher testing costs

  • Post New Thread   Reply Reply
    Thread Tools Search this Thread
    Old 02-13-2020, 06:13 PM   #1
    IceStationZebra
    Member
    (male)
     
    Join Date: Jan 2020
    Posts: 79
    IceStationZebra HB User
    Decipher testing costs

    Has anyone else had this issue with their insurer? I have BCBS insurance.

    After the decipher lab billed $5,491 for the test my insurer approved the claim which ended up giving me 'plan savings' of $3,670 and my EOB says that I owe $1,821. So it looks like the insurance company just let me piggy back off their contract rate but actually paid nothing.

    I didn't even ask for this test, not that I was against it, but it seems inappropriate to order a test that's not covered by my insurance and indebt me for nearly $2K. Had they told me it would be $2K out of pocket I would have said heck to the no.

    I'm not happy but I came home to a message from the lab that they'd be sending me a statement out.

     
    Reply With Quote
    Sponsors Lightbulb
       
    Old 02-13-2020, 07:00 PM   #2
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 177
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: Decipher testing costs

    Quote:
    Originally Posted by IceStationZebra View Post
    Has anyone else had this issue with their insurer? I have BCBS insurance.

    After the decipher lab billed $5,491 for the test my insurer approved the claim which ended up giving me 'plan savings' of $3,670 and my EOB says that I owe $1,821. So it looks like the insurance company just let me piggy back off their contract rate but actually paid nothing.

    I didn't even ask for this test, not that I was against it, but it seems inappropriate to order a test that's not covered by my insurance and indebt me for nearly $2K. Had they told me it would be $2K out of pocket I would have said heck to the no.

    I'm not happy but I came home to a message from the lab that they'd be sending me a statement out.
    I suggest you find out who ordered the test and ask why you weren't consulted. Something is amiss there.

    I also suggest calling the billing dept. at GenomeDx. Explain that your didn't approve the test, are not happy with the out-of-pocket balance, and wouldn't have approved it at that cost to you. The company is usually very good at working out maximum out-of-pocket costs with patients. I speak from personal experience.

    You have a lot to gain and nothing to lose. Please put at least your path-report findings in your sig. Thanks

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 02-13-2020, 07:34 PM   #3
    Insanus
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 41
    Insanus HB User
    Re: Decipher testing costs

    Sounds to me like no one got an insurance approval. Call Decipher. They will probably make you a deal.

     
    Reply With Quote
    Old 02-14-2020, 05:42 PM   #4
    IceStationZebra
    Member
    (male)
     
    Join Date: Jan 2020
    Posts: 79
    IceStationZebra HB User
    Re: Decipher testing costs

    Figured it out.

    Last year I met my out of pocket max. My insurer first denied it because the lab was OON but there were no in network providers. Thankfully it went to underwriting and they approved the payment. However when they paid it, it had a 2020 date on it instead of the actual date of coverage. So they reprocessed it into 2019 and because I met my out of pocket max, they will pay the rest.

    That was a maximum pucker moment when I heard the amount of that bill.

     
    Reply With Quote
    Old 02-14-2020, 08:48 PM   #5
    corybaby
    Junior Member
    (male)
     
    Join Date: Nov 2011
    Location: ca
    Posts: 11
    corybaby HB User
    Re: Decipher testing costs

    Hey my blue shield PPO did the exact same thing, the Path Lab sent a confirmation test to a lab in arizona, it was a few grand? anyway thats what they called it,confirmation,?
    i called blue shield and they called that lab and ended up changing it from an out of network provider to an In-network, sent ME a check for what the lab will REALLY accept which was like 250$ minus my 30$ deductable, then when i get the bill i just pay them directly....i thought it was kind of weird but the Ins Guy said it happens all the time....since i didnt approve it or couldnt be expected to pay that much the provider agrees to accept what the ins co will pay..

    good luck, call your Ins
    __________________
    Cory in calif
    60 active walker,etc. long hair ex-surfer dude feels 45 not 60
    Robotic prostatectomy done 1/21/20

    Path : Gleason downgraded to 4+3 from 8 no extra capsular extension neg lympth neg seminal ves
    Localized and gone!

     
    Reply With Quote
    Old 02-15-2020, 05:14 AM   #6
    Steve135
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Location: NJ
    Posts: 34
    Steve135 HB User
    Re: Decipher testing costs

    "Has anyone else had this issue with their insurer? I have BCBS insurance."

    Quote:
    Originally Posted by Insanus View Post
    Sounds to me like no one got an insurance approval. Call Decipher. They will probably make you a deal.
    Not all BCBS's are the same there is usually a prefix or suffix, each vary greatly.
    I'm forever having to correct this with Billing as most BCBS require pre-approval on major cost.
    And I have BCBS FEP "federal" which requires no Pre- approval on anything but over night stays. When looking up co pays they alway charge me that of BCBS of NJ which sometimes is hundreds more for a Pet Scan.
    I currently have an outstanding bill for 13k, all because of the billing address.
    My treatment was in NJ and billing address in PA and this has caused such an issue.
    And it seems as if medicare is tighten the strings in 2020 on testing, my older brother is on Medicare, and has just loined our club.
    As with our PCa each of us have different issue"s and sometimes issue's with the same insurers.
    steve d

     
    Reply With Quote
    Old 02-15-2020, 07:22 AM   #7
    IceStationZebra
    Member
    (male)
     
    Join Date: Jan 2020
    Posts: 79
    IceStationZebra HB User
    Re: Decipher testing costs

    Quote:
    Originally Posted by Steve135 View Post
    "Has anyone else had this issue with their insurer? I have BCBS insurance."



    Not all BCBS's are the same there is usually a prefix or suffix, each vary greatly.
    I'm forever having to correct this with Billing as most BCBS require pre-approval on major cost.
    And I have BCBS FEP "federal" which requires no Pre- approval on anything but over night stays. When looking up co pays they alway charge me that of BCBS of NJ which sometimes is hundreds more for a Pet Scan.
    I currently have an outstanding bill for 13k, all because of the billing address.
    My treatment was in NJ and billing address in PA and this has caused such an issue.
    And it seems as if medicare is tighten the strings in 2020 on testing, my older brother is on Medicare, and has just loined our club.
    As with our PCa each of us have different issue"s and sometimes issue's with the same insurers.
    steve d
    This is the GA HMO plan and they are actually great. I've had a couple labs that were OON and they paid what they would have paid had the lab been in network. Then the provider accepted what was paid. I've been very happy and have had no real problems out of my insurer, they really have been tremendous.

    I called the insurer and the issue was that they processed the claim after underwriting review in 2020 instead of 2019. They moved it back to 2019 and then it fell under my maxed out out of pocket for 2019 and they will pay the rest. Very thankful, I settled all bills and paid everything, absorbed the lost wages due to short term disability and then released the rest of my "surgery and recovery" fund to buy my daughter a car. If I had to pay this I would have had to murder Peter to pay Paul (forget robbing Peter, he'd have to die) 😁

     
    Reply With Quote
    Old 02-15-2020, 09:05 AM   #8
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 177
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: Decipher testing costs

    I had a suspicion my BCBS of NC would not pay for a Decipher RP because of my clean path report. I called GenomeDx and worked out a very low out-of-pocket cost for that contingency.

    My doc ordered the test and later was told that it wasn't done because my insurer denied coverage. The reason was, as I predicted: even though I was a G9 (5+4) after surgery, I was no longer high risk because of my path report. Of course this is BS -- I wasn't getting PSA testing every 3 months for the fun of it, and I will forever remain high risk.

    I called GenomeDx and paid the nominal fee we agreed on. They had my tissue shipped to them and I got my results couple of weeks later: 0.37, low risk.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 02-15-2020, 09:12 AM   #9
    IceStationZebra
    Member
    (male)
     
    Join Date: Jan 2020
    Posts: 79
    IceStationZebra HB User
    Re: Decipher testing costs

    Quote:
    Originally Posted by DjinTonic View Post
    I had a suspicion my BCBS of NC would not pay for a Decipher RP because of my clean path report. I called GenomeDx and worked out a very low out-of-pocket cost for that contingency.

    My doc ordered the test and was told that they didn't run it because my insurrer denied coverage. The reason: even though I was a G9 (5+4) after surgery, I was no longer high risk because of my path report. Of course this is BS -- I wasn't getting PSA testing every 3 months for the fun of it, and I will forever remain high risk.

    I called decipher and paid the (very) small fee we agreed on. They had my tissue shipped to them and I got my results couple of weeks later: 0.37, low risk.

    Djin
    Nice. On the voicemail they said they would send information about lowering my cost.

    I'm glad I met my out of pocket max with all that craziness last year. By the time I got to surgery, I didn't pay a dime for any of it.

    Here is to a year with limited doctors appointments and low out of pockets this year.

    Last year was a life disaster. But just found out one of my classmates from high school found a cancerous tumor in his colon and what they believe is cancer in his liver. He is my age 49. So it could be worse but looking back it's like "wow, that was a tough year".

     
    Reply With Quote
    Old 02-15-2020, 02:10 PM   #10
    OldTiredSailor
    Junior Member
    (male)
     
    Join Date: Dec 2019
    Location: Punta Gorda
    Posts: 12
    OldTiredSailor HB User
    Re: Decipher testing costs

    I have read several posts on other forums/boards saying Decipher will either waive the cost, charge you a nominal fee, or work hard to make the insurance company pay.

    I know when I checked to see if Florida BCBS would cover the cost not paid by Medicare that I was told that at most my cost would be less than $200.


    Just checked Medicare paid $3930.54 and FL BCBS paid $34.46 to Decipher in November 2019 for my test.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 1/1/20 0.050

     
    Reply With Quote
    Reply Reply




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 08:29 AM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!