Genetic Testing - Navigating the Insurance Process 

The oncology field is constantly innovating and changing, and in response so are testing methods to determine the location of the cancer, monitor progression, and metastases, and most recently to determine the most effective treatment option.

Typically, when monitoring your cancer or determining progression your oncologist may order either a tissue biopsy or a liquid biopsy.  A standard tissue biopsy is when the specimen is taken directly from either the tumor or bone marrow.  A liquid biopsy, on the other hand, is taken from a blood sample.  

Biomarker testing is done on both tissue samples and blood samples and is important as it helps evaluate various mutations that may be present in the cancer cells. The results of these tests may guide treatment decisions and further identify which treatments may or may not work.

Genetic testing in the form of a liquid or tissue biopsy can help identify a treatment plan that will improve a patient’s outcomes. For example, if an individual is ready to begin a breast cancer chemotherapy regimen, selecting the treatment regimen based on results of genetic markers that will respond better to one type of treatment over another, may result in more effective therapy.  

A more novel popular genetic test used in oncology is Next Generation Sequencing or NGS testing.  This particular test will provide detailed results of which treatment type will provide the best response based on the patient’s genetic makeup; thus improving overall survival and outcome.

Considering Genetic Testing? How to Navigate the Insurance Process:

There are many options and many diagnostic tests that differ based on the specific type of cancer a patient may have.  Since many of these tests are not yet approved by the FDA, insurance companies frequently deny these charges.  Considerations for the patient thinking about genetic testing include:

• Many of these tests are sent out to third-party laboratories who have their own billing practices, guidelines, and contracts with different payers.  
• You may be considered in-network with your provider but out of network for many of these particular tests. 
• The insurance company will often allow for a member to initiate an appeals process, which you can work on with the help of your provider’s office.  
• Many of these third-party laboratories offer their own form of financial assistance, so it is important to give them a call and discuss your options.

If your provider’s office has a Patient Financial Advocate (PFA), they can help you navigate these patient assistance programs as well as help you work through the appeals process with your insurer.  If your office doesn’t have a PFA I recommend navigating the company’s website for patient assistance or other resources or giving them a call directly about your specific situation.  Lastly, I recommend speaking directly to your ordering provider about other options as well.

Do you have questions for Ketki?  Please join the conversation in our community forums! https://cancergrace.org/forum/how-combat-financial-toxicity-during-your-cancer-treatment-what-do-you-think

*Please note:  The below links are information only and GRACE has no financial relationship with these organizations.

Helpful Resources:

https://www.foundationmedicine.com/patients#resources 

https://www.clonoseq.com/adaptive-assist 

https://myriad.com/myriad-cares-2/financial-assistance-program/ 

http://www.guardant360.com/ 

https://www.patientservicesinc.org/patients/supported-illnesses