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Thread: Decipher No Insurance coverage

  1. #1
    Senior User
    Join Date
    Jan 2019
    Posts
    455

    Decipher No Insurance coverage

    The final outcome of my insurance claim for a Decipher test was denial. I can confirm if you have a Decipher with a insurance denial they currently have a program at any income level for $395 for the test.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT - 6/3/19
    ART - 8/5/19

  2. #2
    They wanted $5150 international rate from me and their sales representative didn't bother to ask back why I stopped answering. I think it's exclusively for Americans or the rich.
    --------------
    DOB 1965
    PM me for PSA graphing service & detailed story
    PSA 6.8 11/17
    PSA 7.5 04/18
    MRI 05/18 inconclusive, PI-RADS3?
    PSA 11.8 01/19
    PSA 10.1 02/19
    12 core random biopsy 02/19 (4+3)=7 suspicion of vascular invasion, grade 4 cribriform pattern, no PTEN loss
    Bone scan negative 04/19
    PSA 13.3 04/01/19 pre-surgery significant urinal symptoms and some ED
    RRP 04/04/19
    pT2c pN0 (0 of 7 lymph nodes positive) pL0 pV0 R0(local) Pn1
    Perineural growth predominantly on right hand side, tumour diameter 15mm 90% G4 10% G3
    Prostatic parenchyma with glandular hyperplasia and chronic granular, partly purulent inflammation.
    PSA 0.14 04/30/19
    PSA 0.02 05/13/19
    PSA 0.008 06/04/19

  3. #3
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,282
    $395 for a Decipher test is a deal....go for it!
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19
    We'll see....what is not known dwarfs what is thought to be fact

  4. #4
    Quote Originally Posted by Duck2 View Post
    The final outcome of my insurance claim for a Decipher test was denial. I can confirm if you have a Decipher with a insurance denial they currently have a program at any income level for $395 for the test.
    This is hard to comprehend. You were high-grade disease with serious negative path findings, and your Decipher was high risk! I can only assume they deny ALL genomic testing for PCa. (?) Did they provide a reason?

    In my case, BCBS hid behind my good path report in denying my Decipher with G9, saying I was "no longer high risk". Had my result not come back low risk, I would have appealed the decision.

    Because of (what I later deduced was) an employee mistake, I was emailed a lower out-of-pocket price by the testing company when I inquired about Decipher cost before my test request (I had a bad hunch about what my good path report meant re coverage). After my insurance denial, GenomeDx honored the quote when I gave them the test go-ahead. Only later did I learn that the quote was low.

    Djin
    Last edited by DjinTonic; 07-11-2019 at 11:30 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    2013 TURP (90→30 g) path neg. 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
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  5. #5
    Senior User
    Join Date
    Jan 2019
    Posts
    455
    Quote Originally Posted by DjinTonic View Post
    This is hard to comprehend. You were high-grade disease with serious negative path findings, and your Decipher was high risk! I can only assume they deny ALL genomic testing for PCa. (?) Did they provide a reason?

    In my case, BCBS hid behind my good path report in denying my Decipher with G9, saying I was "no longer high risk". Had my result not come back low risk, I would have appealed the decision.

    Because of (what I later deduced was) an employee mistake, I was emailed a lower out-of-pocket price by the testing company when I inquired about Decipher cost before my test request (I had a bad hunch about what my good path report meant re coverage). After my insurance denial, GenomeDx honored the quote when I gave them the test go-ahead. Only later did I learn that the quote was low.

    Djin
    My policy does not cover any genomics testing. My URO told me my cost would be a couple hundred and we did the test.

    After the insurance denial and getting a $5400 bill, I called GenomX and they said how about $395 since your don’t have coverage and we want everyone to have access. Paid $395 over phone and done.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT - 6/3/19
    ART - 8/5/19

  6. #6
    Quote Originally Posted by Duck2 View Post
    My policy does not cover any genomics testing. My URO told me my cost would be a couple hundred and we did the test.

    After the insurance denial and getting a $5400 bill, I called GenomX and they said how about $395 since your don’t have coverage and we want everyone to have access.
    Well done, Duck. Maybe I should have tried a little harder getting a similar deal. For $400 I'd be in, but wouldn't want to pay $5000 out of pocket.
    --------------
    DOB 1965
    PM me for PSA graphing service & detailed story
    PSA 6.8 11/17
    PSA 7.5 04/18
    MRI 05/18 inconclusive, PI-RADS3?
    PSA 11.8 01/19
    PSA 10.1 02/19
    12 core random biopsy 02/19 (4+3)=7 suspicion of vascular invasion, grade 4 cribriform pattern, no PTEN loss
    Bone scan negative 04/19
    PSA 13.3 04/01/19 pre-surgery significant urinal symptoms and some ED
    RRP 04/04/19
    pT2c pN0 (0 of 7 lymph nodes positive) pL0 pV0 R0(local) Pn1
    Perineural growth predominantly on right hand side, tumour diameter 15mm 90% G4 10% G3
    Prostatic parenchyma with glandular hyperplasia and chronic granular, partly purulent inflammation.
    PSA 0.14 04/30/19
    PSA 0.02 05/13/19
    PSA 0.008 06/04/19

  7. #7
    Quote Originally Posted by Duck2 View Post
    My policy does not cover any genomics testing. My URO told me my cost would be a couple hundred and we did the test.

    After the insurance denial and getting a $5400 bill, I called GenomX and they said how about $395 since your don’t have coverage and we want everyone to have access. Paid $395 over phone and done.
    My case went a little differently. When BCBS denied coverage, my tissue wasn't even sent to GenomeDx. Only after I heard the insurance denial from my doc, contacted the company, and paid the small pre-agreed fee by phone did they go ahead. It took about a week extra to get my result, because the tissue then had to be sent. Perhaps it has to do with how one's doc completes the test request form (?)

    Djin

 

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