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Health Insurance Coverage and Reimbursement Genomic Health® understands that many factors affect the decision to select the Oncotype DX® Breast Cancer Assay. One important consideration is a patient’s insurance coverage. We will assist patients throughout the process of determining coverage and billing insurance. Genomic Health is prepared to bill insurance plans directly on behalf of insured patients in the US whose authorized healthcare providers order the Oncotype DX assay. Genomic Health is pleased that many insurance plans have established favorable coverage policies for Oncotype DX for node-negative, estrogen receptor-positive breast cancer patients. These insurance plans include Medicare (through a local coverage decision developed by the National Heritage Insurance Company which applies to all testing billed by our California facility), United Healthcare, CIGNA*, Aetna*, Kaiser Permanente, Health Net, Humana, Blue Shield of California, WellPoint §, and many others. It is not known whether payers will cover the test for patients with node-positive breast cancer. However, we are committed to expanding coverage for the Oncotype DX assay and continue to work with all major plans across the nation to establish favorable policies. Through our Genomic Access Program (GAP), the patient’s authorized healthcare provider can request a Benefits Investigation (BI) to determine if the Oncotype DX Breast Cancer Assay is covered by the patient’s insurance plan. Some insurers require a prior authorization prior to the processing of the patient’s specimen; the GAP team can also help facilitate this process. If a claim is denied on first review, our GAP team can appeal this denial on the patient’s behalf, with input from the patient’s authorized healthcare provider as needed. However in those cases where all appeals are exhausted and the claim is not fully paid, the patient will ultimately be responsible for any balance remaining on the invoice. Genomic Health provides a generous Financial Assistance Program for patients with financial hardship and a program for uninsured and underinsured patients. The reimbursement professionals at Genomic Health will do their very best to obtain coverage for this test, but they cannot guarantee success. The Genomic Access Program (GAP) has been designed to assist patients and authorized healthcare providers with any billing or reimbursement issues related to the Oncotype DX test. Genomic Health welcomes questions and encourages you to contact GAP if you have questions. Please call Genomic Health Customer Service at 866-ONCOTYPE (866-662-6897). |
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