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Help to get insurance to cover testing?

Page last modified on: August 26, 2008
Question from Unnell: My insurance company has denied my request for BRCA testing, even though I have a family history (my mom and a first cousin on my maternal side). The out-of-pocket cost of the testing is over $3,000! Is there anything I can say or do that will make the insurance company cover my testing? Would you, if you were me, proceed with the testing regardless of the insurance company?
Answers —Carol Cherry, M.S.N., R.N., A.P.R.N., B.C.: It's hard to answer your question without knowing all the details of your particular situation. Your decision to proceed with testing is really a personal one so what I would do is not that relevant. Have you worked with a genetic counselor who has helped you understand the requirements of your insurance company for coverage? The reason I say this is because sometimes counselors can write letters of medical necessity on your behalf to the companies to request coverage. Sometimes we're successful and sometimes we're not.
Terri McHugh, M.D.: An alternative, if insurance does deny coverage after meeting with a genetic counselor, is to test a relative who has had cancer. That might be most beneficial.

On Wednesday, March 19, 2008, our Ask-the-Expert Online Conference was called Breast Cancer Risk and Your Family. Carol Cherry, M.S.N., R.N., A.P.R.N., B.C. and Terri McHugh, M.D. answered your questions about how family genes affect risk, pros and cons of genetic testing, and ways to lower your breast cancer risk.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Carol Cherry, M.S.N., R.N., A.P.R.N., B.C.Carol Cherry, M.S.N, R.N., A.P.R.N, B.C. is health educator, Research Project Manager, and Cancer Risk Counselor in the Margaret Dyson Family Risk Assessment Program at the Fox Chase Cancer Center in Pennsylvania.

Terri McHugh, M.D. is a medical oncologist/hematologist and director of the Cancer Risk Assessment and Genetics program.

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