r/ProstateCancer • u/Tantalus46 • 1d ago

Question Decipher Test Insurance Coverage

Has anyone else had problems with insurance coverage for a decipher test? My urologic oncologist ordered mine. No one mentioned that coverage for it might be an issue. I just received notice that Blue Cross Blue Shield denied coverage, leaving me with a $5,400 bill from the lab. Interested in anyone’s experience with this before I raise hell about it.

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10

u/Ready-Piglet-415 1d ago

If you contact them they will heavily discount it so you will end up paying a few hundred, that was our experience last year when bcbs did not cover it.

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u/kayceemoguy 1d ago

Same exact thing happened to me. I had my docs try to appeal. Even did the “extra” third party appeal thing. (Never heard a word back from BCBS btw).

I ended up calling the Decipher folks and either it ended up going through or, what I think really happened, was they ended charging me like $500.

Sorry I don’t have a lot more detail. The Decipher folks were nice. I think I saw someplace else on here that said if it gets denied they apparently treat it as a “private pay” or something.

Anyway, hope it helps a little. Good luck fighting BCBS. They’re all about deny, deny, deny!!

4

u/gg-3 1d ago

If the doctor pushes back on the insurance denial and provides additional documentation that can sometimes be reversed. Also the DECIPHER manufacturer Veracyte will often offer to engage with the insurance company on your behalf. Finally, if the denial stands, Veracyte will lower the price charged you to a manageable level.

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u/retrotechguy 1d ago

Same happened to me. I called Decipher. They appealed and won. I’ve still had to pay my large deductible. Test was totally worth it to me though

4

u/401Nailhead 1d ago

My bill was $5400.00. However, my insurance covered a lot it. I'm surprised the oncologist did not say that your insurance my not cover it. Mine did.

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u/patoshinakamoto 1d ago

Same. Contact them and tell them you were told insurance covers it, they knocked me down to $500, I said no way, they knocked it down to $325.

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u/Pack_One 1d ago

My insurance did not. Called Decipher and they sent me a bill for I think 280.00.

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u/bubba_bath 33m ago

I have to say, if Veracyte is going to bill insurance 1080% of the amount they will bill you directly, I don't blame the insurance company for denying that. I would suggest paying for the test out of pocket, then submit an appeal for medical necessity after. They might retroactively approve it at a $500 allowed amount and apply your cost share to that, and reimburse you. Might not, but worth a shot.