Will my insurance cover the Oncotype DX test?

Genomic Health understands that many factors affect the decision to select the Oncotype DX^® test. One important consideration can be a colon cancer patient’s insurance coverage. Our Genomic Access Program (GAP) 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 U.S. whose authorized healthcare providers order the Oncotype DX test.

Through GAP, the patient’s authorized healthcare provider can request a Benefits Investigation to help determine if the Oncotype DX colon cancer test is covered by the patient’s insurance plan. Some insurers require a prior authorization before processing 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 assist in appealing this denial, with input from the patient’s authorized healthcare provider. However, in the rare 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 comprehensive financial assistance program for patients with financial hardship and a program for uninsured and underinsured patients based on financial eligibility.

GAP has been designed to assist patients and authorized healthcare providers with any billing or reimbursement issues related to the Oncotype DX colon cancer test. Genomic Health welcomes questions and encourages you to contact GAP if you have questions. Call Genomic Health Customer Service at 866-ONCOTYPE (866-662-6897).

As of September 29, 2011, Palmetto GBA, the designated national Medicare contractor for the Oncotype DX colon cancer test, have established a formal coverage policy for all Medicare patients. The policy covers men and women with stage II colon cancer. Palmetto's decision is based on the results reported from clinical validation trials performed using tissue from two Phase III randomized trials; QUASAR and CALGB 9581. You can reference the Palmetto GBA coverage policy by clicking here. Medicare coverage is effective for services performed on or after September 18, 2011.