Will Insurance Companies Cover Molecular Testing for My Lung Cancer?

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What options do lung cancer patients have for having their genetic testing covered by their insurance?  Janet Freeman-Daily hosts this short discussion with Dr. Nisha Mohindra of Robert H. Lurie Comprehensive Cancer Center, and with Dr. Ross Camidge of University of Colorado-Denver.  Drs. Camidge and Mohindra discuss what they refer to as “multiplex testing” and explain how testing for two or three markers in one multi-test not only saves the patient numerous biopsies, but it also saves money since insurance companies will pay for EGFR, ALK, ROS1 and KRAS testing and multiplex testing is bundled.  

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Janet Freeman-Daily:

So I realize that doctors don’t have much visibility into patients’ insurance. But I know that most patients find their insurance will cover molecular tests for say EGFR, ALK and ROS1. But it might be more difficult to get tests covered for other things. How can patients explore this option of getting tested for other things without it coming out of their pocket? Do you have any options for that?

Dr. Mohindra:    

I—I know that some of the molecular testing companies will have financial assistance for patients. So if their insurance either doesn’t cover or covers only a small portion, they’ll try to—the company will try to help the patient with some financial assistance to make it a more reasonable cost. 

We don’t want these tests to, you know, put a patient out by any means. And we try to do our part into looking at the insurance. But I—I would say there’s some assistance from companies as well.

Dr. Camidge:       

The other thing that’s emerged is when, you know, not that long ago, we used to do one test. Then, we’d do another test. Then, we’d do another test. Each one would use up tissue and use up expense. Now, we can do a lot of tests at the same time, so-called multiplex testing. And what you find is maybe you test for 30 things, but you can only bill for three of them. But the billing for three through your insurance covers the cost of all of the other stuff. And so the other stuff just comes along for free. 

Janet Freeman-Daily:      

Okay. 

Dr. Camidge:       

But it kind of is one of the reasons why there’s been an emphasis to try and do multiplex testing from the get-go as opposed to trying to backfill something.

Janet Freeman-Daily:

Especially when—if a patient has just had a needle biopsy, they may not have much tissue. If they do all the moleculartests, they won’t have anything left for doing more extensive tests. 

Dr. Mohindra:    

And what we’re doing here is an in house panel of multiplex testing. So whatever the insurance would have covered, like you were saying, for EGFR and ALK and KRAS, ultimately, gets—covers that. So they end up getting 22 genes sequenced. And then, we can use all of the information. So I think that’s the better—if you can do that, it’s a nice way to go.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 


Page last updated on December 20, 2016