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Oncotype DXTM Testing

Be Aware of Unexpected Costs When Being Treated for Breast Cancer

If you are undergoing breast cancer treatment, the last thing you need is to be surprised with unexpected out-of-pocket medical expenses. 

It’s important to know what tests and procedures are covered by your health benefit plan.

More doctors are requesting genetic tests for breast cancer patients, specifically, the Oncotype DXTM test. This test is an eligible expense only if medical appropriateness criteria are met. This means a portion of the test may be covered by your benefit plan if specific criteria are met according to the BlueCross BlueShield of Tennessee medical policy.

Please talk with your doctor about test and treatment options available in order to make the most informed decision about your health care.

If the Oncotype DX test is appropriate for you:

  • Please ask your doctor to send a predetermination request to BlueCross before the test is conducted.
  • Reviewing medical necessity in advance will prevent payment delays and help you know what costs to expect.
  • If a predetermination request is not sent to BlueCross in advance, we will request your medical records when the claim is submitted.  

We want to provide you with the most accurate information and help you prevent unexpected out-of-pocket medical expenses. Should you have any questions about your benefit plan, please contact the member service number on the back of your BlueCross member ID card. 

More About Oncotype DX

The Oncotype DX test is only conducted by one provider, Genomic Health, a lab in California. Because Genomic Health is not a network provider, you may be liable for any amount charged that exceeds the maximum allowable charge. In addition, you may have to pay any co-payment, deductible and coinsurance amounts that apply.

If your coverage allows benefits for genetic testing, benefits will be paid for eligible expenses at the in-network benefit level up to any health benefit plan terms and/or limits and up to the maximum allowable charge.

If your coverage has a genetic testing limit, benefits will apply to that limit and you will be responsible for any additional charges.

If your coverage does not provide benefits for genetic testing or the testing does not meet medical appropriateness criteria, you will be responsible for the total charge submitted.   

Final determination will be made when the claims are received.  Payment of benefits remains subject to all health benefit plan terms, conditions and exclusions, including applicable pre-existing review, and the member’s eligibility for benefits at the time services are provided. 

Page Modified:May 18, 2012