Very Important News re: TNBC/BRCA testing

I am 74. Should I get the TNBC/BRCA testing? (Diagnosed 1/2011) I have a daughter and a granddaughter I'm concerned about.

I will and thanks for the info.

Just a quick reply for your mom. My tumor last year was 1.5 cm. Lumpectomy 3/7/11. All nodes clear. Stage 1, Grade 3. I was treated in Denver with ACT (16 treatments + Neulasta shots) followed by 30 RT. I had no issues. Both chemo and radiation went well. I am enjoying the Winter in AZ. I'm 10+ years older than your Mom and am glad I trusted in my Dr and my faith, refusing to listen to anything or anyone that would bring me down. Best of luck to you and your family.

Grateful for today wrote: Skclayton wrote: Judy--did you know that since Jan 1, 2012 the new medical care forbids for Tricare and other fed based medical programs to pay for genetic testing AND my BCBS refused to pay for it if you are diagnosed with BC 1 day past your 60th birthday Skclayton, Thank you for posting the above. No, I am not aware of the information you posted. There is another topic forum/thread:    http://forum.tnbcfoundation.org/very-important-news-re-tnbc-brca-testing_topic8458.html?KW=BRCA that has been addressing BRCA testing matters. I am going to copy your post onto that thread in hopes that others may post whatever updated information they are aware of. It may take a few days to checks out what you have shared....that is try to find the fine print so that we really understand what the status of BRCA testing is as of January 1, 2012. I am hoping some fine print or references might give additional clarification to the information you were given. With caring and positive thoughts to all, Grateful for today..........Judy

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Hi,

Skclayton posted the above on another thread.   (Above is my response on the other thread)

Does anyone have information about the new BRCA testing info Skclayton referred to?

Thanks.


Grateful for today..............Judy


Edited by Grateful for today - Apr 03 2012 at 12:23am

Dear Skclayton,

Hi Skclayton,

Sounds like you have already researched and tried multiple ways to have the BRCA test via insurance.

As you said, as of January 1, 2012, BRCA testing is no longer a benefit with Tricare.

For those with other government funded policies:
The following seems to be the current situation in general:    (always re-check for one's own case)
           Medicare:   BRCA testing is covered when certain criteria are met.
               (Myriad will go over the Medicare criteria for BRCA testing when one calls Myriad)
           Medicaid:
                  Each state has it's own policy about BRCA testing.
                         Some states cover BRCA testing and others do not.
                  For those states that do have a benefit for BRCA testing, each state sets it's own criteria
                          for when BRCA testing is covered.

One last thought.
You mentioned that you have already appealed the insurance denial.
Believe after an insurance denial for commercial insurance products like BCBS/Aetna/United etc,
       there is an option for an outside external appeal.   This is sometimes coordinated by the
       insurance's member services dept or the consumer affairs dept or the grievance dept.
If you have not had an external outside appeal, you may want to consider if this is an option and
how to proceed with your insurance company.

With caring thoughts to you,

Grateful for today...............Judy


Just a FYI for all.
From Myriad website:
Myriad Financial Assistance Program
Myriad is able to offer testing at no charge to uninsured patients that meet specific financial and medical criteria. Due to regulatory limitations, patients who are recipients of governmentfunded programs (ie, Medicaid, Medicare) or those that have any third-party insurance are not eligible to apply.

                 
            

Both of my insurances turned me down because I was over 60 at the time of diagnosis.  Doubtful you can get an insurance---especially medicare---to pay for the very expensive test.  You will be told the same as me---"too old".

debby,

Noticed there were no responses to your April post.   Sometimes that does happen........members
intend to go back and post a response.......or one posts on a day where there are a lot of new posts
..........and sometimes there are no definitive answers to questions asked.....or no one reading the forum
had a similar experience (believe others might have had the experience it's just they are not on the forum)
PLEASE if you or anyone post and do not get a response........post again asking for responses.
Was glad to see you posted after April on other threads and did get responses.


Sending you lots of caring and good thoughts,
Grateful for today..............Judy

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FYI.   Re; Myriad Genetics and the BRCA test pattern. Wondering what the outcome of this will be?   

SALT LAKE CITY, Nov. 30, 2012 (GLOBE NEWSWIRE) -- Myriad Genetics, Inc. (Nasdaq:MYGN) reported today that the Supreme Court of the United States granted certiorari(*) agreeing to hear the case of The Association for Molecular Pathology, et al., v. Myriad Genetics, Inc., et al (Docket No. 12-398). The Supreme Court will review the earlier decision by the U.S. Court of Appeals for the Federal Circuit, which declared that Myriad's composition of matter claims covering isolated DNA of the BRCA 1 and BRCA 2 genes are patent-eligible under Section 101 of the United States Patent Act.

Link for full article:
http://globenewswire.com/news-release/2012/11/30/508826/10014200/en/Supreme-Court-of-the-United-States-to-Hear-Isolated-DNA-Patent-Case.html



*
DEFINITION FROM NOLO’S PLAIN-ENGLISH LAW DICTIONARY of "certiorari"
Certiorari: Latin for "to be fully informed." In cases in which there is no appeal as a matter of right,
certiorari is a writ (order) by the appeals court to a lower court to send all the documents in a case so that the appeals court can review the decision. Certiorari is most commonly used by the United States Supreme Court, which grants certiorari when at least four Justices believe that the case involves a sufficiently significant federal issue.
Definition provided by Nolo’s Plain-English Law Dictionary.



Grateful for today...........Judy


Edited by Grateful for today - Dec 22 2012 at 11:52am

Debbie in England----please give us an update since April..................

I have TRICARE as my secondary (retired military) and since I was 60 years and 4 months at diagnosis, I am not under the 60 years ----as Steve indicates.  So Tricare denied me based on no family history and over 60 at diagnosis.