This is kind of a set back for women to find out if they have the potential of developing breast cancer, although it is not ruled out, the insurance company is starting a new procedure to having prior notification sent to their offices so they can monitor which patients are having the genomic blood test done. United stated they may also contact the provider office to get additional information before an approval process takes place.
The test costs $3000.00 and a spokesperson at United stated that 80% of the women being tested, should not be. It appears if you can’t substantiate the test (and again I’m not sure how that is really done and what algorithmic formula would be used) you are on your own ticket to have to the test to see if you are more likely to develop breast or ovarian cancer. Hopefully soon we may have a partial answer with complete sequencing taking place some day.
Anyway, if you are covered by United you might be in for some more red tape to have the test covered and the articles says they will offer you genetic counseling. It appears that having that upfront knowledge and having your carrier pay for the information that we thought was so great to know for early protection is suffering in the reigns and the availability to have the blood test may get a lot tougher. BD
United Healthcare is requiring that Myriad Genetics first inform the insurer before testing policy holders on its BRACAnalysis test to establish their hereditary genetic risk for breast and ovarian cancer.
"During the current difficult economic environment, United Healthcare recently instituted a prior notification requirement for BRACAnalysis," Gregory Critchfield, president of Myriad Genetics Laboratories, told analysts and investors during an earnings call this week. "We have been working very closely with United Healthcare to assist physicians [with regard to] UHC's prior notification policy."
By instituting a prior notification policy and placing Myriad in charge of determining which patients get tested, United Healthcare can monitor more closely which of its policy holders are receiving testing on BRACAnalysis. This type of strategy suggests that in the future, if United Healthcare finds that too many women are being unnecessarily tested on BRCA testing, the insurer may renegotiate its contract with Myriad.
In a July bulletin, United Healthcare informed Myriad that as of Aug. 16, the company must record and submit for verification the information required to assess a patient's genetic risk for the BRCA mutation and to make a coverage determination.