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BC/BS & PGx Health

katcarn
0 Recommendations

PGx Health (Familion) contacted our insurance company (BC/BS). PGxHealth sent us a written confirmation. Apparently the cost for the genetic testing is $5400. We have a deductible of $300. We have to pay $300 + 30% of the balance ($5100) = $1,530. However, when I called the insurance company to confirm this, the representative said that genetic testing is not covered only if it applies to conceiving (reproduction); it has to be a medical necessity. Does anyone know where I should go from here. I do not want to get genetic testing done unless I know it will be paid for. The genetic testing would be for my 17 year old son who is restricted from ALL activities. Any help you can give me would be greatly appreciated....

4 replies

Genell

My 13 year old daughter had the Familion genetic testing done earlier this year. Our children's hosptial, being a university hospital, stated that if our health insurance would not pay then the hospital would pay due to research on Long Q-T. Her results came back positive for LQT type II. The rest of our family of 6 was tested, however the hospital did not pay the $1000. per family member only the initial $5400 for my daughter. We picked up the difference and found out that my husband and 16 year old son have LQT too. You might discuss the possiblity of the hopsital picking up your bill if it is only you.

asweetnam

Hello from Atlanta,

I understand my 17 year old daughter was diagnosed with LQTS last year. I am also with BC/BS and they paid the entire bill. Now our doctor wrote to BC/BS which must have helped Dr. Campbell is also head of Children’s hospital here in Atlanta. So I recommend you get your doctor to either write or contact Dr. Robert Campbell. Also if your company has flex spending I thought I was going to have to pay for the test so I put that much in my flex account last year needless to say I was so excited when I got the call from Familion telling me it was approved. Let me know if there is anything else I can do and tell your son to hang in there you as well

katcarn

Hi Genelle and hi Atlanta:

I called BC/BS again at the end of Dec and they said something different, that they will pay 70% of the "allowable amount" after our deductible and after Familion. They gave me no dollar amount and I have no idea what the "allowable amount" would be and we can't afford to take that gamble; so I am still nowhere with this; but all your information is very helpful. Thank you very much.

Longqtoo

Please contact Mary Jo Gordon at the CARE Foundation (800-404-9500) as soon as possible if you'd like some help regarding the genetic testing.

Longqtoo

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