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BRCA & HBOC
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Paying for Genetic Services

Locate medical experts and find information on insurance coverage and financial assistance for risk management, treatment and follow up care.

Related Force Information

HBOC, Cancer, and Your Legal Rights
2015 webinar by Anya Prince, Esq. on protections and laws related to HBOC and cancer.

An Advocacy Win for Cancer Survivors Facing HBOC
FORCE blog covers clarification by the Center for Consumer Information and Insurance Oversight (CCIIO), that insurance companies must cover the cost of BRCA testing in eligible women who have had a previous diagnosis of cancer.

Other Websites

Patient Advocate Foundation
A national nonprofit organization that serves as an active liaison between patient and their insurer, employer and/or creditors to resolve insurance, job discrimination and/or debt crisis matters relative to their diagnosis through case managers, doctors and attorneys.

Cancer Legal Resource Center
Cancer Legal Resource Center (CLRC) provides information and education about cancer-related legal issues to the public through its national telephone assistance line.

Medicare Rights Center
The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.


FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION (PART XXVI)
Clarification that under the Affordable Care Act insurance companies must pay for genetic counseling and BRCA testing in women who meet criteria, including coverage for women who have been diagnosed with cancer and who are asymptomatic.

FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION (PART XII)
Released by the Department of Labor, page 4 of this document clarifies that insurance companies must pay for both genetic counseling and genetic testing without any cost-sharing (no cost-sharing, no copays) for women who meet the United States Preventive Services Task Force guidelines for genetic risk assessment.

Center for Consumer Information and Insurance Oversight (CCIIO) at CMS
This is the agency consumers can contact for help when they feel they have been inappropriately denied services or were inappropriately charged a co-pay or deductible counter to the Patient Protection and Affordable Care Act. They run a helpline:

Direct: (410) 786-1565
Toll free: (887) 267-2323 ext. 6-1565

or email at: phig@cms.hhs.gov

Patient Advocate Foundation Guide to the Appeal Process
Step by step guide to writing an appeal letter. Includes sample appeal letters.

Center for Consumer Information and Insurance Oversight (CCIIO) at CMS
This is the agency consumers can contact for help when they feel they have been inappropriately denied services or were inappropriately charged a co-pay or deductible counter to the Patient Protection and Affordable Care Act. They run a helpline:

Direct: (410) 786-1565
Toll free: (887) 267-2323 ext. 6-1565

or email at: phig@cms.hhs.gov

Medicare coverage criteria for genetic testing
This site lists guidelines for BRCA testing under Medicare.

Myriad Financial Assistance Program
Myriad offers testing at no charge to uninsured patients in the U.S. who meet specific financial and medical criteria. Recipients of U.S. government funded programs such as Medicaid and Medicare are not eligible.

Invitae Financial Assistance
Invitae may be able to offer testing at limited or no expense to those who qualify for need-based financial assistance

Quest BRCAvantage Reimbursement Support and Financial Assistance
For uninsured and underinsured patients that meet or fall below the federal poverty level, testing is provided at no charge. Uninsured and underinsured patients who meet income requirements (household incomes of more than 100% and at/less than 400% of the federal poverty level) qualify for an out-of-pocket maximum of $200 for eligible hereditary cancer tests.

Ambry Genetics Financial Assistance Program
For under-insured, and in cases that meet their criteria, Ambry will limit patient out of pocket expense to $100.

GeneDX Financial Assistance Program
If patients satisfy the below requirements, they can be considered for our financial assistance program, which offers patients a discounted out of pocket cost based on their financial standing.
Qualifications for the financial assistance program:
You have healthcare insurance and are experiencing financial hardship
Patient’s GeneDx balance is greater than $100

Pathway Genomics Financial Assistance Program
The Pathway Genomics Corporation Financial Assistance Program (“Program”) is only available for those patients who (i) are uninsured, under-insured, or
qualify as medically indigent; and (ii) meet the financial and medical requirements of the Program.

Medical Diagnostic Laboratories Patient Financial Assistance Information
Medical Diagnostic Laboratories, LLC (MDL) puts forth every effort to make our testing available to those patients without insurance whose physicians have determined the tests ordered are medically necessary to assist with the patient’s diagnosis and treatment. MDL offers financial assistance to those patients that are uninsured and have a qualifying total annual gross household income.

FORCE:Facing Our Risk of Cancer Empowered