Who does braf mutation testing?
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Who does braf mutation testing?

› Forums › General Melanoma Community › Who does braf mutation testing?

  • Post
    • January 12, 2013 at 3:38 pm
    lou2
    Participant

    What does it cost and does insurance pay for it?  I found the Blue Cross of North Carolina policy online and it says only pay for later stages of melanoma.  Testing at earlier stages is considered investigational, so no pay.

    What does it cost and does insurance pay for it?  I found the Blue Cross of North Carolina policy online and it says only pay for later stages of melanoma.  Testing at earlier stages is considered investigational, so no pay.

Viewing 17 reply threads
  • Replies
      • January 12, 2013 at 4:40 pm
      awillett1991
      Participant
      Can’t answer you about insurance, mine was done before Zel was approved – trying to get into a trial, so Vanderbilt Paid. I was already stage 4. I’d think your oncologist would know who test. Any major research hospital would probably do their own.
      • January 12, 2013 at 4:40 pm
      awillett1991
      Participant
      Can’t answer you about insurance, mine was done before Zel was approved – trying to get into a trial, so Vanderbilt Paid. I was already stage 4. I’d think your oncologist would know who test. Any major research hospital would probably do their own.
      • January 12, 2013 at 4:40 pm
      awillett1991
      Participant
      Can’t answer you about insurance, mine was done before Zel was approved – trying to get into a trial, so Vanderbilt Paid. I was already stage 4. I’d think your oncologist would know who test. Any major research hospital would probably do their own.
      • January 12, 2013 at 5:02 pm
      JC
      Participant

      I don't know – I didn't ask or get prior approval, I just asked the Dr to have pathology test for it, and they did. I think I had a copay, but insurance covered their portion.
       

      • January 12, 2013 at 5:02 pm
      JC
      Participant

      I don't know – I didn't ask or get prior approval, I just asked the Dr to have pathology test for it, and they did. I think I had a copay, but insurance covered their portion.
       

      • January 12, 2013 at 5:02 pm
      JC
      Participant

      I don't know – I didn't ask or get prior approval, I just asked the Dr to have pathology test for it, and they did. I think I had a copay, but insurance covered their portion.
       

      • January 12, 2013 at 5:17 pm
      jmmm
      Participant
      Zelboraf is only used for stage 4 and maybe later stage 3??? patients. There’s not much purpose in b-raf testing, unless you would qualify for treatment. Oncologists should automatically test for it when tumors are removed at later stages and insurance should cover it, since it’s an FDA approved treatment. there might be a copay, but insurance should cover it.
      • January 12, 2013 at 5:17 pm
      jmmm
      Participant
      Zelboraf is only used for stage 4 and maybe later stage 3??? patients. There’s not much purpose in b-raf testing, unless you would qualify for treatment. Oncologists should automatically test for it when tumors are removed at later stages and insurance should cover it, since it’s an FDA approved treatment. there might be a copay, but insurance should cover it.
      • January 12, 2013 at 5:17 pm
      jmmm
      Participant
      Zelboraf is only used for stage 4 and maybe later stage 3??? patients. There’s not much purpose in b-raf testing, unless you would qualify for treatment. Oncologists should automatically test for it when tumors are removed at later stages and insurance should cover it, since it’s an FDA approved treatment. there might be a copay, but insurance should cover it.
      • January 12, 2013 at 5:32 pm
      POW
      Participant

      According to the AIM at Melanoma web site, "Which patients: Zelboraf is FDA-approved for patients who carry the BRAF V600Emutation and who have unresectable Stage 3 melanoma (melanoma that cannot be removed surgically) or Stage IV melanoma. Before receiving Zelboraf, patients must test positive for the BRAF mutation."

      If you meet these criteria for Zelboraf, you shouldn't have to be the one to "educate" the insurance company about the benefits of covering Zelboraf and the associated testing. The prescribing doctor (presumably an oncologist) should be the one to educate the insurance company, not you. If your oncologist will not join wiht you in your fight for insurance company approval, I would find a better oncologist. 

      The official Zelboraf web site has a page titled "Zelboraf Access Solutions" ( http://www.zelboraf.com/oncology/support/index.html ) that will help you and your doctor deal with the insurance company. It is in the manufacturor's best interest to help potential patients get funding for the treatment, so they will go to bat for you, too. 

      By the way, be sure you get the newest BRAF test (mentioned recently on this forum a couple of times). The old test gave too many false negatives. 

      • January 12, 2013 at 5:32 pm
      POW
      Participant

      According to the AIM at Melanoma web site, "Which patients: Zelboraf is FDA-approved for patients who carry the BRAF V600Emutation and who have unresectable Stage 3 melanoma (melanoma that cannot be removed surgically) or Stage IV melanoma. Before receiving Zelboraf, patients must test positive for the BRAF mutation."

      If you meet these criteria for Zelboraf, you shouldn't have to be the one to "educate" the insurance company about the benefits of covering Zelboraf and the associated testing. The prescribing doctor (presumably an oncologist) should be the one to educate the insurance company, not you. If your oncologist will not join wiht you in your fight for insurance company approval, I would find a better oncologist. 

      The official Zelboraf web site has a page titled "Zelboraf Access Solutions" ( http://www.zelboraf.com/oncology/support/index.html ) that will help you and your doctor deal with the insurance company. It is in the manufacturor's best interest to help potential patients get funding for the treatment, so they will go to bat for you, too. 

      By the way, be sure you get the newest BRAF test (mentioned recently on this forum a couple of times). The old test gave too many false negatives. 

      • January 12, 2013 at 5:32 pm
      POW
      Participant

      According to the AIM at Melanoma web site, "Which patients: Zelboraf is FDA-approved for patients who carry the BRAF V600Emutation and who have unresectable Stage 3 melanoma (melanoma that cannot be removed surgically) or Stage IV melanoma. Before receiving Zelboraf, patients must test positive for the BRAF mutation."

      If you meet these criteria for Zelboraf, you shouldn't have to be the one to "educate" the insurance company about the benefits of covering Zelboraf and the associated testing. The prescribing doctor (presumably an oncologist) should be the one to educate the insurance company, not you. If your oncologist will not join wiht you in your fight for insurance company approval, I would find a better oncologist. 

      The official Zelboraf web site has a page titled "Zelboraf Access Solutions" ( http://www.zelboraf.com/oncology/support/index.html ) that will help you and your doctor deal with the insurance company. It is in the manufacturor's best interest to help potential patients get funding for the treatment, so they will go to bat for you, too. 

      By the way, be sure you get the newest BRAF test (mentioned recently on this forum a couple of times). The old test gave too many false negatives. 

      • January 12, 2013 at 6:10 pm
      washoegal
      Participant

      I have Blue Cross also (not NC), I am Stage 3a.  Initially testing was disapproved as "investigational"  but the Onc somehow got it approved.  Don't ask me what magic words he used but they worked.  I thinl it's one of those that it's deny first then if appealed approve.  I've run accross a few of those situations.

      Mary

      • January 12, 2013 at 6:10 pm
      washoegal
      Participant

      I have Blue Cross also (not NC), I am Stage 3a.  Initially testing was disapproved as "investigational"  but the Onc somehow got it approved.  Don't ask me what magic words he used but they worked.  I thinl it's one of those that it's deny first then if appealed approve.  I've run accross a few of those situations.

      Mary

      • January 12, 2013 at 6:10 pm
      washoegal
      Participant

      I have Blue Cross also (not NC), I am Stage 3a.  Initially testing was disapproved as "investigational"  but the Onc somehow got it approved.  Don't ask me what magic words he used but they worked.  I thinl it's one of those that it's deny first then if appealed approve.  I've run accross a few of those situations.

      Mary

      • January 12, 2013 at 6:28 pm
      Janner
      Participant
      What stage are you? If early stage, insurance is unlikely to pay for a test that may yield no information for a current treatment. I would guess being stage 0, 1, or 2 would make it difficult to get testing paid for. If stage three or four, then I would appeal.
      • January 12, 2013 at 6:28 pm
      Janner
      Participant
      What stage are you? If early stage, insurance is unlikely to pay for a test that may yield no information for a current treatment. I would guess being stage 0, 1, or 2 would make it difficult to get testing paid for. If stage three or four, then I would appeal.
      • January 12, 2013 at 6:28 pm
      Janner
      Participant
      What stage are you? If early stage, insurance is unlikely to pay for a test that may yield no information for a current treatment. I would guess being stage 0, 1, or 2 would make it difficult to get testing paid for. If stage three or four, then I would appeal.
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