Dr. Esserman ordered the Oncotype DX Test for me over 1 month ago (see post “What is Oncotype DX?”)
Today I received Blue Shield’s denial letter stating:
“A physician advisor has reviewed the information provided and determined that the requested service would not be covered as medically necessary under the terms of this health plan per the BSC Medical Policy: “Gene Expression Profiling for Managing Breast Cancer Treatment.” Specifically, A Blue Shield Medical Director has reviewed the submitted medical documentation and has determined the service is not medically necessary as established in Blue Shield of CA Medical Policy. The clinical rationale used in making this decision is”:
– Documentation does not demonstrate that the patient was recently diagnosed (within six months)
– Documentation does not demonstrate that the patient will be treated with adjuvant hormonal treatment.
Now I know why BS stands for Blue Shield!
I called Blue Shield and reported a grievance. The process, they say, can take 30 days.
Here we go….