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This past week I had my annual well woman check-up/exam. Since this is routine preventative care the appointment is covered 100% from my insurance. BUT, something came up during my appointment that probably WILL end up costing me a pretty penny or two.

I just got a new doctor so I don’t know how this has never come up before with any of my other physicians, but when I was filling out my family medical history, my doctor commented on the incidence of cancers in my family. Specifically, my maternal grandmother and maternal grandfather had cancer at relatively young ages (prior to age 50). My grandmother had breast cancer and grandfather had colon cancer – both are known to be heritable. Because of my grandparent’s young ages and the heritability of these diseases, it raised a red flag and my doctor said she’d like run some blood to test for the genetic markers related to these diseases (side note: colon cancer, more common in men, is also related to uterine cancer in women.)

Maybe its just because genetic testing has been improving across recent years but I was kind of surprised no other doctor has ever brought up this possibility before. I decided I would, indeed, like to know whether I carry the genetic marker(s) that make either of these cancers more likely (and, along with these two cancers, several other cancer markers are checked as well). If I test positive for any of these markers then you can take necessary steps (along with more frequent/earlier examinations) to stay healthy. But, obviously, I’m hoping for negatives all around and a big sigh of relief that I don’t have any genetic loading for the most common heritable cancers.

My doctor explained that many insurance companies now cover this testing, at least in part. She said the way the process works is that they get my blood and send to the lab while processing with my insurance. If the out-of-pocket costs of the lab work will end up being $350 or less, they go through and automatically process it. If it will be over $350, they call and inform me of the cost and I can make a decision from there. I was a little shocked that $350 is the “magic number” they choose for informing patients. It still seems rather high and I wish I could provide my own figure (e.g., Give me a call if it will be over $200), but I didn’t get that option. My only option was blood work or no blood work, and given my family history I decided to opt for the blood work.

So right now it’s just a waiting game and I’m crossing my fingers that (1) my insurance will cover the blood work, and (2) the costs are minimal. I have no idea how that will turn out.

If I get the call that it will be over $350, I’m leaning toward declining the tests at this time. I could always have it done again in the future when I’m planning accordingly for this type of expense and can save up. $350 is no chump change!

What would you do? If you had red flags for a genetic predisposition toward certain types of cancer, would you do the genetic testing to find out for sure? How much would you be willing to pay out of pocket for the tests?

PS: Hopefully it comes back negative but – just in case – it’s a good thing I’ve already got my life insurance all wrapped up since genetic loading toward certain cancers would almost certainly pose a problem for getting life insurance for a reasonable rate!!


15 Comments

  • Reply Jackie |

    First let me say I don’t really have a great opinion on doctors. Honestly I wouldn’t get this done. My opinion is when my time comes then it’s my time to die nothing will stop it. Even if you are predisposed and have the markers it doesn’t mean you’d get it. I see doctors push all sorts of things because that is how they make money. I must say I just about never go to the doctor. I went for 2 years of getting blood work done and other tests to find out what was wrong with me. They couldn’t figure it out why I was so sick. Ended up being I was getting sick from all the stress from work and cleaning the infectious rooms at the hospital where I worked. I quit there and have been fine ever since and that was almost 4 years ago. I think the marker testing came popular when the celebrities started get it done. Honestly even if I found out I was predisposed to having something there is nothing I’d change in my life. I have lots of diseases on both sides of the family.

  • Reply Sandra |

    My suggestion would be to get the test — for your peace of mind. So much can be done these days if health problems are detected early. Also, discuss with your physician risk factors and lifestyle changes that might help prevent future problems. Additionally, you might want to check out the website “100 Days of Real Food”. This young Charlotte mother has made a concerted attempt to get additives and other less desirable ingredients out of her family’s diet. She says her family is much healthier now and some of their allergies, etc. have gone away.

  • Reply scarr |

    If you think it will be useful to know the results, get the tests. I also question why no other physician has followed up on your family history of cancer. Maybe it is dependent upon age? hmmm. . . Cancer is not very common in my family but strokes are. I’m of the opinion that it is better to know what you are up against so you can make preparations while you are still in control of the situation.

    Physicians don’t ask for tests because they want to make money (okay maybe some but certainly not all), they ask for tests because it is their job to monitor your health and have a better understand of your health history. Having a job means also receiving a salary. Testing and medical services cost money, much like every other service you utilize such as buying food or clothing.

  • Reply Jenna |

    My question would be how do the results of this genetic testing get used, or will they influence future costs or limit something for you.

    For example, if you test positive as being a carrier – even though you don’t have anything yet – does this provide your insurance with the right of not covering you. Or adding a rider to your policy with extra costs.

    Ultimately, good self care with regular annual physicals, self breast exams, bloodwork, may be a better option.

  • Reply Suzanne |

    Hi Ashley, I am a doctor working in breast cancer care. I hope you don’t mind me commenting here. I will mainly make some points about breast cancer but I think the same comments will probably be relevant to bowel cancer.
    Firstly most breast cancers are sporadic- that means they come out of the blue- unfortunately it is a very common condition these days. Only about 5% of cancers are due to one of the known genetic abnormalities. Doctors judge whether or not there might be a gene in the family by taking a family history- if there are multiple family members in a number of generations, the age at which they got their cancer, if there is any association with ovarian cancer and certain nationalities (eg Ashkenazi Jews).
    If there is an abnormal gene that has caused the cancer then 50% of their children will inherit the abnormality. (Half the children would have inherited the normal gene from their father). Given that you only have one second degree relative with breast cancer even if it was before 50 then I think that there is actually only a very low risk of having an abnormal gene in your family and therefore I would not recommend having the blood test. However if you are still keen to find out I think the best person in your family to have the blood test would be your mother- she is the most likely to have inherited an abnormality if there was one. If she is clear then you would be clear also. If she had it then you could be tested- just remember if you test positive then it opens up another can of worms- what to do with the information.
    Just so you know in Australia it costs $2500 to have the test, but it is probably cheaper in America.

    • Reply Ashley |

      Wow, thank you for the insightful comment! I can’t believe the cost in Australia! That’s exorbitant! The blood has already been drawn at this point but your comment has made me feel much more comfortable in declining the testing in the event that I receive a phone call saying the costs will be over $350.

  • Reply Judi |

    The cost of genetic testing is a bit inflated but it’s not really the doctors that are profiting, it’s usually the companies and a lot of that money goes back into research and development. As someone who does bench work the actual cost is primers for genes of interest ($7 per primers 2 primers per gene), perform a DNA extraction ($1 per sample), pcr amplification ($0.50 per sample), and then sequence amplified DNA ($8 per primer). But I work at a university so these costs may be higher in a hospital. I think it’s worth it since you’ve got 2 young girls and once you’re tested the insurance company covers preventative care for diseases you’re at risk for. Good luck! I’m sending positive vibes and prayers your way!

    • Reply Ashley |

      Wow, thank you for this information! It’s crazy to see the “actual” cost versus patient cost (which I don’t know yet – still waiting for a possible phone call and/or bill). Also, I didn’t know that insurance companies cover preventative care for diseases I’m potentially at-risk for. Makes sense, but good to know.

  • Reply Walnut |

    Assuming you don’t get the call and this test runs $325, where will this come out of your monthly budget?

    • Reply Ashley |

      It would have to come from my “dental/vision” savings (even though this is not dental/vision, it seems like the most appropriate savings to draw from). I currently have $310 in that account so that would cover the majority of it. Any excess would have to be from my “other” monthly budget. Crossing my fingers it won’t run that high, but that’s the plan if it does turn out to be that much.

      • Reply Walnut |

        Are you sure you place a higher value on this genetic testing than you do on getting your husband’s dental work complete? The intent of this comment isn’t to be snarky, but it’s about prioritizing the best possible spend of every dollar in your hands.

        I’ve irresponsibly agreed to tests, procedures, and additional spending on health care related manners that I ultimately would not have spent if I had just slept on the issue.

        I even recall once buying an extended maintenance plan on a vehicle even though I’m the sort of person who drops full coverage the instant it isn’t cost effective any longer. Fortunately I was able to change my mind on that one and get a full refund…BUT I did not get a refund on the extra sales tax I ended up paying on that stupid warranty. Had I just said, “Let me think about it overnight” I would have NEVER spent the money.

        • Reply Misti |

          Walnut – I agree with your intent; and as I was reading this it made me think; you are considering taking a vacation to see your family that will set you back about $1,000 (and you just saw them no matter how rushed it seemed) but don’t want to spend $350 on your health. My point here is that I really think you need to rethink your mindset and you definitely do not need to go on a family visit right now regardles of your decision about the genetic testing.

          • Ashley |

            I have to admit that your comment made me think…. basically I’m valuing family time over health costs. Is this wise? It’s not a necessary health cost (like a doctor’s copay if I’m sick or a prescription medication),which makes the scale tip in favor of seeing family over the health cost…. but its also not necessary to see family after I’ve just seen them. Of course, there are no guarantees in life, so is it wise to put off a family visit? Or is it wise to put of health care costs that could have serious implications? I don’t know. It all seems like more of a philosophical debate than a practical one. In terms of cost….I saw lots of people throw out the figure of $1,000 to visit family. I would have to sit down and add up some costs but I would highly doubt if it cost that much. First, my Mom often helps us with gasoline costs (though I don’t want to “count on” that since she hasn’t mentioned anything about it, but I know this is something she’s done for us in the past). And, second, we’re staying for free with family. We might have to break the drive into 2 days which would force us to get a hotel. But even with gas, food, and hotel costs I’m still thinking we’d be far from $1,000. I do agree this is something that requires additional thought instead of a quick knee-jerk reaction. I need to actually run some numbers, look at exact figures (like hotel costs) and think things through a bit more thoroughly.

  • Reply Jen From Boston |

    I would be concerned about who has access to this information, and if your life insurance company can use a positive result to hike your premium or drop you. There’s a law referred to as GINA(?) that applies to DNA information. I believe it is supposed to prevent health insurance companies from using that information for determining coverage, HOWEVER the law does NOT apply to life insurance!

    • Reply Ashley |

      I think that due to HIPAA laws no one would be able to access the results to these tests without my signed consent. But that issue aside, the type of life insurance I bought has a set term so the annual cost cannot be raised until the term is over (I went with a 20-year term).

So, what do you think ?