What differentiates the anatomic stages of breast cancer? How does this affect my eligibility?
There are five different anatomic stages of breast cancer: 0, I, II, III, and IV. These stages tell you how much the cancer has grown and spread. For example, stage 0 cancer is an early form of non-invasive cancer that is contained in one place, while stage IV is cancer that has spread throughout the body. If you have stage I, II, or IIIa breast cancer, you may be eligible for the Oncotype DX Breast Recurrence Score test.
If you have ductal carcinoma in situ (DCIS), you have stage 0 (non-invasive) cancer. “In situ” means all of the cancer cells have not spread outside the milk duct. Only patients with DCIS are eligible for Oncotype DX Breast DCIS Score test.
Learn more about the anatomic stages of cancer.
What is the GAP?
To ensure patients can focus on their health, Exact Sciences created the Genomic Access Program (GAP), which helps eligible patients determine payment options for our tests. We work with providers, patients, and insurance companies to investigate coverage and complete any prior authorization requirements, where applicable.
How much will this test cost me/how much does the test cost?
Out-of-pocket (OOP) costs for the test, if any, are determined by the insurance company. You may have financial responsibility for a co-pay, co-insurance, deductible, or non-covered charges as determined by your insurance. We strongly encourage patients to contact their insurer when they have questions about their plan design and benefits.
How will I know if my insurance covers testing?
Coverage depends upon various factors, such as your insurance’s medical necessity criteria and benefit plan design. Your out-of-pocket costs for the test, if any, are determined by your insurance company.
What if I don’t have any health insurance coverage?
If you don’t have insurance, our Customer Service team will help you determine your eligibility for financial assistance and explore the best options available to you.
Do I qualify for any financial assistance?
Exact Sciences offers financial assistance for eligible patients based on the Federal poverty guidelines. If eligible, both insured and uninsured patients will have no out-of-pocket costs. Click here to see if you could be eligible for testing at no cost.
To complete our full financial assistance application, please see/download The FINANCIAL ASSISTANCE (FA) DISCLOSURE FORM AND APPLICATION for more information.
Disclaimer: Exact Sciences may modify or terminate its Genomic Access Program (GAP) and/or financial assistance options at any time.
Do you offer payment plans?
Yes, we offer flexible payment plan options. You can sign up for a payment plan using our patient portal or by speaking to Customer Service. We also offer automatic monthly bill payment options as well.
Does Medicare cover testing?
Testing is covered by Medicare Fee for Service (FFS) for patients meeting coverage criteria. Patients who meet clinical criteria for coverage usually have zero financial responsibility.
For patients who do not meet Medicare criteria, an Advanced Beneficiary Notice (ABN) is required before receiving services considered not medically necessary. In these instances, you will be responsible for the test cost should you still choose to proceed.
What do I do if my health insurance sent me a check directly?
In the event your insurance company sent you a payment to cover the testing performed by Exact Sciences, please forward the payment to us using the instructions below. If you have already cashed the check from your insurance, you can mail a personal check to us or make an electronic payment via our patient portal.
- Endorse the back of the check by signing your name and writing “Pay to the Order of Exact Sciences”.
- Mail check to:
PO Box 742415
Los Angeles, CA 90074-2415
- Include any paperwork you received from your insurance company with your payment. Otherwise, ensure your full name, date of birth, and mailing address are enclosed so we can apply the payment to your account.
How can I pay my bill/balance?
Our convenient patient portal is an easy way to check your account balance, set up payment plans, or make recurring payments automatically. Visit My Lab Bill for more information.
How do I appeal a denial decision from my insurance?
With your consent, Exact Sciences can pursue appeals on your behalf if appeal options are available. The appeal process can take several months.
How do I provide my insurance information or updated insurance information?
I received an explanation of benefits (EOB) from my insurance, is this a bill?
You may receive multiple EOBs from your insurance. You will only receive a bill from Exact Sciences if payment is required after the claim is fully processed. Contact Customer Service with any questions.
Below are videos that can help you learn more about early-stage invasive breast cancer, treatments and personalizing your breast cancer treatment with Oncotype DX.
If you have questions about the Oncotype DX test and would like to speak with a knowledgeable customer service specialist at Exact Sciences, please contact us.
Oncotype DX - Outcomes Matter
As the only test proven to predict chemotherapy benefit, the Oncotype DX Breast Recurrence Score® test is included in all major cancer guidelines worldwide and now considered as standard of care for women with early-stage breast cancer with results from the largest-ever adjuvent breast cancer treatment trial with over 10,000 patient participants.