FAQs & Videos

FAQs1-18


What is a genomic test?
A genomic test examines the activity of genes within a sample of tumor tissue. The Oncotype DX Genomic Prostate Score (GPS) is a genomic test, which can help determine how aggressive your cancer is.
What is active surveillance?

Active surveillance is a management plan for carefully monitoring the cancer in your prostate without treatment. Under active surveillance, you’ll have regular check-ups and ongoing testing, typically including

  • Checking prostate-specific antigen (PSA) levels.
  • Regular digital rectal exams.
  • Repeat biopsy as your doctor recommends.

Even with close monitoring via active surveillance, cancer might eventually progress. If your doctor observes any changes in your tumor, you might be advised to receive treatment.

When should the Oncotype DX GPS test be used?

If you are a man who has been recently diagnosed with NCCN® very low-, low-, intermediate, or high-risk prostate cancer, and have not yet begun treatment with surgery or radiation therapy, the Oncotype DX GPS test might be appropriate for you. The GPS test isn’t appropriate for those with advanced prostate cancer. The test can only be ordered by a licensed healthcare professional. See if the Oncotype DX GPS might be right for you.

Does the Oncotype DX GPS test replace other lab tests?

No. The results of the Oncotype DX GPS test are intended to be used together with the results of other tests that are performed to evaluate prostate cancer. These include PSA level, Gleason score, and clinical assessment of tumor stage.

How long does it take to get the results?

Once Exact Sciences receives the sample of your biopsy from your pathologist, it usually takes about two weeks for the results to be available. The Oncotype DX GPS report is sent to your doctor and/or the pathologist who submitted your tissue sample. Once they receive the report, they will contact you to discuss the results and their treatment recommendations for you.

Is the Oncotype DX Genomic Prostate Score test covered by insurance?

The Oncotype DX GPS test is covered by Medicare for NCCN® very low-, low-, intermediate-, or high-risk disease. Private insurance coverage varies. To help you navigate insurance and other payment options for Oncotype DX testing, Exact Sciences offers the Genomic Access Program (GAP). This program can help you determine if you have coverage, and if so, to secure reimbursement. If you don’t have coverage for testing, GAP will work with you to make an appeal and/or provide financial assistance when possible.



Billing FAQs

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.

  1. Endorse the back of the check by signing your name and writing “Pay to the Order of Exact Sciences”.

  2. Mail check to:
    Exact Sciences
    PO Box 742415
    Los Angeles, CA 90074-2415

  3. 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?

Please contact Customer Service to provide this 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.




Useful Videos

Below are videos that can help you learn more about prostate cancer and personalizing treatments with Oncotype DX Genomic Prostate Score test. If you have questions about this test, talk to your healthcare provider, or contact our Customer Service to speak with a knowledgeable specialist at Exact Sciences.

Your Oncotype DX Genomic Prostate Score Test May Help You Navigate Through Your Treatment Options

Your Oncotype DX Genomic Prostate Score test will arm you with additional information that may help you take charge of your cancer treatment decision with confidence.

REFERENCES

  1. Klein et al. Eur Urol. 2014.
  2. Cullen et al. Eur Urol. 2015.
  3. Van Den Eeden et al. Eur Urol. 2017.
  4. Eure et al. AUA 2017.
  5. Brand et al. Urology. 2016.
  6. Knezevic et al. BMC Genomics. 2013.
  7. Badani et al. Urol Pract. 2015.
  8. Dall'Era et al. Urol Pract. 2015.
  9. Lynch et al. Am J Manage Care 2018.
  10. Albala et al. Rev Urol. 2016.
  11. Bonham et al. USCAP 2016.
  12. Salmasi et al. J Urol. 2018.
  13. Eure et al. Urology. 2017.
  14. Leapman et al. PloS One. 2017.
  15. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. V.2.2021.
  16. Eggener et al. J Clin Oncol. 2019.
  17. Cullen et al. Urology. 2020.
  18. Data on file.

b. DOI: 10.1016/j.eururo.2017.09.013

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

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