10/05/2015
Blue Shield Federal
P.O. Box 272510
Chico, CA 95927-2510
Explanation of Benefits: <Claim Number>
Dear Sir or Madam:
I am writing to request that you reconsider your payment decision for my Afirma Thyroid FNA
Analysis on <DOS>.
Dr. <Ordering Physician>, biopsied my tumor and the pathology result was “indeterminate,” a
classification that is not clearly benign or malignant. My physician recommended ordering the
Afirma test as a next diagnostic step instead of proceeding immediately to surgery.
As a result of the Afirma test, my tumor was diagnosed as Suspicious increasing my likelihood of
having cancer, and my physician and I were able to make an informed decision on the next
steps of my treatment.
I am requesting that you reconsider the payment amount determined for my claim and
substantially increase the amount paid for Afirma. Veracyte has contacted me and shared that
they have appealed my claim requesting further payment with no response. Veracyte also
shared that most Blue Shield members that are not Federal Employees have their Afirma tests
paid at rates exceeding $4,000, substantially reducing the amount owed by the patient.
It is inappropriate that there is a discrepancy in the cost sharing amounts between Federal and
non-Federal employees for the same service. Additionally, I find it unfair that you would
arbitrarily subject Federal Government Employees to such a large financial burden. Afirma
testing was able to help my physician decide on the next step in the treatment of my thyroid
disorder. If you do not increase the payment for this claim I will pursue the dispute process at
the Office of Personnel Management.
Please include myself and Flavia Beyer at Veracyte in all correspondence regarding my
reconsideration request.
Sincerely,
<Patient Name>
Subscriber ID: <Subscriber ID>