CrohnieToo ~ question for ya

bump

Thanks for the bumps, Ivy!!!

Yes, to the best of my knowledge, Genova is still the only lab in the USA doing the fecal calprotectin test as developed by Magne Fagerhol, etc.

Genova bills $140 or $149 to Medicare and Mediare has been paying for it as it is some form of ELISA assay and is billed under that code. I don't remember looking to see what Medicare actually pays for it nor what my secondary insurance pays but I think Genova accepts just the Medicare reimbursement.

I usually get a form from Genova stating it is NOT bill but stating the amount billed about the same day my gastro gets the FAXed results.

Now, I understand some doctors give you the kit and have you bring the results back to them for shipping in which case the billing may be different.

My gastro gives me the signed order/script and the entire kit w/packaging for pre-paid shipping, etc. and I do the collection, call DHL and have it picked up and shipped. She only "kicks loose" w/ONE kit at a time.

Now, I "have" heard of doctors who handle it all themselves - and charge extra for the "handling". That's a crock and NOT what Magne had in mind when they were developing the test. What they had hoped for, but FDA wasn't going along w/it, was a home test kit. The patient could have several kits at home and submit the sample when they felt it was necessary. They didn't anticipate the need for a script nor insurance involvement since they aren't in the USA.

Whoa!!! I just checked my Medicare statements! Genova bills Medicare $149 for the fecal calprotectin test. Medicare allowed and paid $27.42 and there was no copay necessary!!

Now THAT US$27.42 is the price range that Magne had been aiming for!!

With Medicare there is a Billed amount, then a Medicare Allowed amount, then the 80% Medicare pays for some claims and the 20% copay.

For instance, in the case of an office call to the doctor:
Say the doctor charges $70 an office call, the Medicare statement will show:
BILLED amount: $70.00 - ALLOWED amount: $57.96 - PAID amount: $46.37 - CO-PAY amount: $11.59

I checked the statement for my local hospital's outpatient lab, unfortunately, since the CRP was part of several tests done on one blood draw the breakdown isn't as complete. But evidently there is no copay for lab tests. (I never checked that close, guess I assumed my secondary was picking up any copays. Duh!)

CRP is approved and paid at $40
Sed rate (ESR) approved and paid at $29

Now amounts approved and paid can vary somewhat by Medicare CMS districts.

Ooh, thanks C2. I rarely check my email, but will now

Good luck with the dexa scan. I was wondering why you were online so early Is the sun up there yet?

I'm heading for bed shortly, so have a good day if I don't exchange posts again with you here.

I.