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Posted 1/18/2018 6:42 PM (GMT 0)
Late last year I had a test done by Prometheus Laboratories (it was requested by my GI) to see if I could take Azathioprine. I just got a letter from Prometheus saying that my insurance provider (United Health Care) has denied their claim and they want me to authorize them to appeal on my behalf. This seems kind of weird, but I guess if anybody is going to have any knowledge of this it would be them. Anyone have any similar experience?
Posted 1/18/2018 6:58 PM (GMT 0)
They did the same for me with a remicade antibody test. After two appeals, my insurance still denied them. They charged me a flat rate that was much, much lower than they billed my insurance.
Posted 1/19/2018 2:36 PM (GMT 0)
Thanks John. I faxed in the authorization and will wait to see what happens.
Posted 1/19/2018 3:46 PM (GMT 0)
Let it play out and see how it goes. Insurance might pick it up under appeal. They can file up to 3 appeals to your insurance company.

In the worstcase (insurance rejects it) then at least your cost isn't huge. Still stinks though! Prometheus should bill you only $250 (price I know for infliximab concentration test, which you didn't get) if the test isn't covered. I'm not sure what the charge is for the Thiopurine metabalites test, might be similar. They also have a patient assistance program that drops the test down to $75 depending on proof of income.

http://www.prometheuslabs.com/Resources/Financial_Asssistance_Application_Form.pdf

Just an FYI, if you need another thiopurine metabolites test, it can be done through most labs now. Prometheus created the test, but others have copied it. So, you can get a lab order to go to quest diagnostics, labcorp, or any of dozens of other labs. Sometimes health insurance tells you test are free if you use Labcorp, or somebody else whom they have a special agreement with on cost.

Oh the joys of chronic illness, dealing with health insurance companies, labs, doctors, and all of this other BS. *grumble*, it shouldn't be hard at all, but unfortunately it is!
Posted 1/24/2018 9:25 AM (GMT 0)
I had Prometheus tests a few times. Generally I had to pay the flat $250, but one time they said insurance had flat-out denied my claim and I owed quite a bit. I called to figure out what to do, and they offered to check with insurance and then send me a form for financial assistance. I filled out the form and didn’t hear from them again, so either it worked out or I’m going to get a very old bill at some point!
Posted 1/24/2018 11:21 AM (GMT 0)
I had the Remicade antibodies test done about 2009. It was not covered under insurance. I was getting Remicade infusions every 6 weeks although they were no longer effective. These ineffective treatments were covered under insurance.

The Promethius test confirmed that I had developed antibodies and my infusions were stopped. Kind of strange that, if I had not taken the test, the way more expensive Remicade treatments would have continued, covered by insurance.
Posted 1/24/2018 1:31 PM (GMT 0)
Just an FYI to others. The remicade antibody test is now generic as well, so dealing with Prometheus isn't necessary anymore. I got one a remicade antibody test done at Labcorp and my insurance covered it in-full. There's a number of other labs who will do the test as a generic, so ask around!
Posted 1/27/2018 7:32 PM (GMT 0)
How soon after starting Remicade should you have the antibody test?

Oh, I also got a bill from Prometheus this week, seems that UHC did cover a portion and I only owed $88 or so. I was expecting it to be thousands!!
Posted 1/27/2018 8:50 PM (GMT 0)
Antibody/concentration test is only really needed upon suspected loss of response. It's helpful in judging dosing but the ideal concentration is a bit guesswork even with that test result. Greater than 3 concentration is good according to the test but patient response varies, some needing higher concentration.
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