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Avoid Prometheus Labs!

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Ulcerative Colitis
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Posted 7/3/2014 7:03 PM (GMT 0)
I have had two blood tests related to my Ulcerative Colitis that have been processed by Prometheus Labs. One was a genetic test to see if 6mp would cause me trouble and another to check the level of Humira in my blood, and now it looks like I will be on the hook for thousands of dollars.

To begin with, before the first test I was told before hand there would be a reduced rate if my insurance did not cover it. Now they are denying it. I call that bait and switch. And the second test is just for a flat out ludicrous amount of money.

So, if you suspect your health insurance is not all that great I recommend refusing all testing done by Prometheus! mad
Posted 7/3/2014 7:25 PM (GMT 0)
Back some years ago my GI put thru some lab work to Prometheus. It was to determine if I had UC or CD. I had no idea my insurance wouldn't cover it. They claimed it was "experimental testing" and denied it. I was stuck with a huge bill. And that particular test isn't even all that reliable. Gigantic waste of time and money. Sorry you got stuck too. Try and fight it at least.
Posted 7/4/2014 12:14 AM (GMT 0)
BYEBYE,
I totally agree with you. Prometheus testing isn't definitive, and overall not very useful.
Posted 7/4/2014 12:44 AM (GMT 0)
I don't know about it's usefullness or not. It gets a lot of bad hype but I'm not sure the bad hype is totally deserved. My GI believes in the tests as a tool to use. Most insurances will not cover it in network so it is a good idea to get a commitment in writing from these people ahead of time as to the cost if insurance does not pay.
Posted 7/4/2014 2:25 AM (GMT 0)
If you don't use Prometheus, what tests do you have done to determine if you are reaching the concentrations of drugs like 6mp or azathioprine necessary for therapeutic benefit? My standard labs are fine, but my results from Prometheus show I'm not processing the drug well, am at an increased risk for liver toxicity and am not at the level of therapeutic benefit. We've based the decisions to move me off of 6mp to azathioprine off of the Prometheus results. Now we're making the decision to move from azathioprine to an infusion (hopefully vedo, but likely Remicade).
Posted 7/4/2014 2:31 AM (GMT 0)
^^ I should mention that the Prometheus 7 test, which is used to diagnose Crohns vs. IBD is not of great value.
Posted 7/4/2014 3:39 AM (GMT 0)
I had the "Answer IFX" test done by them last year to determine if I was gaining antibodies to Remicade. Before I did the test I got literature and phone confirmation that I would be held to no more than $250 of responsibility if my insurance did not cover it. Luckily my insurance (United Health Care at that time) did cover the test. But, it's always smart to check and see on those sorts of tests before you have them.

I feel it's shady though of any physician to prescribe the test if they have an idea that it might not be covered, and not forewarn you first.
Posted 7/4/2014 3:40 AM (GMT 0)
Also, please argue with them and stand up for yourself if they did lie to you at Prometheus. That publicity could be very bad for them and they need to know that. Work your way through until you find someone that cares there.
Posted 7/4/2014 12:41 PM (GMT 0)
My GI's office warned me that many insurances do not cover it and gave me an estimated cost if they didn't.
Posted 7/4/2014 1:16 PM (GMT 0)
Most health insurance does not cover Prometheus labs tests. They can file up to 3 appeals to your insurance company. Prometheus should bill you only $250 if the test isn't covered. 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
Posted 7/4/2014 8:54 PM (GMT 0)
My insurance refused to pay for Prometheus testing. My awesome GI sent them letters and journal articles on importance of testing (when I was messing w/ imuran dosage). And Aetna still refused. So I got stuck w/ the bills.
Posted 7/7/2014 11:41 PM (GMT 0)

Spartan4Life said...
If you don't use Prometheus, what tests do you have done to determine if you are reaching the concentrations of drugs like 6mp or azathioprine necessary for therapeutic benefit? My standard labs are fine, but my results from Prometheus show I'm not processing the drug well, am at an increased risk for liver toxicity and am not at the level of therapeutic benefit. We've based the decisions to move me off of 6mp to azathioprine off of the Prometheus results. Now we're making the decision to move from azathioprine to an infusion (hopefully vedo, but likely Remicade).


From my knowledge, Prometheus is not *necessary*. You don't need to check therapeutic concentrations of these drugs. There is a fixed dose of these drugs and one should not go beyond that. Forgot the dose now, should be there in my older posts somewhere.
If you are not processing these drugs, you liver function will be markedly off and that is an indication to either lower the dose and stop cold turkey.

When I started Azathioprine, I wasn't even living in the US. All my Swedish GI did was to check my liver function every time before raising the dose, i.e. every 2 weeks. All well, go ahead, not well wait for 2 more weeks. Once I reached the dose necessary, 150mg, he checked function for 3 months, each months and then every 3 months. All went well, no worries at all.
Posted 7/8/2014 1:16 AM (GMT 0)
For a recent test the Prometheus lab rep. said if the insurance didn't cover it the cost would be $250, if I provided a copy of the EOB (explanation of benefits) as proof denial.
Posted 11/19/2015 12:26 AM (GMT 0)
I had the test to determine genetics, serology and inflammation. I am going to follow my doctors advice. I checked to see what was covered and what was not first. Some was and some was not. I'd suggest this for all medical tests. My GI told me it may or may not be. Sorry you had an issue but I'd also suggest contacting them again. Getting to irate can effect the results very negatively. Again sorry to hear
Posted 11/19/2015 3:16 AM (GMT 0)
First of of all the original post was over a year ago. But 2 years ago I had a Prometheus test to determine the antibodies of Remicade in my system (which were fine btw) and even tho I consider myself lucky, I was responsible to pay $250. And before that, I also had the metabolite test to determine the 6mp in my system, I paid nothing. The prices that people have to pay for these tests tho are outrageous! How else are we to know how these meds are effecting us?? Seems it's a catch 22.
Posted 11/19/2015 3:43 AM (GMT 0)
Mayoclinic does the exact same testing and my insurance covered it.
For the test to check for antibodies to remicade and the amount in serum the code was infxr and my insurance covered it
The hospital just sent my labs to mayoclinic and it took only 2-3 days to get results if I can remember correctly.
Posted 11/19/2015 11:59 AM (GMT 0)
LabCorp offers some of the tests that used to be Prometheus only, such as the test for Remicade antibodies. My doctor did not know this - it's something I found out on my own - and I had to ask him to rewrite my lab orders so I could use LabCorp.
Posted 11/19/2015 12:14 PM (GMT 0)
The thiopurine metabolites test is no longer exclusive to Prometheus, it's available by quest diagnostics and labcore to name a few. I've heard labcore has the infliximab(remicade) levels/antibody test. There are generic options available now that might be covered in-network for usa health insurances.
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