Prometheus blood test

For those who have had the Prometheus blood test to measure the level of your biologic (mine was for my Entyvio trough level) — how much was your charge (total charged to insurance).

I just saw my EOB and they billed Medicare $2500!!!! I’ve seen expensive blood tests before but nothing even close to this. Medicate has denied the claim and there’s no way I’m going to pay them $2500! Hopefully if medicare won’t pay they’ll deeply discount for no insurance but I want a comparison. I know they bill insurance high to end up with a decent wmount after the discount but this is ridiculous.

Thanks!!

I pay $75 for Remicade level and that’s what they charge.

Prometheus always tries for $2,500.00 from your insurance, after denial they bill the patient $75. There's a Prometheus Links program which can reduce the cost based on your income. Any questions, I would give Prometheus a call and they are helpful. https://www.prometheuslabs.com/patients/insuranceandbilling.aspx

I had one prometheus test about 4 or so years back and that was their policy then.

I didn't have to negotiate. I just called and asked how much I would have to pay and they said $75. Easy peasy.

I was going to appeal the decision but last time I did that over a blood test I got nowhere. But sounds like your insurance doesn’t cover it either? No one at Prometheus told me it might not be covered (which they’re supposed to do) but it was probably in the fine print.

Keith was your test recent?

Thanks!

If you do not want to deal with Prometheus Labs again, you can get the test ordered generic through other labs. Looks like LabCorp has this test now, as an example.

https://www.labcorp.com/tests/504567/vedolizumab-and-anti-vedolizumab-antibody-i-dose-i-assure-vdz

I insisted on using labcorp. My Gi office tried to insist it couldn't possibly be the same test. I called Labcorp, and they mail it to Promethius. Office told me max I would pay with Promethius would be $250. Labcorp only bills $458 in my area, and even with them being out of network for me, my part was $25.

I got my insurance estimate of benefits in the mail today. The Humira test was $37 after insurance through Labcorps.

My update: still haven’t received anything from Prometheus so I assume they are resubmitting to try to get paid. Glad to have a bargaining chip that everyone else was charged $75, should I need it.