Crohn's Disease Forum » Treatment » Remicade/Infliximab » Does your insurance pay for Remicade levels/ antibody tests?


04-20-2018, 04:17 PM   #1
xmdmom
Senior Member
Does your insurance pay for Remicade levels/ antibody tests?

I am wondering if anyone has had luck getting insurances to pay for
1. Remicade levels
2. Remicade antibody levels.

It looks like my son's insurance policy is to NOT pay.

..considers measurements of serum levels of infliximab and antibodies to infliximab (human anti-chimeric antibodies (HACA)) (e.g., the Anser IFX test (Prometheus Lab) and InformTx therapeutic drug monitoring (TDM; Miraca Life Sciences)) experimental and investigational because the clinical value of these measurements for individuals receiving infliximab therapy has not been established.
04-20-2018, 05:23 PM   #2
Lisa
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Yes, I actualy just had the tests done (both results were GOOD!).....

My Doctor's office specifically told me to go to LabCorp, I did check with my insurance first also, and they said as long as I went to a covered facility/lab, they 'should' cover the test.....

Oh - I have United Healthcare/Empire Plan for coverage.....
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30 plus years and counting with UC/Crohn's!
on remicade since 11/05

While my experiences may not be what everyone has had- I feel it is worthwhile to share any and all experiences that may be beneficial to others.
04-20-2018, 05:59 PM   #3
Echodog
 
Join Date: Jun 2013
Yes, I actualy just had the tests done (both results were GOOD!).....



My Doctor's office specifically told me to go to LabCorp, I did check with my insurance first also, and they said as long as I went to a covered facility/lab, they 'should' cover the test.....



Oh - I have United Healthcare/Empire Plan for coverage.....


Mine didnít but they only charged me $250 since I qualified for financial assistance


04-20-2018, 06:31 PM   #4
Maya142
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I'm going to tag crohnsinct since she knows a LOT about this.
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
04-20-2018, 07:32 PM   #5
crohnsinct
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Join Date: Mar 2012
Location: California

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Hey there XMD!

Most insurance companies will not pay for this test. Knowing this and realizing that a lot of people would drop Remicade prematurely without knowing that all they needed was more drug, Jansen has a new policy where they pay for two tests per year per patient. Your doctor just needs to send the sample to Jansen's chosen lab.

Was the test done already? If so, what lab was it sent to? If Prometheus, they used to charge $2,500 for the test (it might be less now with the increase in competition). If your insurance denies the claim, they will file appeals on your behalf until they have exhausted all appeals. After that point, if your insurance still denies the charge they used to write it down to $250.

I have a thread here all about this but Prometheus is an OON lab for most people so it is actually to your benefit for insurance to deny the claim because otherwise you will be on the hook for your OON deductible and then your percentage co pay.

It takes over a year for this whole process to work it's way through.

All subsequent tests (same exact test code) would then be billed at something like $300 and same process with the appeals but I am not sure how far they write that down as I never got that far before Jansen started covering the tests.
__________________
Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Vit d 2000IU
Multi vitamin plus iron
Calcium

Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Remicade
Vit D 2000IU

Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
04-21-2018, 02:58 PM   #6
malorymug
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Miraca labs test are free! Janssen pays for 2 per year. Prometheus is much harder to get without paying out of pocket.

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Mom to: 15 year old boy
Crohn's in stomach, small intestine, large intestine, and perianal disease
Diagnosed April 2014, at age 13

Currently taking:
Remicade 10mg/kg every 6 wks
Methotrexate 7.5 mg/wk
Cipro
Augmentin
Miralax

previous meds:
6mp 50mg
Flagyl
Cipro
Prednisone 30 mg
05-15-2018, 04:19 PM   #7
Guywhocan
 
Join Date: May 2017
Location: Edison, New Jersey
Miraca labs test are free! Janssen pays for 2 per year. Prometheus is much harder to get without paying out of pocket.
Thank you for the info about Miraca. I will look into it. My sonís GI didnít mention it. He knew about Prometheus and the 2,500 cost.

He thinks that the labcorp esoterics test overstates the level of relevant remicade antibodies.
05-15-2018, 05:32 PM   #8
crohnsinct
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Join Date: Mar 2012
Location: California

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Jansen actually uses a few different labs depending on where in the country you are located. Your GI just has to process the test through Jansen and they cover the cost. They can check with them to see what the actual procedures are.
05-15-2018, 06:52 PM   #9
xmdmom
Senior Member
Thank you very much for this information!
05-23-2018, 12:55 AM   #10
Lynda Lynda
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Join Date: Feb 2018
Location: Arizona
Thank you for sharing this information.
Even $250 would be too much for me to pay.
05-24-2018, 06:49 PM   #11
TxGrizzlyBear
 
Join Date: Mar 2018
Location: Conroe, Texas

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I agree with you there Lynda! I can't afford that either. Hell, I'm having a hard time paying my utilities now as it is! Damn good thing the house is paid off otherwise I'd be in a real shit storm! I'll be discussing all these options with GI doc at next appt. This coming Tuesday I go for my 4th infusion and today has been a day from hell. Been nauseous most of the day and the diarrhea has been persistent. The only thing I am for sure positive that doesn't piss my digestive system off is rice, so I am going to go make a batch and go back to bed.

JB
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Montgomery County, Texas
Dx: Crohn's (March 2018)
Medication:
...Remicade
...Cholestyramine
...EnteraGam
...Budesonide
...Viberzi
...Paroxetine
Also have:
...GERD
...Gout
...Obstructive Sleep Apnea
...Major Depression/Anxiety
06-03-2018, 03:52 PM   #12
aypues
Senior Member
 
Join Date: Mar 2013
Location: San Diego, California
Thank you for sharing this information.
Even $250 would be too much for me to pay.
I just got word from my doctor that Prometheus will be lowering the non-covered rate to $75!
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