Hi folks,
I'm hoping some of you have experience with this lab, because Im unable to get any definitive answers otherwise.
It's 4 weeks after my 5th dose of Remicade. Ive had Crohns for ~20 years, been through pretty much all the meds and a couple surgeries and am also taking Azathioprine.
At this point in the cycle my Dr. likes her patients to get the Prometheus Anser IFX lab done exactly 4 weeks after their 5th infusion. As I understand it, it measure antibodies your body has built up to combat the medication and gives us an indication of whether or not Remicade will be a long term solution. It has definitely helped, but I did have a flare a few weeks back that put me in the hospital with a partial small bowel obstruction (lots of scar tissue and stricturing)
The problem with this lab is that it is not FDA approved (as I understand it) so most insurance companies reject it. The cost is $2500. After talking to Prometheus labs, they explained that they will bill my insurance and then go into negotiations once it is rejected. This can last up to 9 months. Once a final decision is made, if the insurance company flat out rejects it, the lab bills me $250 and eats the rest. I would do that, Ive spent a lot more than that in this journey. The worse outcome is if the insurance company accepts some part of that, say $1000 or $1500, since its out of network, I have a separate out of network deductible of $3000 so will end up paying the full residual amount out of pocket.
Has anyone been through this process? Any experience, especially with Blue Shield of California or similar is appreciated.
Thanks!
I'm hoping some of you have experience with this lab, because Im unable to get any definitive answers otherwise.
It's 4 weeks after my 5th dose of Remicade. Ive had Crohns for ~20 years, been through pretty much all the meds and a couple surgeries and am also taking Azathioprine.
At this point in the cycle my Dr. likes her patients to get the Prometheus Anser IFX lab done exactly 4 weeks after their 5th infusion. As I understand it, it measure antibodies your body has built up to combat the medication and gives us an indication of whether or not Remicade will be a long term solution. It has definitely helped, but I did have a flare a few weeks back that put me in the hospital with a partial small bowel obstruction (lots of scar tissue and stricturing)
The problem with this lab is that it is not FDA approved (as I understand it) so most insurance companies reject it. The cost is $2500. After talking to Prometheus labs, they explained that they will bill my insurance and then go into negotiations once it is rejected. This can last up to 9 months. Once a final decision is made, if the insurance company flat out rejects it, the lab bills me $250 and eats the rest. I would do that, Ive spent a lot more than that in this journey. The worse outcome is if the insurance company accepts some part of that, say $1000 or $1500, since its out of network, I have a separate out of network deductible of $3000 so will end up paying the full residual amount out of pocket.
Has anyone been through this process? Any experience, especially with Blue Shield of California or similar is appreciated.
Thanks!