• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

New to the forum - Hey everyone!

In 2007, I was diagnosed with Spastic Colon. I had no idea that was related or in the family of IBS until just a few years ago. Over the last decade, my IBS morphed to IBS-D and then in 2016, I was diagnosed with Crohn's. Likely had Crohn's long before 2016 but ignored systems (typical guy) because in 2015, my wife was diagnosed with the rarest form of breast cancer, so I became a caregiver.

Now, like many of you, our health insurance (BCBS of South Dakota) is denying claims for fecal Calprotectin and a Humira anti-body level test done by Prometheus Labs. Calprotectin came in at 367 and anti-bodies showed negative, so the frequency of Humira treatments were increased to weekly. However, my stress levels are through the roof because I now find myself being stuck with an additional $2,800 in labs bills because BCBS is armchair diagnosing me, stating the tests are experimental and investigational, just like many of you. Really?

Anyway, my doctor suggested, a while back actually, that I join CCFA because it's a wonderful resource. So, hey there everyone!
 
I've had insurance initially deny coverage for lab tests but say that my doctor could fax a letter explaining why it was medically necessary. Is that an option you've tried?
 

dave13

Forum Monitor
Location
Maine
Welcome to the Forum. Sorry to hear about your insurance issues. It is something many of us share here in the good 'ol U,S of A. Do you have a good rapport with your doctor? Having a doctor call the insurance company and explain why a test is needed before it is done may help. Not always,but it is worth a try. This information does not help now,I know. Perhaps it may help in the future.

Is your doctor associated with a hospital? If so,there is a thing called good faith payments. You acknowledge your bill and pay what you can a month. I am doing that now. Perhaps it varies from state to state. I have bills from previous surgeries gone to collection agencies. I was surprised they were easier to deal with than the hospitals. Haha. I was able to come to a mutual agreement and I pay that amount each month.

Good luck to you.
 
Top