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Calprotectin cost

My insurance company doesn't cover calprotectin, so it's been $250 out of pocket for me each time. I tried appealing the insurance company but it was denied because "calprotectin is experimental." I found a lab in Chicago that does the test by mail order for $125 but the doctor has to sign up with the lab. My doctor is contracted with his employer not to sign up with any (non employer) labs. He would give me a requisition in hand, or be happy to fax the requisition to any lab but that's not good enough for this lab. Does anyone have any advice?
 
You can argue with the insurance company that it is not experimental. Several different brands of fecal calprotectin (FCP) tests have been approved by the FDA. Not being FDA approved is what most insurance companies use to claim that some drug or test is experimental, but clearly this does not apply to FCP.

Here is just one of several FCP tests from the FDA showing it has been cleared for use:
https://www.accessdata.fda.gov/cdrh_docs/reviews/K050007.pdf

Show this to your insurance company and shout that it is NOT experimental. The FDA has certified it as safe and effective, and they did so 12 years ago - that's hardly "experimental."
 
You can argue with the insurance company that it is not experimental. Several different brands of fecal calprotectin (FCP) tests have been approved by the FDA. Not being FDA approved is what most insurance companies use to claim that some drug or test is experimental, but clearly does not apply to FCP.

Here is just one of several FCP tests from the FDA showing it has been cleared for use:
https://www.accessdata.fda.gov/cdrh_docs/reviews/K050007.pdf

Show this to you insurance company and shout that it is NOT experimental. The FDA has certified it as safe and effective.
Thanks for answering. That document however doesn't justify using calprotectin for determining efficacy of a medication which is what my doctor is using it for. The manufacturer did not even try to get the test approved for determining the current extent of disease. I
 
Thanks for answering. That document however doesn't justify using calprotectin for determining efficacy of a medication which is what my doctor is using it for. The manufacturer did not even try to get the test approved for determining the current extent of disease. I
Just to determine if the patient has IBD or IBS. It's clear that I have IBD so they are justified in saying that it's experimental.
 
I have two daughters with IBD and one who only shows inflammation in her fecal cal test (not blood tests). We thought we had a good argument and nada. It's unbelievable because their negotiated rate for the test is $20. If you run the test 6 times over a year that is a total of $120. Would they rather surveillance scopes every other month? Or how about the cost of hospitalization or surgery for undertreated disease.

Obviously a ore point with me.

You are absolutely right. They cover the test for screening functional vs. organic disease in order to screen who should have scopes but still consider it experimental for disease monitoring.

Recently one of my daughter's tests was covered. The other wasn't. When I called to find out why, it seems the test was coded differently for each girl. The one that was coded as Crohn's disease small intestine was covered. The one coded as Crohn's disease of both small and large intestine was not covered. If you have small intestine disease perhaps submitting the test with different coding would work.
 
I have two daughters with IBD and one who only shows inflammation in her fecal cal test (not blood tests). We thought we had a good argument and nada. It's unbelievable because their negotiated rate for the test is $20. If you run the test 6 times over a year that is a total of $120. Would they rather surveillance scopes every other month? Or how about the cost of hospitalization or surgery for undertreated disease.

Obviously a ore point with me.

You are absolutely right. They cover the test for screening functional vs. organic disease in order to screen who should have scopes but still consider it experimental for disease monitoring.

Recently one of my daughter's tests was covered. The other wasn't. When I called to find out why, it seems the test was coded differently for each girl. The one that was coded as Crohn's disease small intestine was covered. The one coded as Crohn's disease of both small and large intestine was not covered. If you have small intestine disease perhaps submitting the test with different coding would work.
I may have found some relief from the cost of calprotectin. My step sister's husband is a naturopathic doctor in Oregon. In many states a doctor doesn't have to be an MD or a DO to order tests or even prescribe medicine. He said he would order the test from doctor's data. Doctor's data will send me a stool test kit and a mailer. That will mean that I will be paying only $125 instead of $250!
 

Lynda Lynda

Senior Member
Wait, I was just tested for C-diff and Calprotectin ( two stool samples. ) I had a C-diff stool test three years ago but don't recall a problem with my Insurance paying for it. I had my first calprotectin stool test this month, I hope I don't have to pay a lot of money for it "out of pocket." Recently I have have a blood draw, two urine samples and 2 stool samples plus a flu shot and a tetanus shot. I hope my Insurance company pays most of the cost. I called my Insurance company recently and have found out most things are going up in price.....medications, x-rays, ultrasounds.:(
 
Hi Lynda Lynda, I hope you have good luck with the coverage. My calprotectin from "doctor's data" ended up being only $80 because of the lack of mark-up that my step sister's husband gave me. I just finished paying for my last $250 calprotectin from the local quest lab.
 

Lynda Lynda

Senior Member
Great, I still have not received my billing from the lab for the calprotectin stool sample test. I have received all my other lab testing billings and they were very inexpensive. Always so many tests and always waiting to see how much everything cost.:ack::ack:
 
I was just quoted $400 for the two tests my dr wants.
No medical ins and just spent 35 days in the hospital.
Sry frusta our right about now

Lauren
 
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