David
Co-Founder
Has anyone here had the Prometheus IBD sgi Diagnostic done and knows what it cost them? We're trying to figure out what it costs with and without insurance so that we can add that information to the wiki. Thank you!
Cost of Prometheus IBD sgi Diagnostic
- Thread starter David
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I had the Crohns Prognostic, TPMT Genetics and the TPMT Enzyme.
My first GI ordered these tests and they were completely paid for by my insurance(Tricare Prime Remote). I did have a list of what they cost, but I believe I threw it out after I checked to make sure they would be covered. I do remember them being in the $200-$700 range.
Also, just FYI, I went for a second opinion at the University of Michigan Hospital (what an amazing difference) and the GI there told me that there is never any reason to order both the TPMT Genetics AND the TPMT Enzyme. It's just a waste of my insurance's $$$!
I was also told that at the UM, they never order the Prognostic test either. This is because the company doesn't publish how they get the results they give the Dr & patients and it didn't seem like the Dr.'s trustednthe results from the Prognostic. I thought it was interesting, also, I was happy to hear it since the percent of complications over the years all ranged in the 90's!
I know this didn't answer your cost question, but I hope it helps!
My first GI ordered these tests and they were completely paid for by my insurance(Tricare Prime Remote). I did have a list of what they cost, but I believe I threw it out after I checked to make sure they would be covered. I do remember them being in the $200-$700 range.
Also, just FYI, I went for a second opinion at the University of Michigan Hospital (what an amazing difference) and the GI there told me that there is never any reason to order both the TPMT Genetics AND the TPMT Enzyme. It's just a waste of my insurance's $$$!
I was also told that at the UM, they never order the Prognostic test either. This is because the company doesn't publish how they get the results they give the Dr & patients and it didn't seem like the Dr.'s trustednthe results from the Prognostic. I thought it was interesting, also, I was happy to hear it since the percent of complications over the years all ranged in the 90's!
I know this didn't answer your cost question, but I hope it helps!
Here is a Prometheus fee schedule they recently gave me(2/24) since I was having my Remicades levels checked.
I don't think all the the tests are related to IBD but I listed all the test and fees on the sheet they provided me. They gave me this upfront in case my insurance didn't cover the cost of these more "specialized" tests.
IBD sgi Diagnostic - $690.00
Thiopurine Metabolites - $270.00
Serum Infliximab - $125.00
Serum Infliximab / HACA Measurement - $225.00
FIBROSpect II - $350.00
TMPT Genetic Assessment - $395.00
Celiac Disease Serology - $290.00
Celiac Genetics - $509.00
Celiac Plus - $799.00
FIBRO Sepct - $350.00
I don't think all the the tests are related to IBD but I listed all the test and fees on the sheet they provided me. They gave me this upfront in case my insurance didn't cover the cost of these more "specialized" tests.
IBD sgi Diagnostic - $690.00
Thiopurine Metabolites - $270.00
Serum Infliximab - $125.00
Serum Infliximab / HACA Measurement - $225.00
FIBROSpect II - $350.00
TMPT Genetic Assessment - $395.00
Celiac Disease Serology - $290.00
Celiac Genetics - $509.00
Celiac Plus - $799.00
FIBRO Sepct - $350.00
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Mine was about $400 total - insurance paid it, so it was probably a negotiated price.
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My son had the Thiopurine Metabolites test and insurance denied it. Hospital cost, $980, negotiated insuranace rate, $680. (why do they have a negotiated price if it is a denied procedure.) I looked into paying it privately and the price was the $270 amount listed above and was told it we paid within 30 days the price would be $170. I would need to get a lab that did not have a contract with prometheous to do the courtesy draw.
Waiting on the appeal with insurance. Talk about a huge markup. The US medical system is not very cost efficient.
Waiting on the appeal with insurance. Talk about a huge markup. The US medical system is not very cost efficient.
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Hi - what is your insurance, if you don't mind my asking?
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Hi - did your GI suggest which one to order between the TPMT Genetics or TPMT Enzyme --- if he advised not to order both? Thanks!
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I had the Prometheus IBD test done twice and it did not show I had crohn's either time. The first I paid out of pocket about $400 and the second time, my insurance picked it up as I had the test run in a different facility. I do have crohns and just recently underwent a bowel resection for strictures. I don't know if anyone else had this experience with the test. This may be a topic for a different thread. My first gi went solely by that test even though I had other markers for crohns e.g. anemia, inflammation, scarring, high CRP levels, high white blood cell count, etc. I got a second opinion after three years of believing I did not have crohns.
I was told the test was right about $2000 and not covered by ins
also not reliable This was the rep telling me so I didn't pursue it
lauren
also not reliable This was the rep telling me so I didn't pursue it
lauren
David
Co-Founder
Wow Vonnie. Did biopsies of your intestinal tract show Crohn's disease that your GI ignored as well?
My son had a prometheus test, insurance did not cover it (blue cross) and we ended up paying around $450.
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As I speak my stomach is rumbling and grumbling but they can't seem to prove I have Crohns even after resection. On steroids another montha and then I'll have the Prometheus and any other tests. Biopsies showing nothing from the surgery and not cancer thank God.
I can't believe this disease is so hard to diagnose but I'm holding out for Crohns free until they either prove it -- or I have another resection. I'm not in pain, rarely have D...I feel pretty normal actually.
I can't believe this disease is so hard to diagnose but I'm holding out for Crohns free until they either prove it -- or I have another resection. I'm not in pain, rarely have D...I feel pretty normal actually.
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David what is the "Crohns test" that my GI has mentioned - do you know? Nice photo.
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Vonnie how do you know it is Crohns? Every GI I have had is either Crohns yes or Crohns no. Different diagnosis X 4. What determined that you have it?
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They did a small bowel follow through and found a stricture. I was having severe pain because food was not going through properly. My gi also went by my white blood cell count which was high, my crp which was high, and I had alot of symptoms: night sweats, fevers, joints that would swell for no reason, severe diahrrea, stomach pain, weight loss, anemia, etc. I had a bowel resection and when they went in, they found other skipped spots along my small intestine where inflammation was in between healthy areas so they had to take out a little more than they expected. I hope you can get a diagnosis and start feeling better.
I may be Johnny Come Lately here but just got the bill copy for this test, said they are sending to insurance for collection first then back to me in 45 days if not covered...it was $690.
I am currently fighting with my insurance about tests from Prometheus labs so I have all the bills infront of me. These are the full retail prices:
IBD sgi Diagnostic: $690
TPMT Generics: $395
TPMT Enzyme: $220
My insurance denied all the charges but somehow paid about $74 of the total $1300 bill. No idea what thats about.
IBD sgi Diagnostic: $690
TPMT Generics: $395
TPMT Enzyme: $220
My insurance denied all the charges but somehow paid about $74 of the total $1300 bill. No idea what thats about.
Hi,
My 19yo daughter just had these tests - Aetna HMO does not cover- awaiting appeals.
Test was $696, I believe.
My daughter was diagnosed with Crohn's 2 years ago after biopsies + inflammation/granulomas.
This year she's having big problems and can't seem to get under control. GI said her colonoscopy this time didn't show inflammation visually, but microscopic (biopsies) + for inflammation throughout entire colon. He thought this was more consistent with Ulcerative Colitis or a mixed disease. We did this test to get answers, but we are just more confused than ever.
Came back as pattern not consistent with IBD. I told the GI doctor to send them the pictures from her colonoscopy 2 years ago.
Does anyone know if Prometheus will discuss results with patients?
Her results were positive for EVERY genetic assay tested, every single inflammatory marker was elevated. However, the only serology marker that was elevated was Anti-OmpC IgA, and her IBD specific pANCA was normal.
I don't get understand.
My 19yo daughter just had these tests - Aetna HMO does not cover- awaiting appeals.
Test was $696, I believe.
My daughter was diagnosed with Crohn's 2 years ago after biopsies + inflammation/granulomas.
This year she's having big problems and can't seem to get under control. GI said her colonoscopy this time didn't show inflammation visually, but microscopic (biopsies) + for inflammation throughout entire colon. He thought this was more consistent with Ulcerative Colitis or a mixed disease. We did this test to get answers, but we are just more confused than ever.
Came back as pattern not consistent with IBD. I told the GI doctor to send them the pictures from her colonoscopy 2 years ago.
Does anyone know if Prometheus will discuss results with patients?
Her results were positive for EVERY genetic assay tested, every single inflammatory marker was elevated. However, the only serology marker that was elevated was Anti-OmpC IgA, and her IBD specific pANCA was normal.
I don't get understand.
I have Aetna as well (PPO) and am fighting an appeal with them now.
Here is how the IBD test works: They compare your daughters results statistically with the results of a sample of patients who they were told (by doctor's diagnosis) who either have Crohns, UC, neither but GI issues, or are totally healthy. The IBD result they show is simply the result of a statistical hypothesis test comparing your daughters results with those of the training sample.
I wouldn't worry too much about the fact it came back as not consistent with IBD if there is substantial clinical evidence to the contrary. Statistical tests can never be 100% accurate. The test sheet shows this test has a 74% "specificity" for IBD, which means that in validation data the procedure only identified 74% of the actual IBD patients as having IBD.
Therefore, I think what matters are the serology, genetic, and inflammation results, and your GI should use these to make a diagnosis. If your doctor doesn't know how to interpret these results maybe its time to look for a new doctor.
Here is how the IBD test works: They compare your daughters results statistically with the results of a sample of patients who they were told (by doctor's diagnosis) who either have Crohns, UC, neither but GI issues, or are totally healthy. The IBD result they show is simply the result of a statistical hypothesis test comparing your daughters results with those of the training sample.
I wouldn't worry too much about the fact it came back as not consistent with IBD if there is substantial clinical evidence to the contrary. Statistical tests can never be 100% accurate. The test sheet shows this test has a 74% "specificity" for IBD, which means that in validation data the procedure only identified 74% of the actual IBD patients as having IBD.
Therefore, I think what matters are the serology, genetic, and inflammation results, and your GI should use these to make a diagnosis. If your doctor doesn't know how to interpret these results maybe its time to look for a new doctor.
Thanks! It helps to know the percentages - that they miss as well as catch.
We're actually thinking for going for a visit at the Mass General Crohn's and Colitis Center.
My son has other totally different issues, and the program he's in with Children's Boston has been amazing. Therefore, we're hoping for a similar situation at Mass General.
Whatever is causing this flare to not respond to prednisone, Remicade, etc., she needs help that's beyond local. It's a long trip from Florida, but it's been well worth it for my son, and we're hoping for similar for my daughter.
Thanks for your help!
We're actually thinking for going for a visit at the Mass General Crohn's and Colitis Center.
My son has other totally different issues, and the program he's in with Children's Boston has been amazing. Therefore, we're hoping for a similar situation at Mass General.
Whatever is causing this flare to not respond to prednisone, Remicade, etc., she needs help that's beyond local. It's a long trip from Florida, but it's been well worth it for my son, and we're hoping for similar for my daughter.
Thanks for your help!
No problem, glad to help. Boston has great doctors and hospitals so you can't really go wrong. I personally go to the GI clinic at Brigham and Women's hospital. The funny thing about Boston hospitals is they are all literally crammed right next to each other, so if you don't like one another isn't far away!
