Does your insurance pay for Remicade levels/ antibody tests?

[xmdmom]

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.

 

[Lisa]

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.....

 

[Echodog]

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 didn’t but they only charged me $250 since I qualified for financial assistance

 

[Maya142]

I'm going to tag crohnsinct since she knows a LOT about this.

 

[crohnsinct]

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.

 

[malorymug]

Miraca labs test are free! Janssen pays for 2 per year. Prometheus is much harder to get without paying out of pocket.

 

[Guywhocan]

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 son’s GI didn’t 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.

 

[crohnsinct]

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.

 

[xmdmom]

Thank you very much for this information!

 

[Anna's Bandit]

Thank you for sharing this information.
Even $250 would be too much for me to pay.

 

[TxGrizzlyBear]

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

 

[aypues]

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!