my GI wanted me to take the Prometheus test before i get steps 2 & 3. so . . . i just got this letter from my insurance company that says:

[we] have reviewed the information submitted and determined that Immunoassay and Immunofluorescent Study is considered experimental or investigational and is not in accord with policy for the following reason(s): the clinical value of determining serum antibodies in evaluation of inflammatory bowel disease has not been established.

i've heard it's not 100% accurate, but isn't it still useful to take this test? for some reason my GI is really adamant about me getting it. thanx!

Hi! My insurance, Anthem BC/BS hasn't covered the cost of this blood test either. As I recall, it costs about $270 (at least it did a year or so ago when I last had it).

However, if you pay for the test BEFORE submitting it to your insurance company (right there in your doctors office before you have the test), there is a discount from Prometheus Labs--I can't remember if it's 10 or 20%.

I suggest you check with Prometheus Labs BEFORE having the blood drawn to see if there is still a discount and what the current discount is.

I have the test once in a while to see how 6MP is affecting my liver (I think). Prometheus Labs is in California.

Flora Q,

I had the Prometheus blood test done recently and my insurance company (ConnectiCare) covered the test. Please note that there are different tests Prometheus does and I am not sure if the one your GI ordered is the same one I had. That might be the reason for the denial. Prometheus has like 7-8 different tests that they do. If you are not being ordered for the cheapest, basic diagnostic test that could be the real reason behind the denial, although I am just speculating. It's also possible that some insurers are starting to question the scientific validity of these tests.

The test I had was the IBD Serology 7 which costs $445 without insurance coverage. That is the basic, cheapest test, from what Prometheus told me. Prometheus also does other more expensive tests ranging up to $799. I let Prometheus deal directly with my insurance company and they were happy to do so and they were effective in doing so. More about my experience dealing with Prometheus directly here in this thread (see post #5 in the thread in particular although I think this link takes you right there):

http://j-pouch.org/eve/forums/a/tpc/f/3251071921/m/5891...581026582#8581026582

This message has been edited. Last edited by: DJBHusky,

Most regular labs can do IBD serologies that do not need to be sent out to Prometheus Labs. Of course, Prometheus claims that their new matrix is superior to other tests and more accurate for diagnostic purposes. However, even with that, the consensus in the medical community is that none of these tests can be relied upon for diagnostic certainty and tissue biopsy provides the most information.

Sometimes (actually many times) less is more and having every single diagnostic study available will not alter your treatment options or eventual outcome, so it can be money down the drain. One thing you might do is ask your doctor why he is so adamant about it, and if so, perhaps he should write a letter of medical necessity to the insurance company. It might help, but as long as the insurance company considers something experimental, it can exclude it from coverage.

Jan

When I had the tests, the results all pointed to UC. But the interpretation said it suggested crohn's.......consequently, my GI disregarded it as inconclusive and went with biopsies anyway. Insurance did cover it.....sometimes I wonder how many wasted tests I've had. Ok, maybe I should let the doc be the doc, but lately I don't do the bloodwork unless I want to know the results.
LoriP