Insurance MAY cover EnteroLab A1+C1 Panel

[Summer S]

Hi Folks,

Been a while since I've been here, things are still hopping along here I see. I'll have to check out the new posts. I did add Shrimp and Cauliflower pancake recipe to the recipe forum earlier this week. I actually whipped it all up in my NutriBullet and got 6 small pancakes out of it, fried them in coconut oil which added nice flavor.

The saga continues on my getting the lab tests done. I just assumed that my insurance would not cover the abovementioned tests, so I ordered it and was going to send off my sample, but I decided to call my insurance JIC (just in case). They said they WOULD cover the ICD9 and CPT codes that were on my email receipt. I saw on EnteroLabs website there is a cancellation policy, that I can cancel my order and get all but $50 processing fee back. That's reasonable.

I already had an appointment with the Nurse Practitioner of the GI office where I had my colonoscopy done. After seeing the GI that did my colonoscopy and disliking him intensely, I had called and left a message that I wanted to see another GI about the LC diagnosis. Two days later I got a call and they said they had another GI look at my results and they said they would also prescribe Budesonide and that's it. I told the person that I refuse to take it because of the side effects, she asked what else she could do, did I want to see the NP? It only takes 10 days or so to get in to see her rather than a month or so to see another GI. So I said yes, I would see her. I thought she would know if the rest of the GIs in the practice would be pill pushers or open to alternative solutions.

I saw her yesterday and she said that that is what all the other GIs (5 more) in the practice would do as they have found that the Budesonide works for all their LC patients. If a patient has another flare up, they come back for more pills. I said that they must not have any patients with severe symptoms. No comment. I asked if they have heard of actually eliminating foods from diets to put LC in to remission. She said that yes, some people cut out things like coffee. I thought, ok maybe this isn't an open minded as I would like. I told her what I wanted to do, get the panel done with EnteroLab and eliminate offending foods and that I would need an order from her/that practice, to get it. She was fine with that, got a generic prescription pad, she checked with the folks there that do lab orders and they said that would work for a non-common lab, and wrote the order with EnteroLab's name on it. Thank goodness I thought to ask for that. Also, I showed her a prescription that the unlikeable GI gave me and I asked what it was for, she said it was for acid reflux. She looked at my records and could not see why he gave me that, so I tossed it. He had also told an assistant on the day I saw him to get me an endoscopy, I told her that he did one the previous week! Turns out he he meant that breath test. She called it a typo. I said I the breath test 10 days before, should be in my records, they had me do it again with the same result, nothing. How some of these doctors keep practicing (and not getting it right) is beyond me.

So armed with that I called EnteroLab (so nice to reach a person straight away, not listen to menus and pick numbers hoping they are the right ones to only find you ended up in CA and had to call the number that you called before and have no idea how you got on to CA and they couldn't help you...) and explained that I had already ordered the test, got the kit, has a sample waiting in the freezer and I had since found out my insurance would cover it. She explained that she would have to cancel my current order as the receipt date could not be changed, and a new order taken after the date of the order I got from the GI NP. Makes sense. Then she asked if I made sure that my insurance covered the stool version of the codes and not just the blood version.

Ah! I did not know that. So I said I would call my insurance company and then get back to her. I called and waited 20 mins. only to get disconnected, called again and waited only 15 mins. The gal there said they would cover the stool version IF I got a prior authorization mentioning the specific lab as it is not contracted with my insurance. An urgent request would take 72 hours to authorize, a standard request would take 10 working days to get authorized. I've got time, I can cancel my current order with EnteroLab within 60 days.

I called the GI office which only lets you leave a message or dial another number to do with changing appointments or billing. I left a message saying I saw the NP yesterday and need to speak to her re the order she gave me, I need a pre-authorization and it needs to have specific information on it, could she or somebody that does the pre-authorizations call me back. That won't happen today I'm sure as they close at 1pm.

So, if I can 'save' $489 with my insurance paying for the tests, I will be worth all the hassle.

In the meantime, I was eating pretty basically, no raw vegies, no fruit and I got C. So I have been having a plum a day and put a handful of baby spinach in my morning smoothie and that helps. I've been wrapping my eggs and bacon in corn tortillas (great idea Tex!) so have had no dairy (butter on GF toast) but I still get the sneezes now and again, head pain hasn't been around for a week or so. YAY!

So I am in pretty good shape thank goodness and am grateful for that. Just curious to see what else I need to cut out of my diet besides gluten, if anything.

[tex]

Hi Summer,

It's a shame that insurance adds so many complications, but that's certainly a lucky break that they will cover the tests (and your NP was willing to order the tests). The sample will keep as long as it's in the freezer, so the only loss will be in terms of time.

And it's good to hear that you're making progress with the diet, also.

Thanks for the update.

Tex

[Summer S]

Thanks for your encouragement, Tex!

I doubted a GI would order the test, didn't really expect the NP to, but she did.

Tis so appreciated,

Summer

[JLH]

I have LC and Entocort NEVER worked for me. Probably gave me Candida overgrowth though......

Great about your insurance.