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Insurance denying calprotectin stool test?

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Ulcerative Colitis
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Uniform Charlie
Veteran Member
Joined : Jul 2015
Posts : 1104
Posted 1/13/2020 6:34 AM (GMT -7)
Has anyone had issues with insurance covering this test? I got a denial letter saying this is considered "experimental" for my condition. Seems to be a standard test based on what I read from members here.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7223
Posted 1/13/2020 8:27 AM (GMT -7)
I think I read that happened to someone else here, too. That sucks. I would ask if your doctor can file an appeal for you.
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16389
Posted 1/13/2020 10:10 AM (GMT -7)
I've heard of some insurances denying it over the years. I think it is a stretch of the word experimental, it is not. As far as inflammation tests go, Calprotectin is one of the newer tests for it and with that it carries a higher cost than the C-Reactive Protein test does. In the end, it is bean-counters saying there's cheaper ways to get the same answer.
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CCinPA
Veteran Member
Joined : Dec 2014
Posts : 2235
Posted 1/13/2020 10:40 AM (GMT -7)
I would appeal it and see if you doc will send a letter that it is a standard test for IBD.
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Uniform Charlie
Veteran Member
Joined : Jul 2015
Posts : 1104
Posted 1/16/2020 5:05 PM (GMT -7)
I called the lab, which is connected to a local hospital. When they saw the bill get kicked back as "medically unnecessary" they just wrote it off.
No payment necessary.

Medical billing is ridiculous.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7223
Posted 1/16/2020 7:59 PM (GMT -7)
How strange. That's good though you can get the test.
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Eph
Regular Member
Joined : Nov 2010
Posts : 369
Posted 1/17/2020 5:30 AM (GMT -7)
Is there a reason for people with diagnosed UC to get that test? My doc says it is not a good substitute for colonoscopies.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7223
Posted 1/17/2020 7:38 AM (GMT -7)
Less invasive, way cheaper, way easier for the patient, no chance of risks/dangers with a giving stool sample...because of all of that, you can do it more often than you could reasonably ask someone to get scoped.
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Uniform Charlie
Veteran Member
Joined : Jul 2015
Posts : 1104
Posted 1/17/2020 8:09 AM (GMT -7)
All I know is what I have read. It is a decent way to monitor inflammation but reliability has been questioned. It is a more accurate test for UC inflammation than Crohns.

My old GI did not use it at all. This was my first visit with new GI. Perhaps he didn't want to scare me away by requesting I get a colonoscopy on the first visit but wanted to get a sense of what happening in my gut.
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 18981
Posted 1/17/2020 8:31 AM (GMT -7)
It depends on the dr. This test will show whether there is inflammation in the intestines. Depending on the range, say if's high the dr can add something to help reduce the inflammation. Or depending on the meds a person is on, it can help determine if a complete change in meds is needed.

I would rather do this test than have repeated scopes close together, lol.
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