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Prometheus blood test

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Ulcerative Colitis
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted Today 5:16 PM (GMT -7)
For those who have had the Prometheus blood test to measure the level of your biologic (mine was for my Entyvio trough level) — how much was your charge (total charged to insurance).

I just saw my EOB and they billed Medicare $2500!!!! I’ve seen expensive blood tests before but nothing even close to this. Medicate has denied the claim and there’s no way I’m going to pay them $2500! Hopefully if medicare won’t pay they’ll deeply discount for no insurance but I want a comparison. I know they bill insurance high to end up with a decent wmount after the discount but this is ridiculous.

Thanks!!
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ks1905
Veteran Member
Joined : Sep 2005
Posts : 5857
Posted Today 7:02 PM (GMT -7)
I ended up paying $75 after my insurance denied my Stelara blood test. I had expected to pay $350 if my insurance denied it per their paperwork/plan. In the interim Prometheus changed it to $75(ish).

This was a few years ago so I may not be remembering the numbers exactly but it’s definitely close to those numbers
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countess18
Regular Member
Joined : May 2016
Posts : 421
Posted Today 7:10 PM (GMT -7)
I pay $75 for Remicade level and that’s what they charge.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted Today 7:43 PM (GMT -7)
That’s crazy they tried to get $2500!!!!
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16194
Posted 3/3/2020 7:46 AM (GMT -7)
Prometheus always tries for $2,500.00 from your insurance, after denial they bill the patient $75. There's a Prometheus Links program which can reduce the cost based on your income. Any questions, I would give Prometheus a call and they are helpful. https://www.prometheuslabs.com/patients/insuranceandbilling.aspx

I had one prometheus test about 4 or so years back and that was their policy then.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted 3/3/2020 5:14 PM (GMT -7)
Thanks John! I knew I’d have to negotiate but needed to know a possible goal to shoot for!
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CCinPA
Veteran Member
Joined : Dec 2014
Posts : 1572
Posted 3/3/2020 5:25 PM (GMT -7)
I didn't have to negotiate. I just called and asked how much I would have to pay and they said $75. Easy peasy.
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ks1905
Veteran Member
Joined : Sep 2005
Posts : 5857
Posted 3/3/2020 6:42 PM (GMT -7)
I was prepared to pay $350 (according to my GI’s office) and then Prometheus asked for $75. They said they changed their policies. No arguments
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted 3/4/2020 7:48 AM (GMT -7)
I was going to appeal the decision but last time I did that over a blood test I got nowhere. But sounds like your insurance doesn’t cover it either? No one at Prometheus told me it might not be covered (which they’re supposed to do) but it was probably in the fine print.

Keith was your test recent?

Thanks!
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ks1905
Veteran Member
Joined : Sep 2005
Posts : 5857
Posted 3/4/2020 7:56 AM (GMT -7)

FlowersGal said...
I was going to appeal the decision but last time I did that over a blood test I got nowhere. But sounds like your insurance doesn’t cover it either? No one at Prometheus told me it might not be covered (which they’re supposed to do) but it was probably in the fine print.

Keith was your test recent?

Thanks!

Probably about two years ago
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16194
Posted 3/4/2020 8:45 AM (GMT -7)
If you do not want to deal with Prometheus Labs again, you can get the test ordered generic through other labs. Looks like LabCorp has this test now, as an example.

https://www.labcorp.com/tests/504567/vedolizumab-and-anti-vedolizumab-antibody-i-dose-i-assure-vdz
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 3/4/2020 11:49 AM (GMT -7)
My GI uses LabCorp. It's still kinda pricey, but my insurance covers it. I think I may have owed $40-50ish after insurance for the Humira and Remicade tests.
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Spring
Veteran Member
Joined : Jan 2017
Posts : 528
Posted 3/6/2020 12:40 PM (GMT -7)
I insisted on using labcorp. My Gi office tried to insist it couldn't possibly be the same test. I called Labcorp, and they mail it to Promethius. Office told me max I would pay with Promethius would be $250. Labcorp only bills $458 in my area, and even with them being out of network for me, my part was $25.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted 3/6/2020 1:04 PM (GMT -7)
Sheesh! Thanks for the info. Haven’t got a bill yet. Will see what happens!
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 3/8/2020 7:45 PM (GMT -7)
I got my insurance estimate of benefits in the mail today. The Humira test was $37 after insurance through Labcorps.
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guybyny
New Member
Joined : Nov 2012
Posts : 13
Posted 3/25/2020 4:54 PM (GMT -7)
Hi..same here. After about 9 months of trying to get $2500 from my insurance they sent me a $75 bill last week and I gladly paid it.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 913
Posted 3/25/2020 7:37 PM (GMT -7)
My update: still haven’t received anything from Prometheus so I assume they are resubmitting to try to get paid. Glad to have a bargaining chip that everyone else was charged $75, should I need it.
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