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My son just went to his follow up with Dr. B. He is about 75% better but tics still not responding to prednisone or abx. He also had one reactive band in all the lyme testing he had. He recommended Igenex testing. I had seen here something about it cost $200 when I was trying to prepare myself for this expense.(we are also doing Cunningham) Well in looking at the chart the three tests he has ordered will cost $860! Yikes! not quite what I thought. I was hoping someone could tell me if they have had any luck getting insurance to cover it and how do I go about it. My son has Blue Cross Blue Shield and then he has United Health as secondary. The UH is through his father's work and is very limited compared to other UH programs from what I gather. My BCBS is usually pretty expansive however. I've just never had to seek payment myself through insurance so I don't know the right way to go about it.

 

Thanks for any info you can offer!

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I spoke with our insurance company (Tufts) and they said they would cover it if I got a letter of medical necessity from the doctor. I plan on asking Dr. B for that when we see him again on Monday. I hear you about the cost, though!! We had to do it for both kids.

 

Try calling BCBS and asking whether they would cover if you get a letter of necessity.

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We just had the doctor sign the Igenex form and paid for the testing with our credit card (listed on form). Then when Igenex finished the testing they sent us a detailed receipt to submit to insurance for reimbursement. Our insurance reimbursed us 70% in the past and just recently covered 90%. Our insurance does not require a medical letter of necessity.

 

Note- when submitting form to insurance, be sure to circle the comment of using the modifier code. Our insurance never applies it, and covers the IgM/IgG as one test (since they have the same cpt code). I always have to call them to get the rest reimbursed.

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Has anyone ever had to appeal their insurance rejection for Igenex? If so, just wondering how and what you said in the appeal letter.

 

Kara - I'll try the letter of necessity you mentioned. We were rejected by BCBC because the lab is out of network. 100% out of pocket! And we need to have our 2nd twin tested!!

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My son just went to his follow up with Dr. B. He is about 75% better but tics still not responding to prednisone or abx. He also had one reactive band in all the lyme testing he had. He recommended Igenex testing. I had seen here something about it cost $200 when I was trying to prepare myself for this expense.(we are also doing Cunningham) Well in looking at the chart the three tests he has ordered will cost $860! Yikes! not quite what I thought. I was hoping someone could tell me if they have had any luck getting insurance to cover it and how do I go about it. My son has Blue Cross Blue Shield and then he has United Health as secondary. The UH is through his father's work and is very limited compared to other UH programs from what I gather. My BCBS is usually pretty expansive however. I've just never had to seek payment myself through insurance so I don't know the right way to go about it.

 

Thanks for any info you can offer!

 

I know what you mean. I was stunned at the cost. We just did ours yesterday. Hoping that our ins will reimburse us at least a little. Wondering if anyone ready this has UPMC ins?

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