Cunningham Panel and insurance coverage--experiences so far

[Iowadawn]

Just curious about how well (if at all) insurance is covering if you have had this done and have had your insurance process it.

 

Thanks. Dawn

[Mayzoo]

I am curious as well. I have not called our insurance yet. Get the CPT codes from Cunningham lab, possibly off the website, then the insurance co. can tell you how much they would pay. We just spent almost 700.00 for just the urine tests (not sure how much the blood test will be yet) so another 1000.00 is out of the question right now and likely will not be an option period. If the reimbursement is anything like the tests we just ran, the cash out for one test set was 225.00, and the insurance will reimburse me 19.00. Out of network labs can charge what they wish, but reimbursement is based on what the insurance would have allowed had you gone to an in network lab. For the test I mentioned, the insurance allows 33.00, but the lab the doc insisted we use costs us 225.00. We will likely not be doing the Cunningham test simply because we cannot afford $1000.00 more on top of what is an absolute necessity for our child.

 

Through the contact page I did request the CPT codes. If I hear back from them, I will post the CPT codes here so we all do not have to ask .

Edited May 4, 2013 by Mayzoo

[4Nikki]

Seems like most on the forum have so much more to test way above what we have been doing so far. I hope we are able to nail it down before we go through as much. I feel blessed to have found Dr. B she is very froogle and wants to make sure we have the right treatment.

[Mayzoo]

Seems like most on the forum have so much more to test way above what we have been doing so far. I hope we are able to nail it down before we go through as much. I feel blessed to have found Dr. B she is very froogle and wants to make sure we have the right treatment.

 

In our case anyway, we have other known conditions, IE autism, that we needed to run some tests for as well. Not all her tests were for are for PANDAS. We also strongly suspected that she had PI, but we needed the blood work to back that up.

 

As it turns out, we found out she has some kind of kidney disease that was not even on my radar and I doubt it was on the docs since he never discussed this at all, so that was a good thing we discovered since the sooner you treat this, the better off the child will be.

[tpotter]

 

Seems like most on the forum have so much more to test way above what we have been doing so far. I hope we are able to nail it down before we go through as much. I feel blessed to have found Dr. B she is very froogle and wants to make sure we have the right treatment.

 

In our case anyway, we have other known conditions, IE autism, that we needed to run some tests for as well. Not all her tests were for are for PANDAS. We also strongly suspected that she had PI, but we needed the blood work to back that up.

 

As it turns out, we found out she has some kind of kidney disease that was not even on my radar and I doubt it was on the docs since he never discussed this at all, so that was a good thing we discovered since the sooner you treat this, the better off the child will be.

I have seen Autistic kids get better by being treated for PANS (including my own son...social skills jumped 7 years overnight with IVIG). Also, what is the kidney disease, because strep can cause glomerulonephritis (which is a kidney disease caused by strep).

[nicklemama]

I don't think anyone is going to be out the entire $1000. You pay a deposit of $420. If insurance covers the entire $1000, you would get a refund. If insurance covers nothing, you owe nothing more. This is typical of companies where insurance coverage is not a sure thing. The food allergy testing and other testing done on my DS required a deposit. I owed nothing more and the companies took on the risk of getting insurance payment or not. If you are considering the Cunningham test, call them and inquire.

[Mayzoo]

 

 

Seems like most on the forum have so much more to test way above what we have been doing so far. I hope we are able to nail it down before we go through as much. I feel blessed to have found Dr. B she is very froogle and wants to make sure we have the right treatment.

 

In our case anyway, we have other known conditions, IE autism, that we needed to run some tests for as well. Not all her tests were for are for PANDAS. We also strongly suspected that she had PI, but we needed the blood work to back that up.

 

As it turns out, we found out she has some kind of kidney disease that was not even on my radar and I doubt it was on the docs since he never discussed this at all, so that was a good thing we discovered since the sooner you treat this, the better off the child will be.

I have seen Autistic kids get better by being treated for PANS (including my own son...social skills jumped 7 years overnight with IVIG). Also, what is the kidney disease, because strep can cause glomerulonephritis (which is a kidney disease caused by strep).

 

 

 

Seems like most on the forum have so much more to test way above what we have been doing so far. I hope we are able to nail it down before we go through as much. I feel blessed to have found Dr. B she is very froogle and wants to make sure we have the right treatment.

 

In our case anyway, we have other known conditions, IE autism, that we needed to run some tests for as well. Not all her tests were for are for PANDAS. We also strongly suspected that she had PI, but we needed the blood work to back that up.

 

As it turns out, we found out she has some kind of kidney disease that was not even on my radar and I doubt it was on the docs since he never discussed this at all, so that was a good thing we discovered since the sooner you treat this, the better off the child will be.

I have seen Autistic kids get better by being treated for PANS (including my own son...social skills jumped 7 years overnight with IVIG). Also, what is the kidney disease, because strep can cause glomerulonephritis (which is a kidney disease caused by strep).

 

We do not know what the kidney disease is yet, how severe it is, or what is causing it....YET. I just got the results that confirm a problem about 10 days ago. I did four days of reagent strip testing, and now a nephrologist is reviewing her test results to let me know what they think and if we need to see them or a urologist.

 

The doc that did the tests has still not called us back yet to discuss the results, but they say he was sick for 2 1/2 weeks after he saw us, so he is backloged a lot.

[Mayzoo]

I don't think anyone is going to be out the entire $1000. You pay a deposit of $420. If insurance covers the entire $1000, you would get a refund. If insurance covers nothing, you owe nothing more. This is typical of companies where insurance coverage is not a sure thing. The food allergy testing and other testing done on my DS required a deposit. I owed nothing more and the companies took on the risk of getting insurance payment or not. If you are considering the Cunningham test, call them and inquire.

 

Everyone should call the lab to see if they qualify for aid, and their insurance companies for reimbursement amounts. To call your insurance company, you need the CPT codes and unit values the lab will use. Doing this, you will know exactly how much you will be out of pocket.

 

According to the Cunningham site, whatever the insurance does not pay, they will bill to the patient. We pay the 425.00 up front and if the insurance pays nothing we will be billed for the remaining 500.00. Since they are out of network for probaly everyone, they are not bound by any Maximum Allowable Costs (MAC) or contracts. They may charge whatever they feel is appropriate, and the patient is responsible for everything the insurance does not cover since they agreed to the test. My insurance has never yet allowed more than 5.50 for any one blood test CPT code (50ish done so far), so if that trend holds, they would allow about 27.50 for the Cunningham test, and I would be reimburssed 16.50. I would however owe 908.50 total for the tests. I will know more when the Cunningham lab gets back to me with the CPT codes and unit values.

 

"Unfortunately, we are unable to file government issued insurance such as Medicaid, Tricare, etc. The full cost of the 5 assays and physician results is $925. If your insurance provider pays the full $925, we will refund your entire deposit. If your insurance pays more than $500 of the costs, we will reimburse any amount over $500, up to your full $425 deposit. If your insurance does not pay, or pays less than the difference between your deposit and the cost, we will send you a billing statement for the difference. We understand that some parents may be in dire financial need, and to that end, we will work on a case-by-case basis to provide testing for your children."

 

http://www.moleculera.com/patients/

 

 

They do indicate they have some program to aid patients who cannot afford the test, but for US, we never seem to qualify for any assistance. Last time we tried to get any help (not from this lab), we were told to sell our house, use the money to buy lottery tickets so it was just gone, and then get a divorce. Then we MIGHT qualify for some assistance. I hope it helps some people, but I am too cynical to believe there is a chance it would help us since we refuse to throw what we do have away and get a divorce merely to qualify for limited, and restrictive aid.

Edited May 6, 2013 by Mayzoo

[nicklemama]

I am very disappointed to read this. We had this test done in 2010 when it was experimental and it cost us $400. I had no idea then that was just the tip of the iceburg in out of pocket costs. Frankly, at nearly $1000, I would not bother. It makes me question if the lab will survive. Who is going to pay for that test?

[Mayzoo]

I am very disappointed to read this. We had this test done in 2010 when it was experimental and it cost us $400. I had no idea then that was just the tip of the iceburg in out of pocket costs. Frankly, at nearly $1000, I would not bother. It makes me question if the lab will survive. Who is going to pay for that test?

 

We will try to get to it some day, but many other tests and treatments will take priority over this one for quite a while.