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Hello Everyone: Anyone encounter resistance with insurance reimbursement for this test? My insurer refers to it as a “genetic” test and refuses to pay for any part of the costs. A letter came alleging I had not asked for prior permission for “genetic testing.” I wrote a letter and filed an appeal with the insurer. Insurer booted the letter back to this COTIVITI. (They employ a contractor in Utah, and expect me to essentially send my entire medical file, including genetic pedigree, detailed info on my family history, etc to this unknown company “for review & evaluation.”) Which I resent as an invasion of my privacy. Do others encounter this? Please let me know.
BTW: I had one test about 1 to 2 yrs after diagnosis, ordered by my last rheumatologist, in 2015. Result was 38, moderate activity. This last summer, I was flaring, much discomfort in my hands. At same time, I had to have a screening breast MRI, and it seemed to me that MRI immed. made everything worse. The gadolinium (heavy metal) was injected into my left arm, and immed (right to present) the fingers on that hand and wrist are much, much worse. So, I thought to have my primary care MD order a second Vectra DA test, which documented that the numbers had gone up to 52, the high activity range. My primary is opposed to antibiotic therapy, unless someone else prescribes it first. I absolutely loathe rheum MDs (early ones missed PsA diagnosis, and told me OA cannot be treated, one diagnosed correctly but said only needed NSAIDs, then one crippled two joints with steroid injex… this can happen with PsA, which is what I have. Another made me try plaquenil and injection of methotrexate as a condition to receive doxycycline… which worked well on painful feet.) Have modified diet, do exercise, not overweight, take probiotics & supplements, but having trouble finding a good doctor. Trying a DO in a week. Kind of discouraged. Trillium
Psoriatic Arthritis (hands/feet) b4 May 2013; diag Oct, 2013. Family history: GrF 100% disabled & died of RA age 42. Mom prob had PA, had patches of eczemas, undiagnosed, untreated, deformed hands. Me: HLA-B27 Positive; RA factor Neg; ANA negative; CRP & CCP Ab negative; Sed Rate low.
My rheumatologist let me know that if there was any trouble getting coverage for the Vectra test to let them know. He said they put it thru insurance just in case, but inevitably it’s rejected. However, he said to call front desk if this happened as he was assured his patients would not need to pay the nearly $1000 for this test. A week or so later, after insurance rejected coverage, the lab billed me direct and the amount was $87.54. The first time I had this test, tho, I had to call the doc and they sorted out payment discount for me.
I was told this test measures disease activity based on various immune system markers (not genetic testing).
Click here to read about Vectra Score
Trillium, are there no AP docs in your neck of the woods from the RBF doc search system? I can look for you, if you let me know which state you’re in.
Gadolinium is a heavy metal and not great for overall health. In some instances, needs-must, but anyone with kidney risk factors (lupus, SD, etc) should read up on studies and assess risk-benefit.
I am glad to hear this Maz. I thought since it was a private company it was done not through insurance like any of the private companies. If I could feel secure that I would only pay what you did I would take the test just to see what it said. Good for you! Seems like so often it has to do with the doctor prescribing. My AP doctor fights for lower prices. But my previous chiropractor I visited early on told me she never got in the middle of it. I wound up paying much more that way.
Flare fall of 2014...muscle aches, joint pains, fatigue, hair loss, rashes, etc.
RA Factor 71 in Jan 2015 down to 25 as of September 2017
DR4/DQ8 HLA...biotoxin illness
IGG food allergy to wheat, egg, and dairy...probably all grains
Vit. C&D, probiotics, milk thistle, turmeric, fish oil, methyl b 12, methyl folate, digestive enzymes, Candisol, Ubiquinol, berberine, chlorella, Moducare, LDN, monolaurin, Triphala, Patriot Greens, Paractin
MTHFR compound heterozygous
Igenex IGM positive Lyme, minoMWF1) I live in mid-atlantic region. The roadback list has a few listings, but I have been trying to see someone who takes health insurance!
Earlier this summer, I tried to get an appt with Dr. Z, but that practice is somewhat difficult to reach… very expensive (off insurance) and set up a lot of barriers.(Before Obamacare, it was a lot easier to find indpt. minded doctors).
I got pretty discouraged trying to educate my Primary care doc. All summer, I wanted to try another antibiotic. I hoped having the Vectra test would validate what I was feeling, and serve as a baseline for a short 6-wk trial of clotrimazole. She has patients who are on AB, but for them, she is not the prescriber, does not want to be, thus won’t help. She will renew Rx, but that’s it. Also was being pushed for many weeks to have another MRI, to do a biopsy. The false positive rate is 50% btw, & just the thought of more gadolinium scared me. I did a 24 hr urine test 2 mos out.. it was still in my system. Btw: I have an MS in toxicology.
2) Am not opposed to alternative med, but wary. Integrative M.D.s I meet here don’t seem to like drugs of any kind. The ancillary professions the same, but I do try them.
Ex/ I just made an appt with Dr “L”, DC, CCSP, a chiropractor interested in arthritis, of “R” Ctr for Healing not as a LLMD or rheum, but to explore acupuncture on hands/wrist. However, I really doubt this outfit will help with AP.3) May try Dr “J” next.
Thx, Maz. Wish I had your hands. Can’t wear rings except on one finger now.
Psoriatic Arthritis (hands/feet) b4 May 2013; diag Oct, 2013. Family history: GrF 100% disabled & died of RA age 42. Mom prob had PA, had patches of eczemas, undiagnosed, untreated, deformed hands. Me: HLA-B27 Positive; RA factor Neg; ANA negative; CRP & CCP Ab negative; Sed Rate low.
Hi Trillium,
Yes, Pinkmoth (who sees Dr. Z) was disheartened to hear that she is currently not in practice. If you PM Pinkmoth, she can probably tell you more. She recently saw Dr. B. in MD, so can also fill you in on her experience with him. There are a good number of LLMDs in the mid-Atlantic region though you may need to drive a distance, depending on your location.
With a MS in toxicology, no doubt you’re more aware than most of the potential toxic effects of gadolinium. I had to get an ankle MRI last year for a torn peroneal tendon, but requested MRI without the contrast agent. It’s not always possible but the podiatrist felt he’d get enough info without it. That was needed to get a darn ankle boot crafted to wear for several months while it healed.
Integrative docs should be fine with conventional medications as they use both conventional and naturopathic meds in an integrative approach. Functional med or naturopathic docs, on the other hand, tend not to be favorable. Maybe docs down your way define “integrative” differently? That’s rotten you’ve had this issue. Dr. J. would likely be a very good bet! Have you seen his journey documented in the movie “Under Our Skin?” Worth watching, if not. I think Dr. Z. is experiencing similar (NC is where Dr. J. used to practice), because NC has not been kind to LLMDs.
Thanks, Spiffy! I think it really depends on the doc and what deals they strike with labs. The lab rep (when selling him on the value of the test), reassured him that his patients wouldn’t have to pay that extortionate amount if he recommended the test and the patient’s Carrier wouldn’t cover it. Some carriers actually pay for IGeneX testing, so it prob depends on your plan, too.
I am not a big fam of DR.Mercola but found this interesting.
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