NK Cell Blood work - Challenges with Insurance

Discussion in 'Fibromyalgia Main Forum' started by CarolynAnne, Jan 9, 2006.

  1. CarolynAnne

    CarolynAnne New Member

    I am curious, has anyone had the NK (Natural Killer) Cell blood work done through Quest Diagnostics? Did your insurance cover it. I have United Health Care and I am in my 3rd appeal.
  2. hopeful4

    hopeful4 New Member

    Hi CarolynAnne,
    I had the NK labs through Quest, I go to the Fibromyalgia and Fatigue Center. Medicare is my primary insurance. It did pay for all of my lab work, including the NK cells.

    Medicare pays for "medically necessary" labs.

    What is the reason that your insurance is giving you that they will not cover it? Perhaps we can give you some ideas for the appeal.

    Did you get the results back yet, and if so, what were they? What reason did your doctor order the test for?

    Take care,
  3. CarolynAnne

    CarolynAnne New Member

    It makes me laugh... the NK test (which cost $372.00) is what was one of the final markers that gave me a CFIDS diagnosis. I think my insurance has paid over $10K for blood work the prior 3 years testing me for Cat Scratch Disease to Lymphoma! They should be happy we finally know what is wrong :)

    My NK test came back that I have 2 NK cells when the range is in the hundreds!

    As per my insurance:

    According to your Summary Plan Description, under “Exclusions” it states coverage is excluded for “Non-Medically Necessary Services.” “Medical Necessity is demonstrated through prevailing peer-reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed.”

    Natural Killer Cells is an unproven test for the submitted diagnosis of chronic fatigue due to lack of robust scientific clinical evidence documenting efficacy. In order for this service to be covered such information should be submitted.

    My doctor has written and appeal, I have written one, I have copied articles on the internet that say the NK test is one used to help diaganosis CFS. I am at a cross road.
    Any help would be wonderful..
  4. elastigirl

    elastigirl New Member

    The CDC instructs doctors specifically NOT to use several of the tests widely known to help pinpoint CFS. The CDC states (it hurts too much to laugh) that these tests (such as NK) are not helpful in the diagnosis of CFS, so don't use them.
  5. hopeful4

    hopeful4 New Member

    It's hard enough being ill, without having to fight for insurance coverage. Fortunately, you have your doctor who is fighting for your benefits.

    Your NK cells are so very low. Are you aware that low NK cells can be an indicator for Lyme Disease? Mine were 5.6 in a 20-50 range. Recently I was DX with Lyme. This does not negate the CFIDS/FM DX according to my doctor, but shows that Lyme is the major underlying cause.

    Please consider getting tested for Lyme. Lab testing for Lyme Disease is notoriously inaccurate. The diagnosis itself is a clinical DX, taking into account the patient's history, symptoms, and labs. That is why it is highly recommended that you seek out what is called a Lyme Literate Medical Doctor (LLMD). Other doctors often miss the diagnosis.

    The test that is considered the most reliable is the Igenex Western Blot. This is the specific test to ask for. I've also heard of a test called Bowen which may be good.

    After 6 years of illness without improvement I switched Doctors (again!) and was tested for Lyme (at the Fibromyalgia and Fatigue Center). The first test through Quest came back negative. I was re-tested with Igenex, it came back positive. Many of us on this board are finding that we have Lyme.

    You can find further info on Lyme, testing, and locate a LLMD at lymenet dot org. It is treatable and many people recover and regain their lives.

    Wishing you the very best,
  6. CarolynAnne

    CarolynAnne New Member

    Thank you so much for your post. I cant begin to tell you the test I have had to find out why I have such a low count.

    I have been to the PCP, ID, ENT, Oncologist, Allergist, Hemotologist;...you name it. I have also had the Igenex and Bowen test as well as Quest for Lymes - all negative. I perplex all my doctors. I have even gone the route of having my lymph nodes in my neck removed prior to my CFS diagnosis. Anything to make me feel better...

    [This Message was Edited on 01/10/2006]
    [This Message was Edited on 01/10/2006]
  7. laura81655

    laura81655 New Member

    which was very low, something like 2.9. I had it done at the FFC and my Lymes testing was also negative. I have more of the pain problem than CFS. I have read that people with Autoimmune, CFS, FM can have low NK.

    So far, my HMO, Pacificare has picked up the cost as far as I know. I haven't received a bill and it was done last Sept.

  8. rockyjs

    rockyjs Member

    Did your test results include a breakdown of T-cells, B-cells, etc along with the NK cells? I've asked my doctor for an immune system profile and he's not sure what to order.

  9. hopeful4

    hopeful4 New Member

    Dear CarolynAnne,
    Wow, you have already gone through a lot of testing, and it sounds very complex.

    Rockyjs brings up a good point about the many possible sub-tests. Although I'm not familiar with what they all are, it does seem that having them broken down could help point you in a more specific direction.

    This is not an area I know much about beyond what I've already suggested. Recently I was researching about medicinal mushrooms, and read that certain mushrooms have been shown to increase human Natural Killer (NK) Cell activity by up to 300%.

    There are also other NK boosters that many people on this forum talk about.

    Keep on searching and you will find answers.

    Best wishes always,
  10. Defibro

    Defibro New Member

    Hi Carolynanne!

    I had mine done at the FFC. MY UHC (I have PPO not HMO, via my husband CO.) rejected at first, but paid all the other tests.

    Asked the DR. at the FFC, he wrote a nice letter of "neccessity", my DH resubmitted it, and they paid 80% of the negotiated price, and we paid the rest. The UHC/PPO is a 80/20 deal after the deductibles are met.

    Hope this helps....
  11. CarolynAnne

    CarolynAnne New Member

    Thank you all for your support. This website is a blessing. I am learning so much. It is nice to talk about this with people who understand.

    I am taking Amantadine 100 mg and LDN (Naltrexone) 3mg ever night. This is what we are using to increase my NK Cells. I feel that they are working, but refuse to pay another 372.00 to find out.

    Last year, I think I made the stock in Klenex go up with all the colds I had. Knock on wood - this year I have been cold free.
    [This Message was Edited on 01/11/2006]

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