Athena Diagnostics Bloodwork for SFN
 

My doctor has ordered bloodwork thru a company called Athena Diagnostics. I received the kit in the mail and someone from this company will come to my house to draw blood.

I spoke to a customer service rep about the costs for this. She told me that the cost for the bloodwork is $4,750.00

She gave me CPT codes 83516 X11 and 83520 x10. I provided these codes to my insurance company and I am waiting to hear how much they will cover.

has anyone else had a similar experience or this bloodwork for SFN?
Thank you

Hi Sophie,

That seems awfully expensive. I have found wildly different quotes for both blood work and imaging from different companies. The same CT can run $1200-$7000 depending on where you go. Blood work can run several hundred to several thousands depending on the company and how they bill.

Your insurance may balk or they may have a contract that allows them to pay a small percentage of that. Be careful. Depending on what state you live in you could be billed out-of-network charges for the full remainder. So called "balance billing" is legal in many states and some companies even try to charge when it IS in network. It is important for you financially to be sure what you're responsible for up front.

I sometimes elect to use either healthcheckUSA or privatemdlabs for blood work because it is so much cheaper. Both of them have a full menu of tests that are much more reasonable than most companies out there. I had several rheum tests done affordably.

Athena does DNA confirmation for a hereditary neuropathy called
CMT Charcot Marie Tooth. Most insurances will not pay for
this.

GeneDx cost for SCN9a testing is $5,760. Hospital where blood was drawn is charging $4,375 and I am not sure what this is for. Perhaps it is for genetic counseling after the test result but I don't know why they are charging this upfront. Needless to say I am in the midst of a financial mess and can only reiterate to be sure to know the full costs upfront.

Thank you
 

Littlepaw, Mrs D and Summerfun

Thank you so very much for your input into this. I haven't heard back from my insurance company with regards to if/how they would cover this...I guess I will wait to see if they can cover any of this..
I might have to find a new doctor because the doctor I am using is in another state...just not sure what to do anymore...although this is the doctor that is recommending ketamine infusions..
Anyway thank you again

Athena has a LOT of different tests for Peripheral Neuropathy. They have a financial program that may help you with the cost if your insurance claim is denied. Athena Diagnostics - Athena Alliance Program

You can get a "Letter of Medical Necessity" from them to include with your first request for pre-approval, or with an appeal of any denial. Athena Diagnostics - Athena Alliance Program

Call them up and ask to talk to their Patient Services Department and ask about how they can help you to get your insurance company to come through for you. I've had dealings with a few different specialty testing companies and Athena was the most expert and interested in handling insurance issues.


For neuropathy, they offer many more tests than CMT testing. I think it was this panel that my doctor ordered when I was first diagnosed. Athena Diagnostics - Sensory Neuropathy Evaluation

It tests for four conditions, and ALL of them have some level of treatment available -- that seems to me to be a key factor that an insurance company should look at when deciding whether to cover a test. (A positive result for a SCN9A test, on the other hand, doesn't lead to any effective treatments yet.)

Though it's a little difficult to navigate, their complete test catalog is here. Athena Diagnostics - View Full Catalog

Thank you Nilram.
 

I really appreciate this information!! I called my insurance company about this and I haven't heard back from them yet.
I plan to give them a call next week. The tests could possibly help me with figuring out what is going on. I know some bloodwork just came back and everything seems okay..even my ANA was negative