CgA Appeal to Medicare

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CgA Appeal to Medicare

 

 

 

 

 

 

"Chromogranin "A" is a protein, located in neuroendocrine cells, which is co-secreted with a wide variety of peptide hormones and neurotransmitters. Tumors with neuroendocrine properties typically secrete large quantities of CgA into the circulation.  The assay (CPT Code 82397) is used primarily in the diagnosis and monitoring of patients with carcinoid tumors, islet cell tumors, pheochromocytoma, neuroblastoma, and other tumors of neuroendocrine origin. It may also be used for small-cell lung cancer and prostate cancer, in men with normal PSA levels."

 

 

 

 

 

 

Ouch!

 

 

I began receiving dunning notices and bills from the laboratory (Laboratory Corporation of America - LabCorp) doing my Chromagranin A Assay (CgA) in late 2003. I also received explanation of benefits from Medicare’s agent for my state (CIGNA Healthcare) denying the claims as “experimental”. The following two documents are the initial correspondence I sent and received and the initial test was ultimately paid by Medicare.

 

 

 

 

My letter to CIGNA in WORD 2000 Format

 

My letter from CIGNA in PDF format

 

 

 

 

 

 

Unfortunately, as is usual, things aren’t that simple in real life. LabCorp and its collection agent (LCA Collections) each continued to dunn me for my subsequent tests and simply ignore letters I  sent to them and to their lab-director, Dr. Frank Hancock.

My letter to LabCorp in WORD 2000 Format

 

My letter to to the lab’s director, Dr. Frank Hancock, in WORD 2000 Format

 

 

 

It is my opinion that Labcorp does this intentionally so that they get increased payments from sick patients too tired to “fight” them as Medicare pays only a small fee compared to the fee billed by the lab - $174.00. What is even more astounding, however, is that different Medicare patients in different parts of the country get treated so differently by the Medicare processors

 

 

My wife, Linda Silversmith, spent a great deal of time the week of August 22, 2004, on the telephone with over half a dozen people at LabCorp in North Carolina. She even sent two different faxes, the last of which was finally acknowledged

 

 

 

 

 

 

But, nothing changed, so I wrote another letter to CIGNA Healthcare with half a dozen copies to different people at LabCorp .

 

My second letter to CIGNA in WORD 2000 Format

 

My second letter to CIGNA in PDF Format

 

Note: If you need a printout of the large “Pictures” of letters (below), right click on the picture with your mouse and “Save” the .jpeg file. You can then print the file at your leisure ...

I received the following positive response from Cigna on October 16, 2004. I hope this puts this issue to bed once and for all, but with my previous experience with this provider, I have my doubts.

I received the following additional positive response from Cigna on October 18 2004. Does one have to question why providers want you to pay. They bill you $174.00 for this test and Medicare pays them $29.07 - less than 17% of the billed amount.

 

 

Late February, 2005. The dunning from Labcorp has begun again. So keep tuned ... THE DRAMA CONTINUES ...

 

 

 

This page was last updated June 25 2005

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