MODY Test Insurance Question

HI all,

Well, I have new insurance BCBS of IL. I want to call and ask them about the MODY test which my endo would like me to get if my insurance covers it (or at least most of it)

What exactly do I ask them for? Is there a specific name or code for this test so they are not like “what? I don’t know what that is”??

You can call them and ask about it, but you should probably refer to it as genetic testing. A better way of approaching it would be to contact the AthenaDiagnostics who would likely be the place to actually do the test. You can see that they have certain selected insurance plans that they are “in-network” and where your cost if approved and covered would be modest. You can see that there are a few BCBS plans, unfortunately not yours. You can call Athena directly and they can help negotiate what might be covered with your plan. If you are not covered then you need to be careful.

Make sure you get any test preauthorized and that your doctor is prepared to establish a compelling letter of necessity to get coverage. Even if preauthorized you will likely be denied at first. And being out of network means that even if you get coverage you may still have to pay a big part of a bill that could run into the thousands of dollars.

Hope that helps.

Thanks! Sorry i didn’t respond earlier. I have finally talked to my insurance but they needed procedure codes and I will probably need of those letters… I messaged my endo and waiting from her to get back …

I have the page with the MODY 5 test info… not sure if procedure codes are the same thing as CPT codes?

AthenaDiagnostics can help you with the procedure codes (Common Procedure Terminology (CPT)). They are available on the full catalog pages. You will also need to have the proper diagnostic codes (ICD-9 or 10 codes). This isn’t usually something you need to worry about, your doctor and Athena worry about it. But if they mess it up then your insurance may deny your claim.

We “officially” switched over to ICD-10 diagnostic codes in October 2015, so be sure to use these instead of the ICD-9 codes.

While the (long-delayed) switch was officially supposedly thrown in September 2015 not everyone was ready and various organizations had to support transition plans. The ICD codes are supposed to be invisible to patients but when they get messed up, we as patients have our claims denied. My approach is to “trust but verify.”

I’ve been frustrated by this difficulty as well… My doctor tells me it wouldn’t be covered by insurance – he also is adamant that it’s purely an intellectual quest, " you are insulin dependent and managing your blood sugar very effectively with insulin… I understand you are a curious person, but there is no medical value to this test as it pertains to your treatment-- only potentially to satisfy your intellectual curiousity" has pretty much been his stance on it— which frustrates me-- but also I think it frustrates me because I know he’s right, in my case…

I’ve tried inquiring to my insurance about their coverage for this testing, but wasn’t able to find someone who was actually competent enough to answer the question— and I didn’t have the motivation to pursue it much further since it seems my doctor isn’t interested enough to be on board for advocating for it, etc…

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Been there, done that – can we have the T-shirt now?

So I have been talking to my insurance and my endo and it turns out that the tests I need are also done at my endos hospital - this is new in the past year! I will still need a letter of necessity - per my insurance but now I may not have to go through Athena so it may be cheaper since my endo is in-network for my insurance. There is an extensive test that tests 30 genes for diabetes which is not available at Athena - wow! If possible I am getting that one, might as well get every thing possible tested and get it over with. Even if the results are negative, at least I can leave that option out of my mind for good. Even the negative answer is an answer. My endo is waiting to hear back from someone about the best option for me… :smiley:

Even if it is negative if people ask me what type I have I am gonna lie… No more comments like -

“You are so thin. You must be Type 1.”
"No I am Type 2"
“Oh, so did you used to be fat?”

I hate to say this but I am looking forward to breaking some of those stereotypes… :smiley: That whole idea that if you eat healthy and stay in shape you will never get diabetes - yeah I am living proof of how that is NOT true. Your genes, there is no escape from that.


Some researchers have found a new type of diabetes in thin mice. It’s insulin resistance not caused by obesity but simply by aging. They are proposing the name Type 4 Diabetes. I blogged about it here. One caveat: this has so far been found only in mice and not confirmed in humans, and very often mouse research doesn’t translate into humans. But it suggests there are many causes of type 2 and more will undoubtedly be found in the future.

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I’ve been quite surprised at the genetics involved with T2 diabetes. A lot of the genetics isn’t about obesity as you write. A lot of it is actually abnormal insulin secretion something we may be falsely attributing to insulin resistance.

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