CA 19-9 Immunoassay Tumor Antigen Test

Hatshepsut Member Posts: 336 Member
edited March 2014 in Colorectal Cancer #1
My husband, who is a Stage IV, Colon Cancer survivor (diagnosed May 2006), has been denied coverage by Blue Cross/Anthem for a routine blood test he has every month at his oncologist's office. The test is listed as CA 19-9 Immunoassay Tumor Antigen (quantitative), CPT 86301, test. (I posted about this some months ago when this particular insurance battle started. Several of you were kind to post and encourage us in our fight.)

I continue to fight this Blue Cross/Anthem decision and need data for anyone else who routinely has this test and is covered by insurance. (I believe I read a posting recently on this board from at least one other person who has this test.) The issue, by the way, is not the frequency of the test but, according to Blue Cross/Anthem's paid reviewers, the appropriateness and usefulness of this test for monitoring colon cancer activity. I believe my argument would be strengthened were I able to show that other insurance plans cover this test for colon cancer.

While this Blue Cross/Anthem denial does not involve a huge amount of money, this is the second denial of coverage for my husband's care. Last year, Blue Cross/Anthem denied coverage for one of his chemotherapy drugs, Avastin. The billed amount for that treatment was around $100,000, a significant amount of money for us. Fortunately, after hours and hours of phone calls and letters, we were able to get the Avastin denial overturned. (NO ONE should have to spend time away from the caring and loving of a loved one who has cancer to fight for insurance coverage they've contracted to receive! And, no caregiver should have to endure the stress of such a fight when the emotional toll of cancer in the family is so great. )

Is there anyone out there who is receiving the CA 19-9 test and whose insurance is covering the charges?

Thank you in advance.



  • Monicaemilia
    Monicaemilia Member Posts: 455 Member
    I can't speak to the insurance piece, because I have no experience with it. However, when I went to Argentina they did perform this test, along with the CEA, but I was told by my oncologist in Canada that this was a test generally used for other cancers. Are they using this test because his CEA is not a good marker? Monica