1:16 titer for Coxsackie B; should I be concerned?

[Hip]

It's a mess. 60% of bankruptcies in the US are due to having a health condition.

My question is if you have US health insurance, and you want to get a coxsackievirus B and echovirus test at ARUP Lab, can you arrange that with ARUP Lab directly, and still get your insurance to pay? Or do you need to order and arrange the ARUP tests through the major labs like LabCorp and Quest in order to get the insurance to cover the cost?

A lot of people on this forum have had great difficulty in sending blood serum samples to ARUP via LabCorp and Quest; this is because often LabCorp and Quest will accept the blood sample, but perform the test internally in their own lab, rather than sending the sample out to ARUP in Salt Lake City (but their own internal labs do not use a sensitive enough method to detect chronic CVB and EV infections; only ARUP lab uses the highly sensitive neutralization method of testing that can detect chronic infection; this is what Dr Chia found).

So that's why I was wondering if it might be easier to send your serum sample to ARUP Lab directly, by-passing LabCorp and Quest.

 

[wigglethemouse]

US health system has In-network and Out-Of Network coverage. Many insurances only pay for Labcorp OR Quest OR another lab (e.g. HMO). Even then, not all tests offered by those labs are necessarily covered. When you go for the test you are given an estimate of the cost you will have to pay. If that test has no cost listed then you need to decide whether to test or not to test, or wait until you get a cost that may or may not be right.

ARUP would probably only be covered under Out-Of-Network - where you pay all the cost, and if you have a good plan that has Out-Of-Network partial reimbursement you may receive partial repayment (after meeting $X,000 deductible). That is why it is so important for the likes of Lab Corp or Quest to have a code for send outs so you cam get a good quote.

If the test is not covered by insurance then you will have to pay the non-negotiated rate i.e. list price. This means the price of the test can go up 20x i.e.. many common tests have 75-95% discount through insurance. If insurance doesn't cover the test under your plan, you don't get their discount.

 

[wigglethemouse]

Solution
When getting the draw done give them this number "977180 serum SST" this code is for send out labs and will go to their referral department. The arup test number is 0060055. Which I believe your doctor needs to order this test.
They told me they send out labs all the time to ARUP and this will work. I have not tried yet but will and will update.

@Thegriz I got the lab draw for ARUP coxsackie B test done last week at Lab Corp. Fingers crossed it works.

Lab Corp said to only have one line item, and attach a copy of the webpage showing the specific ARUP test. 977180 is a LabCorp comment code. The staff did not know this and had to ask a supervisor. Perhaps the test order could be written something like this

* 977180 Serum Separator Tube (SST), Refrigerated. Please send to referral department, pass through to ARUP, ARUP test code 0060055, Coxsackie B Antibodies

 

[Thegriz]

Hopefully it works for you. I ended up trying this and failed hard...the employees at the lab collection site insisted they could not send out this lab out becuase they offer a similar test. I believe it was really just the lab employee that was making it an issue, I am going to try to go to a different lab if it ends up working for you let me know.

 

[wigglethemouse]

Hopefully it works for you. I ended up trying this and failed hard...the employees at the lab collection site insisted they could not send out this lab out becuase they offer a similar test. I believe it was really just the lab employee that was making it an issue, I am going to try to go to a different lab if it ends up working for you let me know.

I had the same issue at two different Lab Corp Offices. This time with your instructions it worked and I got the results, but had to again tell them not to do the Lab Corp test.

The lab said to only have one line item on the test order and attach a copy of the webpage showing the specific ARUP test. 977180 is a LabCorp comment code and does not provide any instructions. By attaching a printout of the ARUP test page it will show the blood handling requirements.

Perhaps the doctor could write something like
* 977180 Serum Separator Tube (SST), Refrigerated. Please send to referral department, pass through to ARUP, ARUP test code 0060055, Coxsackie B Antibodies

and attach https://ltd.aruplab.com/Tests/Pub/0060055

 

[Hip]

I am going to try to go to a different lab

You know that Dr Chia found only neutralization-type antibody tests (like those offered by ARUP) are reliable for detecting chronic coxsackievirus B and echovirus. Other methods of antibody detection such as ELISA, EIA, IFA and CFT are less sensitive, and may miss a chronic infection.

In my case, when I was tested for CVB and echovirus by CFT in a London Lab, I came back negative, with no significant antibody titers. But when I retested using an antibody neutralization test in the Netherlands, I showed high titers to CVB4, medium titers to CVB2, and low (but nevertheless positive) titers to CVB1.

So you can come out completely negative on CFT, but come out high positive on antibody neutralization tests.

 

[EddieB]

Hi all,
Just got done doing blood work with LabCorp for enterovirus. My doctor had called Dr Chia’s office to get the correct info. Coxsackie is to be sent to ARUB and the Echo to BioAgilytix Boston (formerly Cambridge Biomed).

I ran into the same problems that Wigglethemouse had, the code 816869 was for a spinal fluid test , even though that’s what we were given. After many phone calls, these are the codes we ended up with...

823361-Echovirus Serum Ab Panel........ $638.00
096263-Coxsackie Virus Group B Ab..... $208.00
998085-Ventipunture................................... $10.00

Perhaps the doctor could write something like
* 977180 Serum Separator Tube (SST), Refrigerated. Please send to referral department, pass through to ARUP, ARUP test code 0060055, Coxsackie B Antibodies

I showed this to the staff, and they had the 977180 code and were good with it, so hopefully it will make it to ARUB. I’m still afraid they may do the test in house.

With the 816869 code, they wanted $1300 for. So something is definitely wrong, I don’t understand why Chia’s staff is giving It out.

Many thanks to the staff at LabCorp, they spent over an hour on the phone trying to sort things out. I just hope they got it right. I will post more when I hear back.

ps...
I would think the cost of the test may determine if it’s the correct one. Has anyone done it recently?

 

[sometexan84]

I've done ARUP enterovirus testing through Quest twice this yr (2020). And the old codes don't seem to work, they don't come up in the system and the techs at Quest are confused.

Now, it seems there's a Quest code for ARUP miscellaneous --- Test Code 39651 "ARUP Laboratories Miscellaneous Order". And then the Quest people make a note of the ARUP lab test codes to be tested.

ARUP Echovirus Test Code: 0060053
ARUP Coxsackie Test Code: 0060055

This includes EV 6, 7, 9, 11, and 30 -- and CBV 1 through 6

If you want to do Coxsackie A9, its Test Code: 0050503

These are all antibody panels, NOT PCR. You have to make sure that they add the right ARUP lab codes in, since it's not something that's going to validate in their own system. And for good measure, you may want to actually confirm w/ them that these will go to the ARUP labs in UTAH. If your doctor puts that in a comment in your lab order, that would be helpful as well.

When I spoke with ARUP, they said Quest will have a hard time getting it wrong if they see a lab order from your Dr that literally specified for the testing to be done in the Utah ARUP laboratory.

Side Note: If your code doesn't come up in their system because the test "is not available in all locations". They CAN still do it. I don't know how. But today, literally all the Quest techs came to my station to help, and they figured it out. I was trying to test for D-Lactate. So, it can be done.

 

[junkcrap50]

I've done ARUP enterovirus testing through Quest twice this yr (2020). And the old codes don't seem to work, they don't come up in the system and the techs at Quest are confused.

Did you have success with getting insurance to pay for your ARUP enterovirus tests, since the insurance is ran through and billed by Quest? Seems like Quest will automatically go through the insurance process this way.

 

[sometexan84]

Did you have success with getting insurance to pay for your ARUP enterovirus tests, since the insurance is ran through and billed by Quest? Seems like Quest will automatically go through the insurance process this way.

I pay for all this stuff out of pocket

 

[junkcrap50]

I pay for all this stuff out of pocket

Ouch! Thanks.

 

[sometexan84]

Watch out for this when testing for ARUP enterovirus via QUEST!

Apparently, there is still confusion at Quest when ordering the enterovirus ARUP tests.

I got charged twice, and received two sets of results. Quest had my sample sent to ARUP AND to Quest for processing. So I got results back from ARUP, as well as from Quest. And as we already know, the Quest labs for enterovirus are completely useless.

Anyway, I was charged for ARUP labwork (as expected), but also charged $150 or something like that for the Quest labwork.

It was miscommunication... and Quest wouldn't give me a refund. In the end, I had to have my bank take care of it.

 

[sometexan84]

If you were ever curious as to why ARUP is recommended for the enterovirus testing, check this out.

These are my results from ARUP and from QUEST using the same blood sample....

Quest results

ARUP results

 

[junkcrap50]

Watch out for this when testing for ARUP enterovirus via QUEST!

Apparently, there is still confusion at Quest when ordering the enterovirus ARUP tests.

I got charged twice, and received two sets of results. Quest had my sample sent to ARUP AND to Quest for processing. So I got results back from ARUP, as well as from Quest. And as we already know, the Quest labs for enterovirus are completely useless.

Anyway, I was charged for ARUP labwork (as expected), but also charged $150 or something like that for the Quest labwork.

It was miscommunication... and Quest wouldn't give me a refund. In the end, I had to have my bank take care of it.

There is confusion and a high risk of a screw up ANY time you go to Quest (at least in my experience). You are at the mercy of the phlembotomist "interpreting" what the doctor's orders are whenever he/she enters the test into the computer.

For example, if the doctor orders "EBV Antibodys" does that mean IgG, IgM, or the whole Antibody Panel? Does it mean VCA or EBNA or a Panel of both? I've run across this for literally every type of test / order. Vitamins, tests using whole blood vs plasma vs urine, etc.

No only that, they frequently "forget" or miss a test if there's a long list of them. Or they accidently add a test that wasn't ordered.

What you must do:

• Be familiar with what you doctor orders and writes on the lab order sheet.
• Do not agree to blood being drawn until you are provided a piece of paper / consent or agreement that requires signature.
• That piece of paper has a print out of every test that the phlembotomist selected and put into the computer. It is very easy to catch their mistakes at this point. Make sure their "codes" or tests match the doctor's.
• If the doctor made a mistake (and chose both Quest & ARUP for example) you can decline and not consent to a test.
• Train your doctor to use Quest's Test Codes instead of writing the name of the test.

@sometexan84 I would bet that the error was entirely on the Phlembotomist. They typed in "Coxsackie antibodies" and clicked on both ARUP & Quest. If you reviewed the consent form that requires your signature, you would have seen a test code for ARUP's tests and a test code for Quests's tests.

 

[Hip]

Train your doctor to use Quest's Test Codes instead of writing the name of the test.

Part of the problem is that there are no exact LabCorp or Quest codes that can be used to order ARUP lab coxsackievirus B and echovirus antibody blood tests. If you read some of the earlier posts in this thread, you will see some of the frustrations patients have with getting these ARUP tests.

 

[junkcrap50]

Part of the problem is that there are no exact LabCorp or Quest codes that can be used to order ARUP lab coxsackievirus B and echovirus antibody blood tests. If you read some of the earlier posts in this thread, you will see some of the frustrations patients have with getting these ARUP tests.

I understand that frustration. But I was under the impression that those codes specifically for ARUP had already been revealed in this thread.

Also, I also thought that there was a code specifically for "ARUP Laboratories Miscellaneous Order" , Test Code 39651.

Quest has other Test Codes at Miscellaneous Orders at other laboratories:
ARUP Laboratories Miscellaneous Order = Test Code 39651.
Mayo Medical Laboratories Miscellaneous Order = Test Code 29854
Cleveland Clinic Miscellaneous Order = Test Code 29862

I understand these links link to the Oklahoma region for Quest and changing the location shows these codes do not exist. But the computer systems at Quest locations, I believe, have more test code options than available online. However, I do not claim or know that these codes conclusively work.

There ARE ways for Quest to send tests and samples to these other hospitals and lab centers.

 

[Hip]

But I was under the impression that those codes specifically for ARUP had already been revealed in this thread.

The LabCorp order codes for these ARUP antibody tests are CVB=816869 and echovirus=823361. However, these codes are for tests performed on the cerebrospinal fluid. There are no LabCorp codes for the ARUP test performed on blood serum (which is what we want).

So when you want an ARUP antibody blood test via LabCorp, you have to use these cerebrospinal fluid codes. If you look at the LabCorp test order form that Dr Chia filled out in this earlier post, you see that Dr Chia uses 816869 for the ARUP coxsackievirus B test, but writes on the form "please do not alter codes, reference [ARUP Lab] will accept serum". So this is what Dr Chia does.

But according to this post, LabCorp will not draw blood serum for these tests codes (even though ARUP will accept serum).

Also, I also thought that there was a code specifically for "ARUP Laboratories Miscellaneous Order" , Test Code 39651.

Yes, 39651 is the Quest test code for a miscellaneous ARUP test order. @sometexan84 discovered and posted this code above. So when ordering the CVB and echovirus ARUP tests through Quest, that looks like a good code to use.

If you use this miscellaneous code 39651, it requires that the Quest order contains the ARUP codes for the ARUP tests that you want (these codes are CVB=0060055 and echovirus=0060053).

 

[sometexan84]

The ARUP Misc Order appears to still be correct, when ordering from Quest. I just don't know how they messed it up.

Look, they even did a "Miscellaneous Referral" for the Echovirus, lol. All I know is that there was confusion, and I think they didn't trust that I knew what I was talking about. Or maybe I just wasn't loud enough? Idk.. there were like 4 lab techs piled up at my station trying to work it out....

 

[wigglethemouse]

The ARUP Misc Order appears to still be correct, when ordering from Quest. I just don't know how they messed it up.

Look, they even did a "Miscellaneous Referral" for the Echovirus, lol. All I know is that there was confusion, and I think they didn't trust that I knew what I was talking about. Or maybe I just wasn't loud enough? Idk.. there were like 4 lab techs piled up at my station trying to work it out....

Similar story here with LabCorp that I posted about a while back. First time lab tech even called remote supervisor for advice and still it was messed up. Second time we got it figured out.

 

[Craig972672]

I was able to get both ARUP tests done through Quest in Feb of 2022 using the instructions in this thread. I really appreciate all who shared info. I wanted to post the details of how I did it, in case it helps anyone. I'm located in the Dallas, TX area.

1. I asked my Doctor's office to put in two electronic Quest orders using the miscellaneous ARUP Quest order code, which is 39651.
2. In the notes for each order, I asked them to put the ARUP test code for the proper test. These are 0060055 and 0060053
3. Also in the notes for each order, I asked them to write "Test must be performed by ARUP labs. DO NOT substitute in-house tests"
4. I printed the test details for both tests from the ARUP website and brought them to the Quest lab.
5. There was some confusion from the Quest tech about the order but I just asked her to take the blood, send it to the distribution center (or wherever the ARUP quest code specified) and include the ARUP website printouts in the container with my blood.
6. About a week later, my Doctor's office confirmed that the blood did actually make it to ARUP labs (by calling them)
7. About a week after that, I received a notification from Quest that results were ready on their website portal. However, when I went there to check them, it just said "Report to follow" and still says that to this day. ARUP had to end up mailing (postal mailing) the results directly to my Doctor's office since Quest couldn't figure out how to show them in their electronic system. So it took a while, but I did get the results and they confirmed the tests were performed by ARUP labs.

Things I tried before Quest that did not work:
1. AnyLabTestNow: They were really confused by the request and said the best they could do is take the blood and I'd have to figure out how to get it to the lab properly myself.
2. I tried calling ARUP labs and seeing who had access to their electronic system and could order the test in a direct way. I got a list of hospitals in my area. I tried calling the hospitals and they said they would only do those labs for inpatients.

I didn't even mess with trying to do it with Labcorp because I've found them pretty horrible to work with in the past anyway.