MaterniT21 plus insurance codes

MeliGOP

Hi Ladies,

My husband and I are both 40 and we are considering the new Maternit21 test. I tried to check with our insurance if and how much our plan covers but they need to know a diagnosis code and/or procedure code. Does anyone know this? We are with Blue Cross Blue Shield PPO.

Thank you

silvercamaro77

You can probably call your Dr and find out. They would have to know in order to file it anyway.

Also I did some Internet research and for what that's worth it sounds like these testing companies generally cap the consumers OOP cost for these tests ar around 250 even if the insurance doesn't cover it at all.

cajunrunner

Could you call your drs office and see how they would code it? That would probably be your most reliable source.

2MamazInSeattle

I'm not sure the code but your doctor's office would know. Many insurances will cover it if you are over 40, but some are still considering it too new/"experimental" - in which case you'll need to as your provider your OOP cost. Many are offering the test for super cheap (I guess the actual cost is $3K) but most are charging between $200-$500 OOP. Ours is going to be $200 if it's not covered, and totally worth it to us. You also get the NT ultrasound which should be covered no problem (looking for fluid on the neck). Hope that helps a little!

ShelbyInLoveWed31149

I just had the Maternit21 test last Thursday. I am 39 and we have BCBS. I was told at the Dr office the MOST we would be responsible for is $235 but most likely less. We were okay with that, so we went ahead and did it without insurance precertification.

MeliGOP

Thank you! I will do that.

MeliGOP

Thanks. Do you know how long before you will get the results? I think this new test is a wonderful thing.

wifemomnurse

I don't know the exact ICD9 or CPT code but the two u can think of are for those over 35 can use advanced maternal age and people who have a history of downs in the family can use family history. We have BCBS as well.

ShelbyInLoveWed31149

We were told approximately 10 business days. Waiting impatiently! With my first pregnancy we did an amnio at 17 weeks, I am unsure if we want to go that route again this time so we did the MaterniT21 last week as a starting point. : Good luck to you!! :

fritz799

This.

My OB said that she doesn't have a guarantee from the company or anything, but that she's never seen someone charged more than $250, even if it was completely out of pocket. 

 

silvercamaro77:

You can probably call your Dr and find out. They would have to know in order to file it anyway. Also I did some Internet research and for what that's worth it sounds like these testing companies generally cap the consumers OOP cost for these tests ar around 250 even if the insurance doesn't cover it at all.

Goodysgirl

I called sequenom directly last week and they said the most they'll bill a patient is $235.  They will try to bill the insurance the full $2900, but if they wont' cover all, or any of it, the company charges the patient up to $235.

I called my insurance and gave them code:  "Misc 81479" (provided to me from sequenom) to see if they cover the test.

danib1016

Insurance companies DO NOT cover this as in-network. they may pay something IF you have out of network benefits. I was told that if my insurance didn't cover this I would be bill $200. My insurance paid $912 and they are STILL billing me $200. To me their billing practices seem unethical.

MitsB707

ZOMBIES!!!!!!

TrueBeliever925