Insurance declining genetic testing

clo1982

I have been going back and forth with my insurance company trying to figure out where my pre-qualification stands for the Harmony test. I have been sent all over the globe talking to this person and that person, none of whom know what is going on. I finally get some lady today who says I have no need for the test, given that I have no past history of genetic disorders and they will be denying it so I would have to pay the $800+ out of pocket to get the test. I asked if the older quad screening would be covered, since with my last pregnancy, it didn't even require a prequalification. She said no, it all falls under the same category now and I don't qualify for the NT scan, Harmony, quad screening or any other early pregnancy testing because I'm 1. not 35, 2. have no family history, 3. have no past pregnancy history of genetic disorders.

 

I was furious! It's not like I have some cut rate insurance. We have BCBS. I hate that an insurance co can make a determination that goes against what MY DOCTOR is saying I should get! It just infuriates me!

TradeMama

My doctor told me that most insurance companies don't pay for the Harmony/MaterniT21/etc. but that if you call the companies that do the tests, they often do them for less. He said that often it's no more than $200 out of pocket. Maybe you can call and confirm that if you really want to do the testing?

KTdid81

I'm sorry.  I hate calling the insurance company too and it sucks what they consider "needed" or "unnecessary".

I'm under BCBS and my NT scan and 2 blood tests are covered.  I made sure that I got the test codes from the DR and then something from the insurance company (in writing) so that I have something to refer back to later - just in case.

clo1982

TradeMama said:

My doctor told me that most insurance companies don't pay for the Harmony/MaterniT21/etc. but that if you call the companies that do the tests, they often do them for less. He said that often it's no more than $200 out of pocket. Maybe you can call and confirm that if you really want to do the testing?

 

That's a good idea. I will try that route and if it isn't too expensive it would be worthwhile to look into. I have had 2 U/S already for other issues and the tech has said both times that there does not appear to be that thickening at the base of the neck,which is nice to know. But I don't believe that applies to the other thigns the testing looks for anyway. I'm not too informed on that end of things.

htn1763

I have BCBS and they wont pay for Harmony/Maternt21 unless it is medically necessary. Most Doctors won't order it unless you are 35 or have a history of genetic issues. I was told if my NT scan comes back with high odds then they will deem it necessary. 

Hrose7091

I didn't do genetic testing last time and won't this time. It wouldn't change the outcome and I have no desire to worry for 5-6 more months. I completely understand why people want them done though so no judgement there. If its truly important to you maybe consider the Nt scan I think that may be the cheapest option of the bunch.

dfchick

If you really feel that you need/want the testing you should ask your doctor for a cash discount or what that cost would be.  If it's reasonable, you can have them file with your insurance company and see if they pay it.  If it's denied then you'll just pay the cash discount.  Hope that helps. 

kkranberry

My insurance will not cover the nt scan until my $500 deductible is meet. I am no where near that. But they have a contract with my ob office for a discount. It will run around $200. We are doing or because it is very important to us to be prepared.

kelley72

I have BCBS of Michigan.. It sucks, not cut rate with premiums but coverage yes..

 

kelley72

opps- meant to say I am 41 so they will cover it... but I havent met my deductible so I will owe $ not sure how much, my original ultrasound for edd establishment based on irregular cycles was not covered and I paid $122. for it

codec

I understand you being upset, but as you said you don't have any indicators for genetics testing. The insurance companies only approve things that are medically necessary, if you can get your doctor to write a note and justify why its medically necessary they will approve. 

I have premera blue cross and they straight up denied my size and dates ultrasound! I was pissed off, but I got my doctor to justify the need for it, my cycles are usually 50-60 days long, grr. They finally approved after receiving the notes from the doctor.

Like someone else mentioned call the testing providers Harmony, etc and see if they can provide some payment assistance.

miramirror

I'll be 35 when I deliver but because my deductible is so high, my patient responsibility for the MaternitT21 would have been $2,000. I declined since I'll have to meet the deductible twice with this pregnancy. It depresses me to think about how much this baby will cost.

I had also heard that bit about the test generally being no more than $200 out of pocket, but I think that is no longer true. My understanding is that Sequenom was absorbing some of the cost to try to get widespread adoption of the test. 

kelley72

"I have premera blue cross and they straight up denied my size and dates ultrasound! I was pissed off, but I got my doctor to justify the need for it, my cycles are usually 50-60 days long, grr. They finally approved after receiving the notes from the doctor."

damn they refused to cover mine even with irregular cycles... ugh

codec

kelley72 said:

"I have premera blue cross and they straight up denied my size and dates ultrasound! I was pissed off, but I got my doctor to justify the need for it, my cycles are usually 50-60 days long, grr. They finally approved after receiving the notes from the doctor."

damn they refused to cover mine even with irregular cycles... ugh

I was annoying as hell though, I called them twice a day, for about 4 days straight. My doctor sent them a negative blood test from June 6th and positive urine screen from July 14th. So going by LMP was putting me 12 days off. And then they got all shitty and said I had not met my deductible, and needed to pay the full amount anyways, but I was annoying enough to just have to pay $30 for it.