How do they consider high risk for MaterniT21?

liz4paws

Hi ladies! I have my NT scan and (hopefully) Mat21 blood draw tomorrow. I'm only 32 but I'm carrying a baby from a donated embryo. My OB suggested the MaterniT21 bloodwork at my 10w appt, although he didn't give the rationale and we didn't really talk about it so I'm not sure why. DH and I personally want the Mat21 blood draw because I don't have genetic history for one of our donors who is possibly the genetic mother of this baby (we transferred two embryos from two completely different sets of donor parents and don't know which implanted.) However I *believe* that genetic mother is also under age 35. I'm just not sure. That being said, I called Sequenom labs to ask about OOP costs just in case I'm not considered high risk, and learned that unless your doctor considers you "high risk" specifically, they won't even run the test. Period. They will send the blood sample back!

So my question is....

Do you know how the OB declares you high risk when sending the sample? Does he just say "Yeah, my patient is high risk" and checkmark a box? Or do they have to justify it with rationale? I've had two miscarriages. Not sure if that will place me in high risk on it's own, or if they want three to be considered recurrent loss.

sunflowermama42212

I have no advice but that is so stupid that they won't let you pay OOP. It's your money and your blood. I would push my DR to call me high risk because you don't have all the genetic info on one of your donors. I hope it works out for you.

PhillyJ33

I am 34 and was first told that I did not qualify for the test and you needed to be over 35 or have a history that warranted it genetically, I guess. However, during my anatomy scan, they found an issue with my umbilical cord (single artery) which may be considered a soft marker for chromosomal issues so they were then able to sign off and order the test. I had to meet with a genetic counselor and she filled out the paperwork but I do remember her listing that was the reason for the test.
That said, a friend of mine is under 30 and she had no problem getting cleared for the testing at 12 weeks (no miscarriage history but she was an IVF pregnancy as well) at a different OB so I always thought the practice set the guidelines. I know cost is a factor for then.

Sorry- that doesn't help you but I was under the impression that the doctor just needed to sign off on it and didn't realize the lab would send it back!

Oh and I think it's an expensive test OOP but some Ladies on here negotiated a lower rate. My insurance covered it luckily.

liz4paws

Thanks for responding, ladies! After I posted this, I decided to call the customer service number and ask the specifics. It turns out that it's really up to the doctor's discretion. He just says you are high risk and lists a basic reason, but they will accept it without pushing further. And it sounds like my OB should be on board for one reason or another since he suggested it. Fingers crossed!

Also, in case anyone is curious, you can call Sequenom and tell them your insurance company and they will check on your OOP situation for you. In my case, my insurance will be billed as out of network and whatever my ins pays, they pay. The max out of pocket the patient pays in my case (Unit.ed He.althcare) is $200 which is great. If anyone is reading this and had similar questions, that's what I learned. Their customer service seems really knowledgeable so I wouldn't hesitate to call them.