Pregnant after 35

Harmony test denied by insurance

Hi! This is my 1st post and I only Bump mobile so I have no cool signature or pic or anything, sorry. I'm a 41 yr old FTM due 12/11/14. I had the Harmony Test in May. My insurance, that I thought was good, has denied the claim. My first appeal was unsuccessful but I'm filing a next level appeal. How many AMA moms, if any, have had their insurance deny their claim? Did you ever get it successfully approved? Thanks y'all!

Re: Harmony test denied by insurance

  • I had the Verifi test, which is pretty similar to Harmony.  We've had a billing glitch so I'm not exactly sure that our insurance denied it vs the original bill from the lab didn't get to the right people with our insurer.  I had to call the lab and ask them to resubmit our claim as it was like $1500.  I'm hoping that it will be at least partially covered.

    Have you talked to the billing person at your doctor's office?  Sometimes they are not labelled correctly, which is why the insurance company denies the claim.  Perhaps they can help?
    BabyFruit Ticker
  • I had the Maternit21 test, my insurance denied it until it was coded properly and my doctor provided additional justification for the test. Once the insurance company received documentation from my doctor it was covered at 100%.
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  • leela02leela02 member
    edited August 2014
    Did your doctor's office check if it will be covered before they did the test? If the doctor's office checked your coverage before the test, it might just be a coding/billing error like other posters have mentioned. My doctor's office found out my insurer only covers Panorama so that's the test I had.

    My insurer denied coverage of all the other genetic screening tests I had (like the ones for cystic fibrosis, thalassemia, etc.). My insurer's EOB statement said I would have to pay for ~$3K (!!! can't afford) worth of tests, but my doctor's office reassured me that the lab they use won't bill me more than $25 per test if the insurance won't cover it. I haven't been billed for any of those tests yet. The doctor's office said that insurers often deny coverage of these tests even for AMA.
  • I had some go rounds with the test last time. I had been approved for all testing, then the Verifi got denied. I called and insurance said it had been coded incorrectly, then lab sent me to collections. I talked to them a few times. I havent heard from them in a while... so I guess it got worked out. I got preapproved this time and went through insurer's lab so I wouldnt have the issue again! :-) GL. Also my OB office had an understanding with their lab that it was a capped OOP price if insurance denied, so I would have been willing to go that route.
    Pregnancy Ticker
  • Make sure dr has labeled you high risk due to AMA . Sometimes insurance denies based on reason from test. Call dr tell them insurance needs different diagnosis to pay. Even if insurance doesn't pay. The company will adjust for out of pocket usually around 250.00... Good luck!
    ***ticker warning*** DS 3/27/12 born 6 weeks perfect boy !! Lilypie Third Birthday tickersLilypie First Birthday tickers [url=][img][/img][/url] image<a href="
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