Shocked at MaterniT21 cost!

anonymousmotley

So, I've seen alot of chatter about coverage and going round-n-round with insurance to get this test covered.  That scared me a little bit, so I started doing some calling of my own. 

I had the blood drawn on 7/31 and no results have come back yet, which is expected.

I called the Sequenom Lab today (8/6).  They had received my bloodwork on 8/4 and it will take 7-10 days from that date to return a result.  Ok, that's fine...

Do you contract with BCBStx? - Yes, we are in-network.
How much is your rate?  - I don't know the contracted rate with BCBS, but we bill out $2762.00.

MY JAW HIT THE FLOOR, FOLKS!!!  I was actually quite stunned for a moment, then asked for the code so I could call insurance.

(Now keep in mind, I have a HDHP with a $4800/ded-$8400/co-ins and my baby isn't due till 2015 so I will have TWO deductibles to meet with this baby. So I am sh*tting bricks at the moment!)

Called bcbs and they were of little help.  Since this test is so new, they couldn't tell me what they normally pay out for this test.  But they did tell me that lab is in-network and they do have a contract with them.  However, it does require a 'pre-determination" for the benefit to be paid out. Luckily, we all meet the criteria as AMA so it should be a covered expense.

Now I just sit and wait for the billing and find out how much this is actually going to cost me.  I wish I wouldn't have read any posts about it so I could be blissfully ignorant until the bill came in! LOL

CRAY-ZEE!

The call ended on a high note.  The rep at BCBS did voluntarily tell me that breast pump rental is covered 100% up to $1000/yr or $150 for an electric pump purchase twice in a year!  So that actually made me feel really good!!

NeonNoon

Thanks for posting the info.  We are self-paying until Dec/Jan when we become eligible to add maternity coverage.  My doc is offering Verifi and also nxtPanel for genetic carrier screening by the same lab.  These tests are important to us.  So, we definitely want to do them.  I was expecting $3k in the worst case (if I couldn't negotiate the price) for both.  But having seen what they told you, I think I'm gonna call when I can, at least to get past the sticker shock.  Even if we had maternity coverage, it would be high deductible, so we'd be out thousands of dollars anyway.

mandyreads

I haven't done that test but I am sitting on pins and needles about the u/s being covered. I am hoping dince I am AMA that it will be covered. I have seen that Aetna will not cover u/s for finding out the sex. But since I am older I am thinking it will be considered a medical necessity.

2redtulips

They bill insurance, but if insurance still sticks you with a big bill, call Sequenom back. They will work with you to get the out-of-pocket cost down to about $250.

My insurance paid all but about $300, so I didn't bother trying to go for that extra $50 through Sequenom.

rae_dylanzmom

My Anthem insurance (CA) paid my Harmony test out at 100%, which was way better than I expected. It did take them forever and they asked for additional records from the ordering physician; but they paid it all.... it was $800, not thousands.

Ditto the pp, if you get socked with a bill over a few hundred, the Maternit21 should knock it down for you. I didn't have to go this route myself, but have routinely seen this comment here on TB.

NeonNoon

We called Progenity.  Even though we don't have maternity coverage, they said we would be charged $25 per test, because we have other insurance (BCBS TX).

If you have no insurance at all the self-pay rates are $795 for Verifi and $800 for the nxtPanel.

anonymousmotley

@NeonNoon - Glad you called and got the rates!!  Those numbers don't sound too bad!

My insurance will cover it, I just don't know what the 'agreed contract rate' is. So whatever my insurance has agreed to, I'll have to pay all out of pocket since I haven't met my deductible yet.  I'm hoping that the agreed amount is $250, like @2redtulips mentioned!!  That number sounds much more appealing that $2762!

@mandyreads - Luckily the scan to determine sex is really an Anatomy scan.  They are checking to make sure all organs and body parts are normal. Determining sex is just a bonus! So there shouldn't be a problem with payment...hopefully! Hoping your stuff is paid for!!

Bigboneded

It was all pre arranged this time, and covered (finally) last time... but was billed for $1500 from lab and sent to collections before they worked it out :-(

2ndGeneration

 OP, I have BCBS also (Fed though, not the high-deductible one) and Sequenem billed that 2762 also.. But because it was in-network (like yours is) they accepted what BCBS paid, 1100 , and I was not responsible for any more (because it is in-network). I did pay 150 deductibe to the hospital for the blood draw-had I gone to the local outpatient it would have been 25, duh to me!

 So it seems like you will just end up paying your deductible.

anonymousmotley

Wow...thanks for the info!  So it looks like I'll be paying $1100 for this test unless I can get Sequenom to reduce it to $250 like pp have said.

Oceanbreezy1

I have bcbstx. Ours was billed through Qwest diagnostics. The billed amount was $2368.15. The in-network discount was $1370.65. This left $997.50. My ded has been met so my insurance paid $575.39, leaving me a balance of $422.11.

cherm1021

Holy smokes! I never even thought about the cost of it! I just got my results on Friday so now I get to wait for the bill. We also have BCBS (MI) and have to meet a deductible. I feel like we are getting doctor bills weekly these days. Especially because my oldest just broke her wrist and we ended up at urgent care and then an orthopedic.

anonymousmotley

This is depressing!  

When I had my son in 1997, I paid my first OB Co-pay of $20 and nothing more.  

When I had my daughter in 2010, I had a $500/ded-$1000/co-ins, then she had her own deductible when she was born. So she cost $1700.

With this one, I have a $4800/ded-$8400/co-ins which I hadn't met much of it since the kids and I are pretty healthy. This means, I have to pay for every ultrasound, urinalysis and blood test.  So far, since I've had so many blood tests and ultrasounds, I'm sitting at $1100 + this Mat21 test which looks like $1100.  So I'm estimating pay OOP during this plan year $3000+.  Then I have to meet next years deductible with the OB fee and delivery, plus the baby's deductible.  My estimate for this baby will be close to $10,000!!!! (more if I have any complications during delivery or need a c-section)

This is CRAZY!

All I can do now is hope that during open enrollment (in December), I'm presented with better healthcare options!!

anonymousmotley

cherm1021 said:

Holy smokes! I never even thought about the cost of it! I just got my results on Friday so now I get to wait for the bill. We also have BCBS (MI) and have to meet a deductible. I feel like we are getting doctor bills weekly these days. Especially because my oldest just broke her wrist and we ended up at urgent care and then an orthopedic.

Did you find out what you're having?

snglmama38

I was told the test would be covered by my insurance and was shocked to receive a bill for nearly $3,000. I figured out that CPS billing code didn't match up with the codes that my doctor and my insurance company gave me. Sequenom used a different generic billing code. This is just something to note in case you are told that it will be covered and then it isn't. I called the lab and had them change the codes and ended up only paying $50 out of pocket as my insurance did cover the rest. The testing is supposed to be covered for women over 35 under ACA in plans that have not been grandfathered in (as are breast pumps by the way). 

mdogan29

I had my Mat21 test done today and stopped by the billing office on my way out to talk about insurance stuff. I know all insurance companies are different, but I have BCBS too (of NC) and the billing lady told me that no matter how much Sequenom sends a bill for (she mentioned about $2500), call them and they'll reduce it to around $200 and that it could be less, but should not be over $200, even if the insurance cover 0% of it. She said if there's a problem, let her know and she'll help me take care of it. So, thought I would share if anyone gets a bill and wants to try to call!

anonymousmotley

Hi ladies!

So Sequenom billed insurance for the $2762 and my insurance denied it, pending supporting documents from my doctor.  It'll be covered, due to my age, but I have to wait for the proper paperwork to be supplied for the covered amount to be applied.  

I'm encouraged to hear that just calling the lab will have my out of pocket reduced to only $250!!