Finding out cost of first trimester testing

ncm1919

Something of an odd question but I am having a devil of a time finding out what the testing is going to cost me.

Called my insurer- they said they need a code. Refered me to my doctor for said code. Called my doctor- they referred me to the lab. Called the lab- they said ask the doctor or call the genetic person at the hospital.

I am in sales and make a living communicating with people...I feel like I'm taking crazy pills. I can't believe I am the first person who has asked this. How did you ladies get to the bottom of this?

What did you guys pay? I'm just trying to get a ball park number so I don't keel over when the bill arrives. I'm 34 and not high risk. It did take 2+ years to get pregnant but I'm not sure if this will have any bearing on coverage. Thanks!!!!

Y0urm0m

I'm sorry you are going through this. Everybody is different. I know for me my insurance covers 100% of my pregnancy all I pay for is the $100 dollar hospital stay when I go in for my RCS. I know some people who got bills in the mail after a procedure was done and I know some woman who didn't get a bill until after the baby was born. Can you try calling your insurance and talking to somebody else or a person in higher authority to try and to get your answers?

jenkeale

I'm sorry people are making this so frustrating for you. I used to work in a specialty Dr.'s office and I think it's crazy they've been sending you around like this. Whoever runs the test has the code and at least with our system, it was very easy to locate for patients. Sounds like laziness to me.
Last pregnancy I was triple insured, so I never payed for anything. This time with only Tricare, I'm paying $900 total for the pregnancy package, so I'm sorry I can't help with giving you a range.

DominiqueU

I'd call wherever you're having the testing done to ask for the procedure codes. I'm getting the sequential screening done at the hospital and they were able to give me the procedure code when I scheduled the ultrasound portion. My insurance covers all ultrasounds so they said this one is covered as well.

thebigoaktree

I have a shitty plan through my job and they have Cigna, and all the first trimester screenings are covered. However, at the meeting with the genetics dr last week he did inform us that the company that does it, does a self pay option that is cheaper paying out of pocket than my deductible. 130.00 compared to 500.00 is a big difference. This would be info for the harmony test, I'm not sure about the others. I would talk to the genetics place you're using,get the name of the company and then call them and ask about self pay if they have it. Hope this was helpful.

trucksntutus

I'm surprised your insurer didn't have this answer for you, who's your provider? I haven't received a single bill for any of my testing or U/S's as I know my pregnancy is 100% covered through my provider as well, but they should still be able to answer that for you. Perhaps can you give them the name/type of the test that you're questioning?

valleyvice

I didn't meet the criteria for genetic testing (NIPS) because I'm under 35 and the sequential screening was negative so I'm low risk ... But I got the pricing for the NIPS directly through my maternal perinatal specialist, and they charge $50 to draw the blood, and the lab charges $130 to analyze... And that's without insurance. Not sure if that helps.

valleyvice

^^ Screening, not *testing

Taymiller

My friend just got a bill for her testing, her so. Is 18 months old! Insurance can be a pain in the ass. @Y0urm0m I want your coverage please!

sboston06

I called my insurance to verify my coverage as well and they told me everything was covered 100%. I'm not getting anything special done and the tests they are doing have medical necessity associated with them. For instance, they're screening for Tay Sachs because I'm French Canadian but they aren't screening for some of the other tests that I have no risk of passing on. Hope you get some answers soon! I also found my coworkers (who have the same insurance) to be a good resource because they've all been through this before.

m8881

When I went I for the genetic counseling they had done estimates for me. We need to meet our deductible and oop and will be having this baby in this billing year (goes to July for us). There was only one option our insurance allows however they cover nothing, it's $750 but goes toward our deductible. I was given cheaper options for self pay but we want to meet our deductible so went with the $750.

ncm1919

Thanks for all the feedback. We got pregnant thru IUI and have met our deductible. We actually have very generous insurance, Aetna, through my husband. Once our deductible was met, ALL infertility treatments were 100% covered. As in, I could have had 7 IVF cycles and it would have been free.

I think after reading this, the place where I get the blood drawn will have the code. And thanks for the numbers. $500 I can swing. 2k needs to be planned for. When we did the infertility treatments, they did some sort of screening on my husband and we got a bill for $2500 before the insurance kicked in. I just don't want to open that envelope again.

ncm1919

Also I went from one of highest ranked infertility specialists in Boston back to my regular obgyn. My specialist and his office ran like a well oiled machine while still being personable. I'm used to getting a phone call with my results the day of a blood draw. So I'm patience is running thin with this run around bullshit. I don't blame my insurance company for not knowing what test I'm talking about. There are obviously several.

LaurenAsh23

Does your dr office have a financial counselor/advisor? We meet with one at the first prenatal appointment, they run your insurance and tell you what things will cost. Maybe try that route instead of trying to call your insurance again...I know the headache that can be.

And @Taymiller the same thing just happened to us...dd is 21 months old and I just got a bill for her delivery last month!! Luckily it was a small (relatively), but still...come on!

ncm1919

@LaurenAsh23 another good point. I live near the doctors office. I'm thinking an I person visit might be more effective. People tend not to be so dismissive when they have to look you in the eye

GoBadgers

If you are talking straight up first tri screen (two blood analytes, Papp-a and free beta hcg and a nuchal translucency ultrasound ) you are most likely taking about cpt codes 84163, 84074, and 76813. Obviously I'm not your medical professional, I just know these are codes that are used so might be helpful. Cpt codes should be universal. Also the question of who is doing the billing can be an important. Is the lab doing the analyzing doing the billing? Is that lab in network with your insurance? Or sometimes things are institutionally billed, where the bill looks and appears to come from a hospital but the hospital has sent your blood to the lab who does the testing and the hospital is paying the other lab, and in turn, turning around and billing your insurance. Most hospitals have what we call in my geographical area "send out" specialists and maybe that person in the lab is your best bet. Consider calling the lab and ask the person in charge of send outs what normal procedure is. (I feel like it is referred to as send-outs throughout the country not just limited to the Midwest where I trained and have worked). I also wanted to make sure you were not advanced maternal age (which might give you more screening options such as noninvasive prenatal screening or some ppl call it free cell fetal DNA testing (ie Materniti21, Harmony, Panarama, Informed pregnancy Screen depending on lab; they all have different names for fairly similar tests). Sometimes it is not caught that the mother will turn 35 prior to estimated delivery so has a diagnosis of advanced maternal age. I work in the field of genetics so have a fairly strong knowledge base on this stuff, although insurance and billing is not my expertise, it often comes up and I feel like I have a solid grasp. Did you by chance read your insurance manual? I read mine and it basically said all screening tests ordered by an OB or MFM are covered like other lab tests without the need for prior authorization (which is quite different then many things for my specific HMO). You might be able to find an online copy of your manual and find if there is a blanket policy that outlines what is covered and what is not during pregnancy. Hope this is helpful! Dealing with insurance and codes can be so difficult!

ncm1919

@GoBadgers wow. Thanks so much. I'm realizing I should have been more specific. I'm talking about the Harmony test or the like. I know that the basics are covered by my insurance.
Thanks so much ladies!

GoBadgers

So for first trimester screen, I would find out from your doctor which lab they use, then contact the lab directly (Sequonom, Progenity, Natera, Counsyl, Illumina) to get the codes and make sure you have the correct icd-10 codes (diagnosis codes--do you have an AMA diagnosis? ) Like a previous poster said, many of the labs sometimes have a deal if insurance won't or doesn't cover. Some of the labs, the deal needs to be done up front before they bill insurance (like Counsyl-they have a tool on their website that helps find out what a persons coverage is) and some of the deals happen after insurance is billed (I am 99percent sure Sequonom still does this--at least I hope so:)). I'm not as familiar with other lab policies. At my national conference we had a 90 minute breakout session focused on various billing issues. It can be so hard and confusing! I do know the blues (anthem) recently decided to cover NIPS (noninvasive prenatal screening--what we call this sort of testing) for all patients, others may have followed suit. I transitioned jobs out of a clinical setting this past summer so am not as up to date as I used to be.

htn1763

If you tell your insurance it's NIPT they should know the code. However, if you're low risk there really is no need beyond the NT scan and blood test at 12ish weeks. If you come back higher risk then your insurance should cover the NIPT then as medically necessary.

ncm1919

I am on the cusp of being ama as I'm 34. Frankly, if it's affordable, I want to do it for my husbands peace of mind. He has been having reoccurring nightmares that there is something wrong. This is not his normal style and this fear is a real concern he expressed long before I became pregnant.

I have been leading the charge on our entire journey to getting pregnant from selecting the fertility doctor to our prenatal provider etc. This is the first thing he's been vocal about so far. Like I said, his peace of mind is worth a few hundred dollars. If it's real money, I'll have a talk with the doctor and my husband to discuss our options.

BostonBaby1

Natinat6 said:

Thanks for all the feedback. We got pregnant thru IUI and have met our deductible. We actually have very generous insurance, Aetna, through my husband. Once our deductible was met, ALL infertility treatments were 100% covered. As in, I could have had 7 IVF cycles and it would have been free.

I think after reading this, the place where I get the blood drawn will have the code. And thanks for the numbers. $500 I can swing. 2k needs to be planned for. When we did the infertility treatments, they did some sort of screening on my husband and we got a bill for $2500 before the insurance kicked in. I just don't want to open that envelope again.

Natinat6 said:

Also I went from one of highest ranked infertility specialists in Boston back to my regular obgyn. My specialist and his office ran like a well oiled machine while still being personable. I'm used to getting a phone call with my results the day of a blood draw. So I'm patience is running thin with this run around bullshit. I don't blame my insurance company for not knowing what test I'm talking about. There are obviously several.

Are you in MA? I have thought that the maximum coverage was 6 cycles of IVF. Do you know if your plan is grandfathered in from years ago of if it is still available? We have had a very hard time and I would love to have that kind of coverage!

But to directly answer your question, the cost (to the best of my knowledge) can be anywhere from $0 to over $2800. It depends on which testing you have done and what your insurance decides to cover. In order to get the code, ask the doctors office that ordered the test to look on the slip and whatever is checked off will have the code next to it. Then you call your insurance and ask to speak with billing. We have Harvard pilgrim and I know that the insurance company has a special fertility line.

ncm1919

@BostonBaby1- I am in Boston. We have Aetna and it was not grandfathered in. It actually became less attractive last year in that we have a much higher deductible. If you want more information, PM me. My husband works for a local health care company. Maybe that's one of the reasons it's so generous.

I forgot about the dedicated infertility line. They have been good to me in the past. My appointment is on Wednesday. I guess I can always call my insurance while I'm there and make a game time decision

BostonBaby1

Natinat6 said:

@BostonBaby1- I am in Boston. We have Aetna and it was not grandfathered in. It actually became less attractive last year in that we have a much higher deductible. If you want more information, PM me. My husband works for a local health care company. Maybe that's one of the reasons it's so generous.

I forgot about the dedicated infertility line. They have been good to me in the past. My appointment is on Wednesday. I guess I can always call my insurance while I'm there and make a game time decision

YGPM!

blissylissy86

@Natinat6 I just left my NT appointment and baby was not being cooperative. We have to go back in two days to see if it will cooperate. I asked what their options are for NIPT in case Wednesday is a no go as well. They said because I am low risk it will not be covered by insurance and is $900, but that will go towards our deductible. That would be for the panorama.

GoBadgers

I know some of the NIPT labs used to refuse to do testing on non high risk women because the original studies were not validated in a low risk population. Sequenom followed this. I know Sequenom has fairly new product geared towards low risk women with a fairly low out of pocket cost (they won't bill insurance for low risk women)---but it also doesn't screen for trisomy 13, the rarest of trisomies that can survive to term. https://laboratories.sequenom.com/patients/visibilit/ In a clinic setting, it is often not easy to just use a different lab than normal. For example, if your physician typically used Illumina, they likely don't have anything they need (or the knowledge base) to send a sample to Sequenom.

GoBadgers

Because I didn't know anything about aetnas policy (and that is an insurance product that comes up in my area) I was curious and did a quick google search. If this is true, you should shop around and arrange with your doctor what lab you want to use since it will be an out of pocket cost. https://www.aetna.com/cpb/medical/data/400_499/0464.html

GoBadgers

counsyl has this tool which I have heard is well received by patients. https://www.counsyl.com/price/ Counsyl calls their test the "informed pregnancy screen"

randypluskate

I'm not sure if anyone's posted this yet but if any of your OBs offer the Verifi test by Progenity, the most you will pay is $99 if your insurance is in network. I highly suggest contacting their financial services department at the number here: https://progenity.com/financial-services 

Now my dilemma is choosing to do the Verifi test or the NT screen/blood work. I really want to know the sex of the baby but I also really want to see him/her! If I do the Verifi, I wouldn't get an ultrasound. Decisions, decisions.

ncm1919

So we just had our appointment. Got to see baby who is looking pretty fantastic. The genetic counselor and I called the testing company and it turns out the cost is only $200 out of pocket.
I think my issues last week are exactly what someone said before. Laziness. I think the d-team was working last week with the holiday

ncm1919

Oh and here is little fiesty. He/she was bouncing around like a kid on a trampoline. That was the most amazing thing I have ever seen.