Progenity Test- Huge Bill!! Anyone else have this issue?

tmc427

I know this is an older post but hoping someone will see this still. I just had this happen to me. We had the genetic testing done at 12 weeks and all we were told from our doctor is that it should cost us around $100. We were not told that the blood work was being sent to Progenity or that it was out of network. Then we get an EOB from insurance saying the cost was $7,500 and that insurance was only covering $239 for us b/c it is out of network. Our insurance also cut us a check from our HCA account for another $2,200 that were are supposed to send to Progenity. However, I do not think I should have to pay this to them b/c essentially that is OUR money out of pocket and the cost should have only been $100 according to our doctor. Progenity is saying we DO need to send them the check and that they would write off the remaining amount. Has anyone else had this happen and what did they do to resolve it? Thanks!

peregrinefalconx

I would ask for a lot more clarification from your insurance agency and their office. There has got to be some sort of appeals process and/or responsibility on behalf of the doc (as they are the ones that chose the test--not you, unless you specifically asked for that one and there are multiple). 

I don't have any experience but sorry. Maybe try the www for your question as well.

optbaby2017

I did not have Progenity, so I can't give 100% advice. I can share that I had called my insurance with the billing codes the doctor gave me for the test they did, and was originally told that they would only cover part of the test, but couldn't tell what my part was to be. We decided to do the test anyway. I watched anxiously on my insurance company's webpage as the initial charges went from $10k, to $2k, to $900, to $200, and then they finally paid it all. I honestly don't know how or why, and that whole process took 2-1/2 months. I had been preparing to fight b/c I was just barely outside a few of the conditions of when they would cover it (for example, baby is due 3 days before my 35th b-day, and therefore they don't consider me to advanced maternal age). All that to say, good luck? 

BelhurstBride

I can't remember which brand test my doctor used but we ran into the same problem. We had to appeal it but it was eventually fully covered. 

MWoodside

If your health savings account sent you that money you can choose not to send it to progenitor but you will still owe that bill. Unfortunately it's up to the patient to figure out the billing before the test. My insurer didn't cover most tests but they did cover MaterniT21 so I got that and the most you gave to pay out of pocket if it's not covered is $100 for that test if you call and negotiate.