March 2018 Moms

Noninvasive Prenatal Testing (NIPT)

13

Re: Noninvasive Prenatal Testing (NIPT)

  • @mintea Not sure if this will be helpful, but when I called my Drs office today to ask about the test, they told me they'd submit to insurance first (I guess to see if they'll cover it), and if not you reach out to Counsyl and they'll just charge $99. I feel like someone else had a similar experience, so it might be worth asking your OB if they have an arrangement like that. 
  • Hi @mintea just wondering how this worked out for you. I was told the same thing from my insurance company regarding NIPT, and am going to verify tomorrow with my doctor's office.
  • Loading the player...

  • @brettanomyces my NT, Harmony and other blood work is tomorrow at week 12 day 2. Strong feeling the ball dropped with me and will be expressing some anxiety to my fertility Dr about this. I know I need to be responsible too, and I was. I called and left messages to book me since end of July. Lesson to learn for others: follow up asap because per my case, you don't want wait so long to hear news. I will get results between week 13 and 14. My heart says all is well but this is extra stressful. FTM too at 38. 
  • Hi @mintea just wondering how this worked out for you. I was told the same thing from my insurance company regarding NIPT, and am going to verify tomorrow with my doctor's office.


    Not very productively so far. I called insurance again and they said the same thing. This time I pressed about what she meant by medical necessity and she said it all depends on how your doctor codes it and if they think you're at heightened risk, and then the insurers review board determines whether they agree it was medically necessary or not. She said examples are advanced age or previous baby with genetic defects.

    I asked if there was a way to get a determination in advance and she said that "preauthorization is not required on your plan" but I pressed if it would be possible to get it anyway and she said the doctor could call for preauthorization. I called the OB and they seemed really confused and were going to call the insurer and call me back. I don't know why this is so hard because I feel like everyone on here is getting NIPT, is this not standard practice by now?

    DD #1: 2012; MMC: 2014; DD #2: 2015; It's a boy! 3/31/2018

  • @mintea it was a huge PITA to get insurance and my doctor's office to answer those very same questions. We spent over a week calling between those two and the actual company doing the test. GL
  • mintea said:
    Hi @mintea just wondering how this worked out for you. I was told the same thing from my insurance company regarding NIPT, and am going to verify tomorrow with my doctor's office.


    Not very productively so far. I called insurance again and they said the same thing. This time I pressed about what she meant by medical necessity and she said it all depends on how your doctor codes it and if they think you're at heightened risk, and then the insurers review board determines whether they agree it was medically necessary or not. She said examples are advanced age or previous baby with genetic defects.

    I asked if there was a way to get a determination in advance and she said that "preauthorization is not required on your plan" but I pressed if it would be possible to get it anyway and she said the doctor could call for preauthorization. I called the OB and they seemed really confused and were going to call the insurer and call me back. I don't know why this is so hard because I feel like everyone on here is getting NIPT, is this not standard practice by now?

    Unless it's regional, but it is not standard practice around here unless you are AMA or have history of genetic defects.
          
  • @mintea Wow. What a runaround! I feel like I'm in this same situation, but you're a couple of steps ahead of me in the process. It's all so confusing and frustrating. Where is the "care" in healthcare these days!
  • @mintea Are you in CA by chance? In CA there is a state program that all insurance policies have to adhere to and in that program you don't qualify for NIPT unless high risk for brith defects and/or AMA. So it's not standard here to get NIPT. It's possible similar programs exist in other states, but I can only speak for CA. 
  • I had to pay $550 out of pocket...not covered in Canada  :(
  • Yup out of pocket...+$500. I did the Harmony. Waiting for results.
  • If your doctor's office will help you get it through Counsyl, their rate without insurance is $349.
        
    Me: 34 DH: 38
    Married: June 2011
    TTC since Feb 2016
    BFP#1: 7/7/16 MMC: 8/16/16 
    BFP#2: 5/8/17 - CP
    BFP#3: 6/27/17 EDD: 3/10/18
  • @nancysimp When I called Harmony about costs, they told me that if insurance didn't cover it, then I would only be responsible for $199. You might want to give them a call and see what they can do. (They also said that if insurance covers it and I haven't met my deductible yet, then I could be responsible for up to $700!)
  • I just had my blood drawn yesterday for NIPT and it will only be $99 regardless of insurance coverage. My doctor's office uses Progenity/Innatal and they have a section on their website saying they're committed to making it affordable. Might be a good option?

  • My midwife (in the usa) told me NOT to call insurance. To call Harmony directly and give them my insurance info and tell them AMA. She said they would figure out if it's covered and what it would cost. Haven't done it yet, but I'll update you if/when I do. 
    BabyFruit Ticker

  • nancysimpnancysimp member
    edited August 2017
    @rachel2107 I was billed $495 Canadian. Going to call insurance to see if they cover any of that but my fertility Dr said they won't since half the cost was subsidized by the government already. Will give it a shot anyhow. :)
  • People who got the NT scan + 2 blood tests instead of NIPT (who hopefully still look at this thread...) Did you get any information to quell your fears at the actual NT scan, or did they wait to tell you anything substantial until after blood test # 2? I'm so nervous about genetic issues-- waiting a whole extra month or more for that 2nd blood test to know anything might drive me insane. 
  • vflux33 said:
    People who got the NT scan + 2 blood tests instead of NIPT (who hopefully still look at this thread...) Did you get any information to quell your fears at the actual NT scan, or did they wait to tell you anything substantial until after blood test # 2? I'm so nervous about genetic issues-- waiting a whole extra month or more for that 2nd blood test to know anything might drive me insane. 
    Did you meet with a dr at the time? We met our RE right after and he noted that the measurement was within the normal range. He also said if any worrisome results come from the blood test that they usually hear within a week so if we didn't hear from them that no news is good news. 

    The next blood test I believe is around 16 weeks which is for spina bifida? 




    BabyFruit Ticker
  • @brettanomyces I graduated from my RE at 9 weeks-- I do have an OB appointment a week after the NT, but my OB definitely won't be present at the actual test because we have to travel to a bigger hospital for it (live in rural area). 

    Is the second blood test really only for spina bifida? I didn't know that. If we rule all the other stuff out earlier that would be a big relief. 
  • @vflux33 I'm sure there are other things the test looks for, just like the NT isn't just for down's. spina bifida is just the main one I remember it being for. 

    So, my experience having my anatomy scan and a late pregnancy ultrasound at a big hospital was that there is a dr there who reviews each ultrasound and after the scan you wait for him/her to come out and give you the result paper and they tell you how everything looks. So hopefully that's the norm and you'll get to chat with a dr after. 




    BabyFruit Ticker
  • @brettanomyces I hope so--that would be great! Thanks for the info. 
  • @vflux33 At my old clinic they wouldn't tell me a single thing at ultrasounds other than boy/girl at the anatomy scan. Everything else I had to hear from my doctor. That said at my other clinic (RE/MFM) the tech told us our NT number (and the range) and then our MFM went through all info directly afterwards— placenta location, SCH status, NT results, heart rate, measurement of baby, etc. I'm sure it really differs. Could you ask your doctor to read the results and have a nurse call ASAP? 
  • @chasingroygbiv Oh that's annoying thats many places do this differently. I guess I'll just have to find out when I'm there! If they don't tell me anything without prodding there I'll definitely ask that--thanks. 
  • @vflux33 when I did it with my last pregnancy they gave us results after the scan. It may have not been at that appointment but it was within a week. 
  • beatingxheartbeatingxheart member
    edited August 2017
    I did Harmony on Thursday, August 17th. It was covered by my insurance, which is why I chose it lol. Idk why though bc I am a ftm and 26? Oh well. My dr said it is $110 without, which I would have paid. Idk if it is like that everywhere though. I already got my results back. The dr will say up to 2 weeks. If you google the company it says 7 days or less. My blood took an hour to draw plus a couple phlebotomists to try to get it. My veins are annoyingly small. Anyway, they rushed the results because of how long it took. I got it 6 business days later (Friday, 25th). Everything was normal & I am having a boy :) . I would recommend it but just know they will say up to 2 weeks. 
  • ishmoneyishmoney member
    edited August 2017
    Had first appointment yesterday and bloodwork was drawn for everything my insurance will cover. (P.s. I work for a university and my insurance covers exactly everything including co-pays. I just have to pay for the childbirth and other classes.)

    But as far as the bloodwork / scans, my midwife drew blood for the most comprehensive blood test...since I'm AMA, that's covered. There were no names. But if the screens come back positive, I would go for genetic counseling. I was expecting her to use one of the names you all have been using but nope. I'll just be patient and wait to see what the results are.

    Edited because this was a draft yesterday (bad food day, sick) that I did not post until this morning sooooo the appointment was Sat not yesterday.
    Me: 39 <3  DP: 49
    TTC since Jan 2017
    BFP #2 7/11/17 | EDD 3/24/18
    BFP #1 5/2/17 | EDD 1/12/18 | MC 5/18/17


    Pregnancy Ticker
  • I just got off the phone with my insurance company. I was just trying to figure out which testing is covered. Holy crap! That was the most ridiculous, confusing pile of bullshit I've ever heard. They wouldn't give me any straight answers, so now I'm really stressed out. It sounded like the testing won't be covered, but I don't even know. I guess I'll try to call Panorama, Harmony, etc. to see if they can tell me if it's covered (?). I can't believe how ridiculous this is.
  • @HappyMonkey817 we had the best luck talking to the testing company on the phone--our insurance was really confused about what was covered or not covered and the doctor's office was less than helpful--they couldn't even give me the CPT codes for the insurance to see if it was covered. GL. 
  • @HappyMonkey817 and @mintea I haven't done NIPT this time around (was planning on it, but now DH and I don't think it makes sense), but my 1st time we were told the reasons insurance would cover is 1) AMA (35+) 2) previous history of genetic abnormalities or 3) which happened to me, NT scans results that showed a higher risk of genetic abnormalities. My insurance at the time (Aetna) covered at 100% after my NT results weren't great.

    When I spoke to the genetic counselor on the phone before scheduling she said in my situation she wasn't 100% sure I would be covered since my results were out of the normal range for my factors, but not bad enough to automatically qualify (I don't remember the terminology she used). Luckily, I was completely covered though. I assume because of how the MD coded it.


    DS:
    Baby Birthday Ticker Ticker
    Pregnant with #2: 
    BabyFruit Ticker

  • Just Did the blood draw today at 12 wks for Progenity. I'm 31 with two other babies and no history of any generic disorders. The most OOP we'll have to pay is $99. My nurse told me the test costs 25k
  • rsquaredr said:
    Just Did the blood draw today at 12 wks for Progenity. I'm 31 with two other babies and no history of any generic disorders. The most OOP we'll have to pay is $99. My nurse told me the test costs 25k
    Did you hear my jaw hit the floor just now? Holy moly. 
  • ladybugsamomladybugsamom member
    edited August 2017
    I just had my blood drawn yesterday for NIPT and it will only be $99 regardless of insurance coverage. My doctor's office uses Progenity/Innatal and they have a section on their website saying they're committed to making it affordable. Might be a good option?

    @ksmwalters Same.  I just had mine drawn today.  It'll be no more than $100 for us, too, which is a relief because I have a $5,000 deductible.

    @rsquaredr OMG!  Seriously???  I spoke to Progenity this morning and she kept telling me not to freak out when I get the bill - just call the financial services # and they'll set it up so that I'll only be OOP a max of $100 or so.  Now I see why she was saying that!  Wow!

    eta: tagging
    Lilypie Pregnancy tickers
  • @ladybugsamom yes. I about fell off the table!! She also told me not to freak if we get a super high bill but just call Progenity. 
  • @rsquaredr Woooooowwwwww hopefully my DH won't open that bill. (I explained the process to him but with healthcare financial stuff he always assumes the worst.) I can see now why they repeated to me several times to not worry and just call them. 
  • Maybe this has already been discussed, but does the NIPT test for spina bifuda???? I'm assuming no since that's not a genetic abnormality?? I got my results back, doctor said everything is fine...but I didn't ask for what exactly we were testing?!?! 
  • Did anyone have issues with getting results back from this test? I took the Harmony test right at 10 weeks (with twins) and it came back as not having enough fetal DNA to test so we have to redo this test. I am on blood thinners but no one mentioned that this could affect the amount of fetal DNA in my blood sample. 
  • @rachel2107 I was told if dating was off by even just a day or two (making you a bit too early) they may not be able to get enough DNA. 
  • I can't get any straight answers about insurance coverage for these tests. Aetna couldn't answer me, and the testing companies say to ask the insurance company. Now I'm afraid to get tested because I cannot afford to pay out of pocket. I really didn't need another thing to stress about.
  • @HappyMonkey817 I'm sorry you're getting the run around.  Can you get the "code" from your Drs office to check with insurance?  (maybe you did already)  I feel like the NT scan is covered for most, but NIPT is more likely out of pocket.
    Me: 30 H: 30
    Dx: PCOS
    Married: June 2013
    TTC#1: January 2015
    BFP #1 8/24/15 | MC 9/3/15 at 6w2d
    BFP #2: 12/12/15 | DD born 8/29/16
    TTC#2: June 2017
    BFP #3: 7/15/17 | DS born 3/20/18
Sign In or Register to comment.
Choose Another Board
Search Boards
"
"