I understand this is recommended for "ama" (quotes because I think the 35 cut off is redic) but what about those with history of loss? I'm so torn. With DS I didn't worry about it. But at that time I was living in a happy 1st pregnancy bubble. Now I'm jaded and just more aware of all the potential outcomes. I feel like I'd be 100% in if insurance would cover it but if not, I don't know about the OOP costs being affordable to us. Naturally I cannot tell from their website and will have to call to ask.
@prpl11butterfly hmm, that is a good question. My insurance covers it even for non -AMA *if* you have a history of genetic abnormalities with previous pregnancies. Yes, calling them is your best bet.
@prpl11butterfly That’s actually good news. My insurance is the same. I just had my MFM office call my insurance’s Preauthorization number and say they recommended a test. And boom! Covered.
I did not get any tests with my first and I wont with this pregnancy either. That being said I am also high risk and seen by an MFM so I get level 2 ultrasounds every 2-3 weeks so a lot of that is covered in my "normal" monitoring.
@srscott3, when you called Harmony, what exactly did you say? I just got off the phone with them and they told me that I would pay the full out of pocket cost for the test since it isn't covered by my insurance. He quoted $300 or more.
@luckystar28 I'm just not sure if they will say it just to get it covered. Maybe because of the MMC they will. I'll have to talk to them when I'm in on the 15th (or sooner if they call after my US).
@prpl11butterfly I’m not sure what they’re looking for to recommend a test. My MFM recommended it due to my history. It’s worth bringing it up to your provider to see.
If you or your family are considered genetic high risk, your doctor should be able to call for pre-authorization. I think there are still a couple insurance companies that require some additional paperwork, but for the most part, it's at least covered in some part as long as you pre-authorize.
@prpl11butterfly I told them that I checked with my insurance and my insurance said the claim would be denied. They asked who my insurance was and when I told them, they said that they have an “agreement” with my insurance where if the claim is denied, the patient only pays $199 max out of pocket. I then asked what if I just don’t submit it through insurance at all and they said it would still be a max $199.
@srscott3 unfortunately we don't have the $199 to spend. We have some hospital bills from DS having a lyme scare and over the summer and we are trying to avoid extra spending due to trying to buy a new house.
@prpl11butterfly i would calmly explain to your doctor why you are worried and that you would like the test but cannot afford it out of pocket. Since you have a history of MMC, I would think the doctor would be open to it. Good luck!
@SpongeWorthy I get your screen name reference to Seinfeld. Just wanted to point out that I got pregnant because that was our birth control method. It obviously failed! 😂
I’ll have the NT scam done on 11/20 when I’m 12w4d.
For me its peace of mind and the opportunity to plan for anything that may be occurring with the baby. That was if we need intervention right after delivery we’ll know
Thankful for this thread, as I already am forgetting some of what the nurse said about this stuff! I am confused because the test my OB office does, they call AFP Tetra. They schedule that at the 15 week appointment, they gave me an info sheet about it. Or we can opt to do the Panorama NIPT at the 11-12 week appointment instead. I just have to schedule a call with them before my appointment on 11/19. So I am not seeing anything about an NT scan on the schedule they gave me. Now I just don't know what to do!
@jmvander I'm not sure - maybe your doctor just doesn't do the NT Scan. Maybe they offer the NIPT if people opt for earlier testing, otherwise you wait for your quad screen in 2nd trimester (Quad = AFP Tetra; it's 4 tests in one - looks at HCG, Estriol, Inhibin A, and AFP). I'm trying to figure some of this stuff out too. I think even if you decide to do the NIPT, there is still part of the Quad you want to do because they aren't just looking for chromosomal abnormalities, they are also look for neural tube defects (like spina bifida).
My doctor does the Nuchal Translucency Test which is a combination of an ultrasound (where they look at the thickness at the back of the neck and at the nasal bone) and a serum blood test that looks at HCG and Pregnancy-Associated Plasma Protein A. Using theses results they can determine the probability of chromosomal abnormalities specifically related to Trisomy 21 (Downs), 18 and 13. The benefit of doing this with the NIPT is that the ultrasound can also be useful in identifying potential abnormalities with your baby's structure. But you will obviously keep getting ultrasounds that will help to do this as well. I would just ask your doctor's office if they do the NT Scan and why they don't if they don't recommend it.
@chrssyms thanks for your detailed response! I hate not understanding things and I would feel like a bother calling my practice back to confirm. I know that I get an ultrasound at each appointment, so I will ask at my next one about the NT scan specifically.
My husband and I are going to do the 15 minute call with natera. It is hard because I don't have anyone to talk to about this in person except my brother, because most people don't know we are pregnant. My nephew has down syndrome and so it isn't an easy discussion with my brother either. At this point my husband and I are just erring on the side of doing the NIPT regardless of what we will get at future appointments anyway because we think it is the right decision for us. It sucks that this topic feels so touchy so I really appreciate those who are willing to share and provide information without judgement.
@ jmvander No problem! And you shouldn't feel bad about calling your doctor's office. I think most of them are used to it and expect it. This is not a thing people go through on a regular basis and it's such a departure from your normal healthcare. Good luck!
I really appreciate everyone sharing their stories. It’s a very personal decision and it helps this FTM to hear from a variety of perspectives and experiences. There is no right or wrong here. We are all parents facing tough decisions. This is only the beginning of the many decisions we will make as parents for our children’s best interests
Does anyone’s OB not offer the NIPT unless you’re AMA or have a history of a genetic condition? I was offered the NT blood test in combination with the anatomy scan and told that because I’m not AMA, I’m not eligible for a NIPT. Seems so odd because it seems to be general practice in some areas.
@carleym93 after reading over the differences between the NIPT and NT I've realized my office only offers the NT blood test and the u/s with the blood test. When I asked about the NIPT (because it reveals gender and I had a friend that did it) the nurse said they don't offer it because unless you have risk factors your insurance isn't going to cover it. Do you like in a small town perhaps? My ob is in a relatively small town so I'm wondering if that's part of it.
Not trying trying to tell you what to do, @carleym93 but remember that your OB works for you. And you’re not “not eligible”. You’re pregnant..you’re “eligible”. Your insurance may not cover it, but that’s not really your OB’s concern if you’re willing to pay out of pocket.
@carleym93 My OB gives the requisition for the NIPT, but it's done in a separate lab. Different labs use different tests like Panorama, Harmony, etc. That's how it works in Canada anyway Our provincial insurance covers it for AMA moms, but anyone can get it and pay out of pocket.
@carleym93, @srscott3 is right. It's possible that they are saying they don't "offer" it because you're not AMA and you haven't gotten your NT scan results yet where the findings showed any concerns and necessitated any additional testing. But you should ask them about the NIPT Harmony, which is an option for women who are not AMA. The test, I believe, costs at most $299. However, my insurance, even if they don't cover the test, still has a negotiated rate with the company so I only pay $199. Just tell your OB you would really like to consider paying out of pocket for it so you can get more information, if that's what you want to do.
Getting my NIPT this Friday (@ 10+2) and my NT scan next Friday. My OB still recommends both when AMA (I only had the latter the last time around). I am one who wants to have all the information and to be prepared. These are all screening tests regardless, so I really don’t understand the discussion on termination based on either one of these non-diagnostic tests. If something were to come back abnormal, I’d certainly has to consider further testing. In my mind, the sooner I know about something positive or negative, the more time I have to either feel reassured or to prepare for the next step. So grateful for the science that has allowed all of these tests to become possible.
I had the panorama (nipt) and California prenatal screening today. Just the blood draw for the screening, the ultrasound will be in a couple weeks. Something I learned was that NIPTs don’t measure hcg, analytes, and PAPP-A, which can be indicative of adverse obstetric outcomes. Yet the California prenatal screening does. Hence why both can be recommended. My analytes were abnormal last time around, so let’s see what happens this time...
@luckystar28 did your OB say what the HCG, analytes and the PAPP-A could indicate if not chromosomal stuff? I'm just curious because my husband were kind of thinking of just doing the NIPT and skipping the NT scan. But we won't skip the NT if there is something valuable we can learn aside from just the Trisomy 13, 18 and 21 chromosomal abnormality information.
@chrssyms I’m not not about all the specifics and cases, I’m sorry. But in my case the abnormal analyses were indicative of an increased risk for preeclampsia and/or preterm labor. I did end up developing preeclampsia and delivering at 34 weeks. However, no matter what the test says this time around I’ll still be at higher risk of developing preeclampsia again due to my history and its severity last time around. So the test won’t mean much, if that makes sense. My MFM is still curious to see the results since they’re still doing research around risk factors and such.
@harrierwife, that’s really interesting. I just had my appointment today and called Tricare in advance of it to ask about what they covered. I was basically told that if my doctor orders the test, it will be covered. My sister had it done six months ago with Tricare and had no issues. I guess the way they do it (here, anyway), is they’ll draw my blood and then won’t run it until they get the confirmation from insurance. If insurance won’t cover, the call and ask if I want to pay OOP and if I say no, it doesn’t get run. 🤷🏼♀️ I hate the inconsistency in these things.
Married 25 May, 2013 William Alexander born 18 September, 2015 Harper Grace born 9 June, 2017 Colton Miles born 9 June, 2017 Bowen James due 19 June, 2019
@harrierwife So I know you’re military and things may be different..but I’m so confused how a doctors office can say the test is a certain price at their office when it’s more about the testing company and the insurance?
My OB’s office said the same thing.. at “their office” it’s $500-600. Then I called harmony and my insurance company and they said it’s $200. After I heard that, I called the billing office at my OB’s office and the lady there said she wasn’t sure why my doc said that. She said everyone’s price is different.
@KissMeImScottish - I went to the referrals office on base last week and asked specifically about these tests. The lady that runs referrals (she's actually MH's cousin so I trust her to be open and frank with me) told me flat-out that because I'm not AMA, it will be denied unless my OB officially orders it. My OB then told me that there's nothing in my history or tests at this moment that would make her order one for me. That could change, of course. She also told me some stories of girls stuck with big bills because they didn't verify coverage of tests or thought they'd strong-arm Tricare into covering it. I just don't think I'm going to go there.
@srscott3 - I verified with billing after my appointment that that was the price, and she confirmed $1400
Just wanted to bring this up so no one gets stuck with an unexpected bill. Moral of the story - confirm the price with the doc, billing, AND your insurance company. And don't assume that its only $200-300 OOP. It might be more.
@harrierwife Take this with a grain of salt because I'm old, so it was covered for me with DD, but I've heard Natera, or Panorama or Harmony, or whoever you use will knock you bill way down if your insurance won't cover it. On a personal level, I did genetic testing with Natera and they gave me the option of paying $300 OOP or submitting to my insurance company. Ins. paid $600 and I paid $97. So there was a difference in what they billed to ins. and what they were going to charge me.
If you really want it, you might want to give the testing company a call to see what they can do for you.
ETA: I assuming when you said you called the billing dept it was for your OB's office, not the test company.
@harrierwife seriously?? +1 to @ruby696 about calling the testing company directly. I’m doing Harmony and their price is $299. They told me that was the price if I choose not to submit it at all through my insurance. It’s possible your ob’s Office won’t work with them or whatever. But if you call the testing company they can tell you where you can go get the test done. I think. I’d just call if you are actually interested in doing it.
I had an amnio done with my last pregnancy. They billed out thousands to my insurance but ended up being out of network (which super annoyed me) and so insurance paid nothing. My MFM had said I would get a set rate and when I called and talked to them only ended up paying around $300.
@chrssyms If I understand your question, you're wondering what the 12 week u/s looks for other than chromosomal issues. One of the big things is spina bifida, which won't be picked up in a blood test.
So this test for me is very expensive out of pocket. There is a way for me to only pay a couple hundred dollars. But I would have to call insurance, give them codes, then they deny it, then I call the doctor, they give me extra codes and then the doctor writes a letter, then I call to follow up, then the doctors fight insurance to get it covered and if everything isn’t coded perfectly then I get stuck with the whole bill. Sooooo im not going to do it.
Re: NT/NIPT Dicussion Thread
For me its peace of mind and the opportunity to plan for anything that may be occurring with the baby. That was if we need intervention right after delivery we’ll know
My doctor does the Nuchal Translucency Test which is a combination of an ultrasound (where they look at the thickness at the back of the neck and at the nasal bone) and a serum blood test that looks at HCG and Pregnancy-Associated Plasma Protein A. Using theses results they can determine the probability of chromosomal abnormalities specifically related to Trisomy 21 (Downs), 18 and 13. The benefit of doing this with the NIPT is that the ultrasound can also be useful in identifying potential abnormalities with your baby's structure. But you will obviously keep getting ultrasounds that will help to do this as well. I would just ask your doctor's office if they do the NT Scan and why they don't if they don't recommend it.
My husband and I are going to do the 15 minute call with natera. It is hard because I don't have anyone to talk to about this in person except my brother, because most people don't know we are pregnant. My nephew has down syndrome and so it isn't an easy discussion with my brother either. At this point my husband and I are just erring on the side of doing the NIPT regardless of what we will get at future appointments anyway because we think it is the right decision for us. It sucks that this topic feels so touchy so I really appreciate those who are willing to share and provide information without judgement.
Do you like in a small town perhaps? My ob is in a relatively small town so I'm wondering if that's part of it.
Sorry. This is probably an UO.
My OB yesterday said that the NIPT testing in her office is $1400 OOP. My insurance doesn't cover a dime of it.
William Alexander born 18 September, 2015
Harper Grace born 9 June, 2017
Colton Miles born 9 June, 2017
Bowen James due 19 June, 2019
My OB’s office said the same thing.. at “their office” it’s $500-600. Then I called harmony and my insurance company and they said it’s $200. After I heard that, I called the billing office at my OB’s office and the lady there said she wasn’t sure why my doc said that. She said everyone’s price is different.
@srscott3 - I verified with billing after my appointment that that was the price, and she confirmed $1400
Just wanted to bring this up so no one gets stuck with an unexpected bill. Moral of the story - confirm the price with the doc, billing, AND your insurance company. And don't assume that its only $200-300 OOP. It might be more.
If you really want it, you might want to give the testing company a call to see what they can do for you.
ETA: I assuming when you said you called the billing dept it was for your OB's office, not the test company.