Beware Fetal Fibronectin test ($500/time)

SuzJune04

So I know that insurance prices are going up and everything, but we got a shocking bill this week.  My OB was concerned about all the BH I've been having so she did a fetal fibronectin test 3wks ago. 

"Fetal fibronectin "leaks" into the vagina if a preterm delivery is likely to occur and can be measured in a diagnostic test.^[1] It is an excellent biological marker of premature (preterm) delivery (a delivery before 37 weeks of gestation)."

My OB never mentioned any costs to be aware of, waiver to sign off on, etc.  Well our insurance just sent us a bill for $500 for this swab test (I thought it would be similar to a pap smear so never considered the price tag).  Aetna insurance considers this test to be an extra non-neccessary test, blah, blah, blah...

Well my OB did another one last week (still waiting for that bill), I think she is on the more thorough side of medical care.  I'm all for being careful but I have a feeling that we are now stuck with a $1000 bill that we didn't plan for and I'm a little pissed.

Thankfully all the results have come back that I'm not having "real" contraction and there are no signs of preterm delivery.  I just wondering how many of us pregnant moms are going to get a shocking bill like this.  Hopefully this gives everyone a heads up to at least ask before their doctor does something extra.

spacey281

I had one a few weeks ago, and Lab Corp billed my insurance company over $800.  My insurance company paid $10.  Very unfair you're stuck with a $500 bill.  I really hope you don't get stuck with two.  I can't see why Aetna would consider this non-necessary.  Have you spoken with someone at Aetna or talked with your OB office about how it was billed?

RedCamaro

spacey281:

I can't see why Aetna would consider this non-necessary.  Have you spoken with someone at Aetna or talked with your OB office about how it was billed?

This! We pay for our own insurance policy so I'm always calling our insurance company and asking questions. Years ago, we had Aetna and everytime I called them, they were very nice and up front with answers. I hope you have the same experience. Sometimes these things are covered under a non-routine visit vs. a routine visit (which is what I'm currently dealing with over a test for my DD when she was sick).

 

MommaErica

First, I'd dispute that with the insurance company.  Your doctor obviously felt it WAS necessary.  All insurance companies have grievance procedures.  Look into yours and don't pay this without a fight.

Second, if your insurance really won't cover any part of it, talk to the doctor or hospital or lab who is billing it.  They may write off a substantial percentage.  

amyh624

Goodness! I've had 2 (both positive, ugh) and I really hope I don't get a bill, yuk!  We have Personal Choice so I'm not sure if that makes a difference?

Augustbride

I second to call the insurance company. Every time I get someone on the phone issues get resolved.

mrs. remy

I would also call and ask for further clarification. if they can't help you over the phone, appeal the claim. I have Aetna and they have always been pretty nice and helpful when i call. Good luck. I've gotten my share of unexpected uncovered medical bills, it does really suck.

KBBH

I used to do case management in a hospital and also have had to deal with insurance companies on my own, so here is my advice:

Most insurance companies will pay and approve the absolute least that they can.  If THEY deem something "not medically necessary," they will deny it.  Your doctor (or someone in the doctor's billing office) needs to call the insurance company and fight the bill that you are receiving, giving the information for why it WAS medically necessary.  Usually it is the doctor who ordered the test calling and doing what they call a "doctor to doctor review."  They will talk to a doctor at Aetna and work to get the issue resolved.

I would call Aetna yourself first, explain that your doctor ordered if for whatever reason it was ordered for, and ask why they deem it not necessary.  If you can't get anywhere with them, have your doc call and dispute it.  If THAT doesn't work, find out what Aetna's appeal process is and fight it.

Medically necessary tests need to be covered.  You may not get it covered at 100%, but you shouldn't owe $500.

Good luck!

sweetpealee

that's crazy!!!!!! To me, wouldn't this be one of the more "necessary" tests that an insurance company should pay for? I'm not sure what you've had so far, but most OB offices (here in NY anyway) seem to order full genetic panels, NT scans, repeat second trimester testing without blinking an eye... but I would think that fetal fibronectin (I had this test as well about six weeks ago...) and possible pre term delivery- thankfully negative both times in your case- would be something the insurance company would deem necessary...

1. I would definitely call your OB billing department and see if it was coded incorrectly and explain the situation.  Sometimes they can call the insurance company to figure out why you are being deemed responsible.  Perhaps they can get around it or the doctor can be part of them considering it not "medically necessary."

2. I would talk to your insurance company ASAP.  If you feel like the person who you are speaking to is not as knowledgeable or doesn't seem to have the ability to make a determination as to why you are being billed- speak to their supervisor... and before you hang up the phone....

3. Have them send you a copy of the portion of your contract that lists your maternity benefits.  This way you have something to cross reference when discussing this or (hopefully won't come up again) future disputes, as well as information about what is covered and what is not... 

I hope this is helpful... FWIW, I think this is one of the most crazy things I have heard of an insurance company denying.  Good Luck!

BeccaMarie

Insurance companies can be such a pain!

 

I agree with the other ladies to start calling and fighting.

 

(we recently had one of DH's ambulance rides to the ER denied by insurance because we didn't get pre-approval - hahahaha.It took a ton of phone calls, but I finally got it covered! So, I feel your pain - just keep calling until you get a satisfactory answer)

SuzJune04

Thanks for all the advice ladies.  We've only had Aetna insurance for 10mo so I'll definitely give all your suggestions a try.  In the past, I had Carefirst stiff arm me on a few claims (we had to see a few physical therapists that didn't accept insurance and file the claims ourselves).  Hopefully Aetna will be better!

Twin.Peaks

Calling to see why it was not covered is well worth it! I bet the doc has is coded incorrect.

Also, do you have a max out of pocket of 500/1000 for the year? I ask because even if you get stuck paying for this then you would not have to pay for anything from the hospital right?

azcobride

Yikes! Thanks for the heads up. I've had two done as well but haven't seen a bill yet (and hopefully I don't). I had no idea that this wouldn't be covered.