Materniti21 - Insurance coverage

Cozfijibride

Got a EOB in the mail the other day saying my PPO - United Healthcare will NOT cover the Maternti21 test I had back in January. 

I was told by the genetic counselor prior to having the test that my insurance WOULD cover the cost of the test all except $200 or so (which I paid for out of pocket).

So I guess I should expect a $2700 bill soon. Which I would NOT have done had I known .

 

WTF. 

emberlee3

My genetic counselor explained that the company itself was capping patient's out of pocket at $200ish, regardless of what insurance contributed toward it.  

You may be able to appeal to the insurance company if that is not the case.

Insurance companies suck.

Cozfijibride

I was not told that. I was told that UHC covers all but $200. Which we paid. The letter said the appeal was denied. 

piper09

I was told that the max I would have to pay was $245.  My insurance (Anthem) considers Sequenom an out-of-network provider, so I was charged the full $2700, but Anthem sent me a check to cover about $2200.  So I am actually responsible for about $450.

I have not received a bill from Sequenom yet (test was performed March 13), so I am not sure what's going on. 

kirac

I think you can appeal again (not with the insurance co.) or check with the state.  We didn't bother (it was a different claim though) since it was $200.  

amandaleigh1

My insurance denied it too. You will not be responsible for paying any more than the 235 you paid directly to sequenom. They are going to absorb the hit. I was told this by my genetic counsellor when I got the test.

 That said, I decided to appeal it, not because I want to get any money out of it, but because I think it is BS and that the test should be paid by any insurance company as it is a valuable diagnostic tool. It was my good deed of the day. 

Cozfijibride

amandaleigh1:

My insurance denied it too. You will not be responsible for paying any more than the 235 you paid directly to sequenom. They are going to absorb the hit. I was told this by my genetic counsellor when I got the test.

 That said, I decided to appeal it, not because I want to get any money out of it, but because I think it is BS and that the test should be paid by any insurance company as it is a valuable diagnostic tool. It was my good deed of the day. 

 

Thank you !

Just called Sequenom and they said they eat whatever ins doesn't pay. Wish my Genetic Counselor would have told me that !!

now Im going to buy myself a new louis vuitton..lol... 

fishy24

I have been trying to get the diagnosis code for this to find out if my insurer (Aetna PPO) covers this. It's been nearly impossible!! I am only going to do it if it's covered. Can anyone share the code?  It should be on your EOB.  And does Sequenom REALLY eat the rest of the cost?? Thanks!! 

Cozfijibride

YES! They eat what they cannot collect. Spoke with them this morning and the max they can charge you is $475 - or something like that.

piper09

Cozfijibride:

YES! They eat what they cannot collect. Spoke with them this morning and the max they can charge you is $475 - or something like that.

Hmmm...this is interesting.  I have a PPO, but was still charged this $475 since my insurance claimed Sequenon as "out of network".  I was told if you have a PPO the most you will get charged is $235.  I will need to investigate this.

fishy24

Would it be possible to post the phone number for Sequenom? 

 

Thanks!

 

Cozfijibride

fishy24:

Would it be possible to post the phone number for Sequenom? 

 

Thanks!

 

google sequenom & ask for billing. they are pst 

tahrna

Cozfijibride:

Got a EOB in the mail the other day saying my PPO - United Healthcare will NOT cover the Maternti21 test I had back in January. 

I was told by the genetic counselor prior to having the test that my insurance WOULD cover the cost of the test all except $200 or so (which I paid for out of pocket).

So I guess I should expect a $2700 bill soon. Which I would NOT have done had I known .

 

WTF. 

I just got mine last week and I hope I don't get hit with that bill!