Amandaleigh1

cojourney24

I know you are busy waiting to have that baby anyday, but I cam accross your post regarding the Materniti21 test. I see you were able to overturn the appeal that said it was experimental. I am preparring my second appeal and was hoping you could give me some insight on what I could say/use to help get this test out of that cetergory?

I have Cigna insurance and am not very hopeful. I found their official policy online regarding their stance on this test.

 Thanks and good luck on the arival of your baby!

amandaleigh1

I am sorry to hear that Cigna is not in favor of appeals to cover this test. I appealed to my insurance with a few arguments that it was not experimental because it had been well tested in an international clinical trial, the results of which were published in peer reviewed journals. I also argued that having the test saves them money in the end if it helps me to decide to opt out of amniocentesis which they would have covered.

I honestly don't know if any of my arguments were all that convincing. My insurance company sent the appeal out to a third party OB physician for an expert opinion, and that reviewer sided with me, so the appeal was ultimately overturned.

I can dig up the document that lays out the third party's response to the appeal when I am home this evening. One argument that person made was that such a test as MaterniT21 is not required to be approved by the FDA (I think the insurance companies like to use lack of FDA approval as  equivalent to an experimental procedure) and that the laboratory performing the test confirms to some sort of industry standard (the name of which is escaping me right now). Also, I think the reviewer also mentioned the published trials same as I had in my initial letter.  

If you pm me your email address, I could even send you scanned copy of my decision letter.

Thanks for thinking of me and my waiting game! I am having "fun" doing the waiting while still working