Mat21 and Insurance

sleepymonkey

I just received my statement from my doctor of the estimated cost of my prenatal care.  On the statement, it says that my insurance does not cover Mat21.  I thought it was standard practice for insurance to cover the test if you're over 35.  Anyone have any experience with blue cross/blue shield and that test?  And if insurance doesn't cover it, what can I expect to pay?  I really don't want to do an amnio but if the mat21 is going to cost a ton of money, I may not have an option.

knjlove

My bcbs covered it.....the EOB did say I might owe provider 2300 but haven't gotten a bill so I am hoping they just took what insurance paid them!! Good luck to you!

Maimes10

We were quoted $2700 if ins didn't cover, which thank goodness, it did.   Because the test is still fairly new some ins companies are still not covering.  Good Luck!

10-4LilBuddy

Ask your doctor's office about the price. My doctor told me that if insurance won't cover it, then the Mat21 company will make it a flat 250ish rate. If your doctor does not know, then call the company. The company is trying to build up their reputation.

Fitnessteach2010

My insurance paid for most of it...I had to pay the difference which was about $175. 

mobilejen

If your insurance does not cover it, the company will prorate the cost based upon your income.  We ended up paying around $600 self-pay  and our income was around 120,000 with 4 people in the household.  Look up the sequenom website and call them & ask about their financial assistance for self-paying pts.  It was worth the piece of mind for me, although we'd had a rough few financial months.  We got an all clear for chromosomal abnormalities at 12 weeks and found out the sex.   Wasn't worth the risk of miscarriage from amnio for $600.  

Rubygirl

No, it's not standard practice.  It's best to verify insurance coverage with your provider in advance of tests/scans/etc.   However, because M21 is fairly new, they may not have a concrete answer for you.  The easiest thing to do is to call Sequenom and have them do the leg work for you.  You provide them your insurance info and they'll call your insurance for you to verify the coverage.  They will have all the necessary codes your insurance company will need.  Then Sequenom calls you back with your coverage info.  When they do, if the insurance coverage is nil or low, you can ask about filing w/o insurance.  It is NOT a flat rate anymore.  It is income based.  They'll ask questions about your household income, dependents, etc.  Good luck and hope this helps!

sleepymonkey

Thanks for the information. I think I will call Sequenom when I have a chance.

kje120

I had the test done in Feb and still have yet to get any kind of bill. I was told when I had it done that they would submit the entire $2700 cost to my insurance and if it wasn't covered and I received a bill the most I would have to pay out of pocket would be $235 - I would just have to call the number on the paperwork that they gave me and it would be taken care of.  

chicagobride_07

I did verifi which is a competitor test. I have BCBS PPO. I could not get a straight answer before I did the test as to whether this would be covered. Verifi does have a program where you pay a flat rate if denied by your insurance, but you need to read the fine print.  The test may be covered by your insurance, but be out of network with a high deductible. In some states, verifi is required by law to collect the deductible- in my case this was 1500 dollars. They cannot offer you the lower pricing if submitted to insurance with an eob claiming a deductible. In our case, we requested to pay out of pocket completely and they offered us a reduced fee- around 395, I believe.  We would not qualify for any need based programs and this was still offered to us.

GL! 

Amanda7676

Call you insurance company and see what they say.  The customer service reps for BC/BS are usually very nice and helpful.

thirsty85

We are doing the sequential test and I called yesterday to verify it was covered.  Mine came back as covered 80% we pay 20%.  My corporate HQ is out of NY and I am in MA, not sure if they run different.

kinarlva

I don't have BC, but so far my insurance hasn't covered it. I'll be 38 at delivery. The EOB I got said that it was close to $3000.

kw42775

I have Cigna and they told me they don't cover it. I called Sequestrum...I know I spelled that wrong...and they told me that I would have to pay 200 and to call them once I got the bill. I haven't had the test done yet as I am only 7w1d but I'm hoping to get it at 10 weeks.