Just wondering if anyone's insurance didn't cover the labwork for genetic screening? I have pretty good insurance and was surprised when I got a bill from my clinic b/c the claim had been denied. Now I am bracing myself for the next bill of the 2 part screening- Everyone I know gets this labwork done when they are pregnant so I assumed it was covered- guess I shouldn't make assumptions. Did anyone else have it come back denied?
Re: insurance coverage for lab/screening
There have been so many changes with the way paper work is processed for insurance since the new health care laws it simply may be the codes that they used.
Call the insurance company and ask them a million questions along with why it wasn't covered when it's a standard procedure. After they explain it to you call the doctors office and ask for all of the codes that it was submitted under, etc. Get a clear understanding. It's difficult when the doctors offices and the insurance just give you the run around.
I'm going through something similar for something standard pre pregnancy and it's been almost a year and I'm finally getting somewhere. I paid the bill so it won't affect my credit but it's a pain and I call and check up on once a week.
When you call any place take notes in a notebook and write the following, Date, Time, Person you spoke to (or employee code), extension if they have one and repeat the conversation at you're writing and let them know you're taking notes. If it's covered you're being taken advantage of. When the insurance company covers a procedure the hospital has a cap (agreement) on what they can charge (it's the cost of using that insurance co for the hospital) and sometimes the hospital/lab knows that they'll get more money if they process it as something covered.
It's unethical and robbery when you're paying $100+ a month for insurance premiums.
As far as I know all of my lab work and ultrasounds have been covered by insurance so far. However we chose not to have any of the genetic screening done as they have a lot of false positives and we would not change anything regardless of the out come of these tests.
Make sure to call your insurance to make sure they cover the proper maternity. The day I found out I was pregnant I called my insurance and found out they do not cover any of the lab/ultrasounds - actually they cover nothing. My husband and I are paying out of pocket because of my insurance. You can also set up payment plans through your clinic and hospital. That's what we are doing..
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IVF #1 ET 1 d3 embryo 10/30/11 BFP
3 Embryos frozen (1 d5, 2 d6)
DS born 07/29/12
FET #1 ET 1 d5 embryo 02/10/15 BFN
FET #2 1 d6 embryo didn't survive thaw, transferred last d6. CP
I was told up front that it is unlikely for genetic screening to be covered by most insurance companies. Even after tracking down the billing codes I couldn't get CIGNA to tell me how much it would cost me. To my surprise, I just received a $1400 bill just for the ultrasound portion of my NT scan, and I still have yet to do the rest of the remaining labatory work. I guess the good thing is is that it all goes towards my $4000 out of pocket maximum in which I am bound to meet anyway.
Not exactly true-- If you have a PPO rather than an HMO, MaterniT21 is charged at $235 directly by the company, Sequenom. The company then tries to recoup the cost with the insurance co. Even if they are unsuccessful, they won't come back asking for more money. The company offering the test will not offer the same deal with an HMO. THey have some kind of compassionate pay plan, but it still may cost close to 2k OOP. I am glad I have a PPO for reasons like this.
IVF #1 ET 1 d3 embryo 10/30/11 BFP
3 Embryos frozen (1 d5, 2 d6)
DS born 07/29/12
FET #1 ET 1 d5 embryo 02/10/15 BFN
FET #2 1 d6 embryo didn't survive thaw, transferred last d6. CP
Also, don't confuse your deductible that you have to reach first for paying so much out of pocket. Each insurance is different. I have Cigna as well but all preventative testing is covered 90-100% and the 10% I have to pay goes toward my yearly deductible. Items that are not covered at all that I pay is also applied toward my yearly deductible as well but they aren't covered because of the plan.
Coding is something in and of itself and it's annoying when talking to the billing departments at each hospital of people that aren't sure and just stick in a code, etc. Then they leave the responsibility up to you (the patient) to call around and figure out THEIR error.
I like the idea of what the girl had to say earlier about listing out each item covered. I am going to do that this week.
Last I checked genetic testing is preventative, because then the health care costs for a child you were unaware had a genetic defect is more costly than the preventative test.
I'd totally fight it.!
Good luck and go get 'em.