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Gotta to love doctor office insurance crap - VENT

kirackirac
in Pregnant after 35

My nurse at my high risk OBGYN told me MaterniT21 was not covered.  Considered experimental, blah.  I called my health insurance (HMO) and there was a 13 page document covering the test so I'm guessing it is covered (in some cases) otherwise they simply say, not covered.  I called them again and it turns out (after they asked my age), that yes it is covered.

I call the nurse and tell her this, and she says it's never be done before (which is shocking at this is supposedly one of the best hospitals - attached to a university - on the west coast) and she doesn't know the code or who to get to authorize it.  I tell her I that genetics counseling does the test and finally she says she'll call them after I say I will try to get that info.

Sigh, does anyone else have these problems? 

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Re: Gotta to love doctor office insurance crap - VENT

  • AdiAdi
    Kirac - I haven't had this exact issue, but I guess whenever there is a new procedure or test there's always a learning curve. Sounds like the genetics folks are more on the ball with this sort of testing. I'm glad you are able to get it covered!
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  • kirackirac
    Sigh.  OBGYN won't give me referral.  Not sure why.  She said its $495 out of pocket and don't expect to get reimbursed.  I called my medical group and they said have the OBGYN submit.  Going to try and have my other OBGYN submit.  I understand if they submit and it is kicked back.  I don't understand why my OBGYN refuses to submit.
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  • amandaleigh1amandaleigh1 member

    I had a similar experience trying to get the message through my obs nurse that I wanted the test. I had to spell it all out and direct her to the website. After a few attempts, I finally got through to them about it and they referred me out to genetic counseling and it was easy peasy from there. Had I known that was where I was going to end up, I would have just referred myself there at the beginning.

    Hopefully this will be the last tug of war you will need to play with your obs office. I have had pretty much smooth sailing since then. 


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  • dukemelidukemeli member
    The way my MFM office explained it was that I had to pay upfront ($235). IThe company (Sequenom CMM) would submit the claim to my insurance. I had to fill out Sequenom's form with all of my insurance info. They said that if my insurance covered the test, Sequenom would reimburse me directly. If my insurance didn't cover it, the test would only cost what I already paid.
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