First and hopefully last insurance vent

nawlinsgrl · January 2013

I just called my insurance provider (Cigna), and was told they don't cover MaterniT21 because they still consider it experimental. Grrr! I really want to get it, since it will give a yes/no answer for chromosomal abnormalities (DH's biggest concern), and tell us the sex much earlier (my preference, but obviously not a necessity).

I just called the MFM's office to see how much it will cost OOP, since I'd really like to consider getting it done, but of course they close early on Fridays (just 10 minutes before I called!).

I realize prices will vary by MD and region, but I am curious if anyone else has done this test OOP and can give me an idea of how much to expect this to cost?

fabulouspinkmady · January 2013

I don't know, but I guess I'll find out soon when I get the bill since I have Cigna too

I didn't call before to verify coverage, but we were going to do it anyway. I had it done last Monday (still haven't got the results). I think my MFM said it was a couple hundred, but not sure.

chicagobride_07 · January 2013

I had the competitor- the Verifi test. Just for reference purposes- that test is $1,200; $200 if submitted to your insurance and denied. $495 if you are OOP. There is a loop hole; if submitted to and covered as "out of network" on your insurance plan, in some states, they are required by law to collect to full deductible. I have a high deductible out of network ($1,500) so would have had to pay the full $1,200. I elected to pay $495 OOP, instead, and not have them submit to insurance. My insurance could not confirm for me if Verifi was in or out of network and I didn't want to take the risk.

I am sure Materniti21 likely has some OOP payment programs in place; I'd call and ask. My OB's office did not charge for this test; my payment and billing was directly through Verifi in CA.

GL!

genmalone · January 2013

I have BCBS and they also don't cover the MaterniT21 but would cover amnio. : Not sure if I could of gotten a cash pay discount but I was told it was over 1k.

fabulouspinkmady · January 2013

genmalone:
I have BCBS and they also don't cover the MaterniT21 but would cover amnio. : Not sure if I could of gotten a cash pay discount but I was told it was over 1k.

Yikes! Maybe I should have confirmed the price, LOL... oh well, I can always submit it to flexible spending

nawlinsgrl · January 2013

I just went ahead and called the billing dept. at sequenom (the people who make the test) and they said that it will be no more than $235 OOP. They said to submit for prior authorization since I will be going out of network, so I'll do that first thing Monday, a week before my appt. They say it takes 2-5 days to process, so I should be fine.

They said I'll get an EOB charging me the full $2760 it supposedly costs (yikes!), but that I'll also get a letter saying I only owe $235. So, keeping FX that this is all correct, and I will happily pay the $235 to get more specific chromosomal answers, as well as learning the sex several weeks faster.

cdale86 · January 2013

YIKES!!! We found out one of the babies has an omphalocele so the MFM doc and the genetic counselor recommended this test as trisomy 13, 18 and 21 are often associated with this type of defect. We were in shock for about a week to a week and a half. I didn't even think twice about getting the test done and NEVER thought about cost. They will submit it to insurance but I really hope we don't have to pay more than the $235. We definitely cannot handle several thousand for this. We didn't do prior auth either because we did all of this during the shock period and no one at the dr's office said anything about that. Now I'm nervous!

chicagobride_07 · January 2013

GL, ladies. The costs and coverage were very confusing to me, too. But, a good result made it all worthwhile! Verifi had a "patient payment plan" leaflet which spelled everything out in great detail. It is likely the Materniti21 has something similar. The out of network loophole for insurance (Verifi said this was state law) really threw me. Who knew it would be cheaper to pay OOP for something than have it go through insurance?

Verifi also had patient assistance programs available for patients with financial need.

Roxie5739 · January 2013

I am in CA but it cost me 235 I think

genmalone · January 2013

Wow, for $235 we would probably of done the test. The nurse never mentioned a reduced price. Oh well.

amandaleigh1 · January 2013

I was denied this too for the same reason. I appealed the decision and won. The review said that it wasn't experimental, because it isn't! I have a ppo insurance plan. Even if I didn't appeal, I would not have had to pay more than the 200 or so it cost me up front that was the deal at the time I had the test. Is this still how they are running things?

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