Harmony, Verifi, etc covered with Blue Cross?

LucyRicardo3 · July 2013

After reading some previous posts about these tests and researching websites, I called my insurance (PPO-Blue Cross Blue Shield) to find out if they cover any of them and the member services rep said she had not heard of these tests, nor could she find any information about them in benefits. I even spelled the names out for her. I was really hoping to go for one of these.

I realize coverage varies from policy to policy, but I guess what concerns me is that the rep had no idea of what I was asking about. I read on the Harmony website that "Many" insurances cover it. Is that the case with everyone, or did you pay out of pocket? What ballpark range of out of pocket expenses are we talking here?

cynthiasun79 · July 2013

I have anthem blue cross HMO. I called Mat21 and the Dr confirmed they covered most expenses. I'm out of pocket 200...I have additional paper work cuz I'm HMO... Hope this helps.

Geeps2 · July 2013

I have BCBS Direct Access and the Drs office ordered the Harmony test since that was covered by insurance. I haven't seen a bill so I think I'm ok. I had it done a few months ago. Hope that helps. I would ask your Drs office that is ordering the test their billing dept should know if it is covered or not.

Good luck

happywifemomofone · July 2013

My OB only offers Maternit21. We opted NOT to do it because of the $250 copay.

Abeille · July 2013

You can call the labs that administer the tests and get the billing codes. Give the codes to your insurance provider and then they should be able to give you a better answer.

For an idea of cost, I was told Harmony would be $795 OOP plus another $150 for gender, which is never covered by insurance. The tests for trisomies were 100% covered for me and we chose to just wait for the anatomy scan to find out the sex.

sleepymonkey · July 2013

I would bet you'll be covered but you may just need to talk to the right person at BCBS. I have BCBS Anthem and when I called them to see if they cover the MaterniT21 test, the rep had never heard of it. But he was super helpful and called my ob for the billing code and then called the lab that runs the test. Because the lab is considered out of network, I was supposed to be responsible for 40% of the cost. But because I met the high risk criteria, Anthem did an exception and I'm being billed at the in-network co-pay (20%).

RNmommyof2 · July 2013

I have Anthem Blue Cross HMO and they said it would be covered with a referral from my doctor since it's an out of network lab (LabCorps) that does the Harmony test my MFM office offers.

I had the test done a week ago. We'll see if I get an $800 bill...

knjlove · July 2013

I have BCBS ppo and I was billed 142 they covered a large bit of it!! Best 142 I've ever spent: good luck

LucyRicardo3 · July 2013

Thanks so much for all of the info! I'll do some more calling around.

Leggett44 · July 2013

I had the Harmony test done on 4/4/13. I have BCBS Blue Advantage. I was given the following response from my insurance company, even though I gave them the billing codes for the test: The eligible procedures for genetic testing on your policy are: genetic testing of the products of an amniocentesis, to determine the presence of a disease or congenital anomaly in a fetus. Genetic testing of a Covered Person's tissue to determine if the person has a specific disease. Genetic test to determine if the person is a carrier of a genetic abnormality is not covered. The reason why doing the test and who test is on will determine if the procedures that you are asking about would be eligible. I thought this was a very vague answer.

I have yet to see a bill come through my insurance from labcorp which is in-network for me. They have 6 months to file though. My MFM office said they would work with labcorp and my insurance to get this test covered. If my insurance denied it, the cost would be $795 and labcorp would accept monthly payments if we couldn't pay it all at once.

kellyk17 · July 2013

I have BCBS PPO too and when I called they needed the codes and I couldn't get them from the lab or OB. We decided to do it anyway. In the end billed insurance 1K and I paid 200. A lot of money but worth our piece of mind.

LucyRicardo3 · July 2013

Thanks, again!

We went through genetic counseling and NT screens/other labwork with my twin preg. I was barely 35 then. It seemed like it raised more questions than gave more answers. Thankfully the girls were born without any of those challenges.

Now that I'm even older (37, DH is 46) it is a bigger concern, just so that we could be prepared for any special care needs if necessary.

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Harmony, Verifi, etc covered with Blue Cross?

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