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Screening denied?

GuennieGuennie member
in Pregnant after 35
Did anyone else with BCBS have their routine quad screen denied? I just got a HUGE bill from Quest Diagnostics and my dr says this should absolutely be covered, he hasn't had a single other patient with an issue having this covered. I'm disputing it but just wondered if anyone has had the same problem.
Me:41, DH:41 Positive for MTHFR mutations- one copy C677T, one copy A1298C. One daughter born on Thanksgiving in 2013. Six losses.
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Re: Screening denied?

  • StephPVStephPV member
    Sorry, I don't have BCBS, but I did a search for the Maternit21 test with my own carrier and a "clinical policy bulletin" came up with standards of what is covered and what isn't.
    I know there are a bunch of BCBS depending on your state or area, but it might help if you do a similar search.  You could also call the member services number and see what is up.
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  • GuennieGuennie member
    Oh I've already called and got no real answers. I finally asked for a supervisor and filed an official dispute. They are going to review the way they processed the claims. And as for trying to find any answers online with BCBS, their website is a joke. Seriously no help whatsoever.
    Me:41, DH:41 Positive for MTHFR mutations- one copy C677T, one copy A1298C. One daughter born on Thanksgiving in 2013. Six losses.
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  • LucyRicardo3LucyRicardo3 member
    I have BCBS (PPO) out of Pennsylvania (Highmark Blue Shield) and when I called early on in my pregnancy to ask about Harmony testing, the rep did not know what I was talking about, but pulled up what testing was standard and she mentioned the Quad Screen and NT scan would be covered for me (out side of co-pays or deductible, eligibility at date of service, blah blah blah)
    I would definitely dispute that denial and make sure that the claim was coded properly in the beginning.
    good luck!

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  • Geeps2Geeps2 member

    I have BCBS Direct Access plan and they paid for the Harmony test this go round.  When I was pregnant with my daughter (she is 1 and a half now) the harmony Mat.21 tests weren't around so they paid for the quad screening.  This pregnancy they paid for my half a quad screening no questions asked.  I got my harmony results back before I had to go for the second round of blood work  for the quad screen so I saw no point in going for another blood test that was less than accurate in the results dept.  And you are right their website is a joke.  I haven't been able to log on with my user ID in over a year.  I just gave up trying to get the problem resolved because I was stuck on the phone and it only left me more frustrated. 

    Good Luck!  It should be covered but with insurance one never knows why they do what they do.

    8-} 

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  • caloneiscaloneis member
    edited September 2013
    I don't have BCBS, but I called to see if my insurance would cover just the AFP portion of the quad screen (already had Mat21 done). They claimed that neither the AFP or quad screen would be covered. I was pretty incredulous after the reason cited was "experimental" tests not being covered but I was getting nowhere with the rep. The lab said it would be $150 out-of-pocket if denied, so I went ahead with the test. Long story short, just got the bill, insurance covered it and my co-insurance is $5. I'm happy with the bill but even more aggravated by the insurance company. They were totally useless in helping me understand the specifics of my coverage. Good luck.
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  • kelley72kelley72 member
    I am sorry and not surprised to hear.  I have BCBS of Michigan and haven't had my sequential test yet, scheduled for next Monday, but to me it seems they refuse coverage alot.  Hopefully they will cover after a review... ugh
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  • Tigger & poohTigger & pooh member
    I had anthem blue cross blueshield in November and it was covered.
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  • McGuinneybabyMcGuinneybaby member
    Dispute it and call requesting to get as high in the chain of command as possible!!!  It was my understanding the quad screen is medically necessary for any woman pregnant over the age of 35.  I know in New Jersey the insurance can not deny any prenatal care deemed necessary by the doctor and women over 35 are fully covered.  I am not sure if this differs by state, but have your doctor write the necessity of the screen and send it in with your dispute.  I had to fight for many things with my son on a plan with Meritain, but now with BCBS, everything is a breeze.  I used to have to go through a customer service rep to a case manager to some nurse then to some doctor all of whom had no real in depth knowledge of our case.  I even went so far as to tell them if they wish to challenge my doctor's then I want their credentials;  i.e. degree, licensure, test scores, current hospital affiliation, residency etc.  I went so far as to contact human resources of the hospital to find out if the doctor had anything negative and then I researched for malpractice suits.  Needless to say, as soon as I began to fully put the heat on, they backed down.

    Good luck and just keep being the squeaky wheel.  Insurance banks on people just giving up, so don't give up!
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  • GuennieGuennie member
    I actually contacted the Florida Insurance Consumers Advocates today and they will be launching an inquiry in addition to the dispute I filed, so maybe that will get me somewhere.
    Me:41, DH:41 Positive for MTHFR mutations- one copy C677T, one copy A1298C. One daughter born on Thanksgiving in 2013. Six losses.
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