Progenity genetic testing - hoping someone can help! : (

sberke · May 2014

Hi! When I went to my 1st prenatal apt my Dr. BREIFLY mentioned this testing for Fragile X etc. We said we may but we already had it done with our son so I'd have to look into it etc. ANYWAYS.... I went and got my prenatal blood work done that same apt as it was just in the next building. Well I noticed the insurance claim from Progenity on my insurance website... I didn't even know the test was requested with and on all of my other blood work paperwork!!! I didn't even get to check to see if they were an in-network provider. Of course I see the EOB online at it was for over $5k and it was denied due to them not being in-network. I did NOT get a bill from them yet but I am just sick over this and unsure of where to go from here. I'm assuming I wait until I get a bill from Progenity but I can't help but to feel frustrated with the Dr.'s office not being more detailed with the information they gave me. They should have given me the name and company for me to check with the insurance FIRST I would think just as my first Dr. did with my son. Did anyone have this happen before? Did anyone end up getting a bill from Progenity and how much if you don't mind me asking. Thanks!

MsAmandaPants · May 2014

Ugh! I'm no help on the cost question, but I would refuse to pay for a test that you did not consent to and which is outside of normal blood work that insurance covers. I'd take it up with your doctor's office.

ETA: I would think you would have been required to sign something consenting to the test. . . . definitely worth talking to your doctor's office.

sberke · May 2014

Thank you I just feel a little nervous because I have to keep going back there for 9M BUT I will def. talk with the Dr. and nurse that did the bloodwork paperwork to see what they have to say. I didn't get it done until a bit later in my pregnancy before so when my Dr. brought it up it was more like a short mention. I had no clue it was going to be on the bloodwork paperwork. We also did not defin. say yes we want it now. It was just a mention conversation which is why I was so surprised. I hope this is not the way the office does things going forward. Patients need to be FULLY informed. If I get stuck paying even a portion over $100.00 I will likely go back to my first Dr. as I will be upset.

Unknown · May 2014

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Bigboneded · May 2014

I am still getting billed for a test done last year, that should be covered, just billing it with wrong code... I learned that my lab will draw what the doc wants, not their lab as billing gets too complicated. I definitely had a separate consent for the $1500 test.

jenkellen · May 2014

I had Fragile X and Cystic Fibrosis through Progenity. It was part of my RE workup. My doctor office had some kind of relationship with the lab so it only cost $25. They said when you see the bill first hit your insurance don't freak out because it was be like $3k. That happened then it got ran through my docs office and it was only $25.

They told me all of this before I got the test though and the test was optional.

I hope this is the case for you. I'd call the office to find out.

My guess is they are doing some kind of research which is why it prorated.

mmsweeney1 · May 2014

I also had a Counsyl test done and got a similar bill for around $6000. They explained to us that they attempt to get insurance to pay (ours denied the full claim) and then the patient is only responsible to pay $250 of whatever balance the insurance company leaves. We just had to contact the lab and explain that our insurance wouldn't pay anything.

I wonder if your test is set up something like that? We were informed of all this going in though, so we knew not to worry when we got the bill.

JCM285 · June 2014

I'm sorry you find yourself in this situation. I had this happen to me at my cardiologist office. I have mitral valve prolapse which is a very minor heart murmur. After my D&C last year, I was feeling palpitations so went to the cardiologist and she put me on one of those 24 hour heart monitors. Since I had used them before, I knew my insurance covered it. When nothing got picked up by that monitor, she ordered a 2-week heart monitor from a different company. I called the doctor to make sure my insurance covered it and they told me the company would call me first to ask about the insurance. Well, they never did and it turned out that the insurance was calling the monitor "not medically necessary" and refused to pay for it. Three very long grievance letters later, the company FINALLY called me to say that they would not have charged me for the monitor (such BS, because they only called me after I wrote three letters and were contacted three times by my doctor's office). However, I was told by my doctor's office that you must write a letter of grievance BEFORE receiving an official bill. As long as it is on the EOB, they can bill you for it. I would recommend calling your doctor to check, but maybe write a letter just in case. These companies will take you for every penny you've got if you let them! Also, Google the test and see whether other people found themselves in a similar situation and what they did. Good luck!

danyellenicole1 · November 2014

Please do not freak out. Here's how Progenity works, if your in network you pay your 80/20 or whatever is not covered. If you are out of network, you receive a very high bill and when you receive it, you call the 1-800 number on the bill, they will then reduce the cost to $25 for being out of network. Either health care providers are not explaining this fully or there is a disconnect in communication. The company is simply profiting from insurance companies and if you don't have an in network provider they any profit. I am not for this, however it seems to be the cheapest way to check for over 20 chromosome abnormalities. And finding out the gender at 10 weeks is nice too.:) hope this helps!

KMW08 · November 2014

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tmc427 · May 2017

I know this is an older post but hoping someone will see this still. I just had this happen to me. We had the genetic testing done at 12 weeks and all we were told from our doctor is that it should cost us around $100. We were not told that the blood work was being sent to Progenity or that it was out of network. Then we get an EOB from insurance saying the cost was $7,500 and that insurance was only covering $239 for us b/c it is out of network. Our insurance also cut us a check from our HCA account for another $2,200 that were are supposed to send to Progenity. However, I do not think I should have to pay this to them b/c essentially that is OUR money out of pocket and the cost should have only been $100 according to our doctor. Progenity is saying we DO need to send them the check and that they would write off the remaining amount. Has anyone else had this happen and what did they do to resolve it? Thanks!

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