Surprise bill for Matern21 test

ladylisalt · August 2014

So I did the gender blood test after reading up about it and looking into whether it was covered by insurance or not. I asked my Insurance company during 2 different phone calls if it was covered and was told yes. This weekend I received a bill from the company that does the test. It was originally about $2400 and was reduced to $1200(gee thanks). I have to call my insurance co. tomorrow but has this happened to you or someone you know? I know I am going to have to deal with a ton of BS to try to get this resolved. The crazy thing is I am due this week and this bloodwork was done 6 mos. ago. It just seems ridiculous. Please share if you've had this experience bc I certainly am not going to pay this willingly. I would of waited and not done the test if I had known this was the end result.

mandyreads · August 2014

If you look back through posts you will find that you can call the company and only have to pay like $250. At least I think this is the same test. ( I opted out). But search thru the feed and lots of others have commented on this before. Hope it helps.

mdogan29 · August 2014

**Not sure if this is the same for you, but sharing my experience:
My insurance/billing lady at my OB told me that Sequenom is out-of-network, so the bill will come straight to me, then even though it's OON, insurance will run it and send a check. Not sure if it's the same for you, but I would check w/ your insurance company again and see if they're sending you a check to then pay the bill. And just like @mandyreads said, even if insurance don't cover it (which they should at least some), the billing lady told me we should not have to pay more than $200, just have to call Sequenom!

HarleyKins · August 2014

Call the lab the does the Maternit21 test. The genetic counselor at your dr office should be able to provide you the number. Good luck. I'm glad my GC explained it all to me before I did he test.

Bigboneded · August 2014

They sent me a bill, I called insurance, was told it would be paid, but had been coded wrong, then they sent me to collections, who I spoke with a few times. Test was done a few weeks before my loss. Yes it was a nightmare, but I havent heard from them in a while, so I believe it was paid.... Good luck. Mine was $1500.

ladylisalt · August 2014

mandyreads said:

If you look back through posts you will find that you can call the company and only have to pay like $250. At least I think this is the same test. ( I opted out). But search thru the feed and lots of others have commented on this before. Hope it helps.

yes, i do remember reading posts regarding this awhile back when I was having it done and many ladies stressed how they were billed ridiculous amounts. I purposely inquired with my insurance company twice if this would be 100% covered and was told yes. Thats why I am BS because you would think when you are given them over $300 a month for a family plan that they could be competent in what they are telling you. The nurse at my dr.'s office did tell me to call the lab and they will most likely reduce it to $200. Of course I am waiting to hear back from them. So frustrating,thanks for the info.

ladylisalt · August 2014

mdogan29 said:

**Not sure if this is the same for you, but sharing my experience:
My insurance/billing lady at my OB told me that Sequenom is out-of-network, so the bill will come straight to me, then even though it's OON, insurance will run it and send a check. Not sure if it's the same for you, but I would check w/ your insurance company again and see if they're sending you a check to then pay the bill. And just like @mandyreads said, even if insurance don't cover it (which they should at least some), the billing lady told me we should not have to pay more than $200, just have to call Sequenom!

I actually just got off the phone with Sequenom and they said because a large amount was paid through healthcare provider(1519.00 out of a ridiculous original cost of 2762.00) the are going to zero balance my account out. Yay for me but dosent that just show the obvious of how they scam ppl lout of money that as long as the get something they are happy. Anyhow, I guess my rant is over seeing that I resolved it but I surely hope other ladies do not get misinformed or have to deal with any nonsense. Thanks for reading.

MsMacual · August 2014

I had this happen with the Verifi test (it's pretty similar). I talked to my insurance co and they said that they had no record of the claim so I called the lab. They resubmitted the claim and said to ignore the bill until I hear from them again (meaning they will send another one if I need to pay). It's been about a month since I did that so I'm thinking that our insurance covered the test. Good luck- it's a pain to deal with!

designchica · August 2014

I called the company and they told me the most I would be responsible for is $250 so imagine my horror when I got a bill for $1600!! It has not been resolved yet.

HarleyKins · September 2014

My genetic counselor told me it couldbe months before resolved. We got the explanation of benefits from the health insurance and ours is $2700. We will end up paying $250 to the lab eventually. Our GC informed us of the process. It seems that many here don't have that luxury of being told how much it would be and the process of how it all worked billing wise.

jab9371 · September 2014

I just had the test done, and my dr had to fill out a form and send it to BCBS, but it was approved. I have to meet my deductible first.

ryemo · September 2014

This isn't a "gender test," it's a fetal DNA screen to test for fetal anomalies. It is only covered if you have certain risk factors.

joifulgrrl · September 2014

I just got off the phone with natera. I received a 3700$ bill. They had not even billed my secondary insurance. And the original cost before they billed my primary was 5500. My OB told me there shouldn't be more than $150 oop. What gives?

lgsdesigner · September 2014

I used to work for a health insurance company, so here is some knowledge on the matter:

1) Maybe the insurance company rejected it accidentally. We used to have billing issues ALL the time. Call your doctor and have them resubmit the bill to your insurance carrier.

2) If they are out of network, that may be your financial responsibility. An insurance rep will tell you it's "covered", but that doesn't mean it's necessarily in-network coverage.

3) They did not see it being "medically necessary". Some things need a doctor's order, and if you did not get a doctor's order, they may have thought it was just something you felt like doing.

HTH!

ladylisalt · September 2014

lgsdesigner said:

I used to work for a health insurance company, so here is some knowledge on the matter:

1) Maybe the insurance company rejected it accidentally. We used to have billing issues ALL the time. Call your doctor and have them resubmit the bill to your insurance carrier.

2) If they are out of network, that may be your financial responsibility. An insurance rep will tell you it's "covered", but that doesn't mean it's necessarily in-network coverage.

3) They did not see it being "medically necessary". Some things need a doctor's order, and if you did not get a doctor's order, they may have thought it was just something you felt like doing.

HTH!

Thanks this is helpful but I do have to say on the #2 I think the insurance rep should let the paying subscriber know that it could be "out of network" and therefore" Uncovered" bc this was not mentioned to me at all. I was just told its definitely covered.

lgsdesigner · September 2014

@ladylisalt - Some of the reps are poorly trained, unfortunately. Them saying "covered" and not giving you anymore info is wrong. I would honestly call your insurance company, and ask to speak to a manager. They may make an exception based on bad communication.

MrsDL · September 2014

I had this happen - I have Cigna and called twice (plus read the policy). Verbally I was told it was covered (along with the others) by two different reps (didn't get names) AND it's written in the policy. Here's the catch - my plan is a 100% in-network plan for things to be covered, so while the idiots at Cigna list the test as covered, Sequenom is not an in-network lab. It's beyond ridiculous. I should have asked that question but logically it didn't even dawn on me that a brand test would be covered, but the developing/processing lab would not be.

So I called and spoke to another rep after I got the same $2500 bill explaining that it was pretty stupid to say a test is approved, but have it not be paid for when the ONLY lab that is the maker and processor of the test is not covered. He agreed, made a note and sent me appeal forms.

I also called Sequenom, the rep there was very understanding and told me to hold off on paying anything, that they would also work with Cigna to appeal on my behalf. Before I even had a chance to complete Cigna's appeal paperwork, the whole thing got worked out between Sequenom and Cigna and I got a letter from Cigna saying my appeal was accepted and it was fully covered. So get the appeal going, but call Sequenom as well, they'll help to appeal, especially it is a case where your insurance will "cover" the test but isn't "in-network" with the lab. Once they realize that Sequenom is the only lab that does it, it will hopefully be taken care of it for you.

EdenAurora · September 2014

I have Cigna and Sequenom was considered in-network. My bill was $164.

joifulgrrl · September 2014

Thanks for the info on Cigna. That's my primary provider and they didn't cover near the amount I was told they would.

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