Having a meltdown: Insurance

norweigan · September 2014

I called my doctor and am waiting to hear back, but someone please talk me off the ledge. So back in June my doctor mentioned that genetic testing that everyone did, and said it might not be covered by insurance but if it wasn't there was a sale and out of pocket would only be about $25. Also, with another testing done during my next appointment (I think it's spina bifida testing, but I'm not sure because my brain isn't working because I'm so freaked out) it was kind of treated like "oh we are doing that testing today. It's usually always covered by insurance" said in a way where I wouldn't have to worry about it, and if it wasn't it couldn't possibly be that much since they always do that kind of testing. Well, I got a letter from my insurance company saying I may be liable for about $14,000 because of those 2 tests ($5,000 for the spina bifida? testing and the rest for the genetic testing). I called the insurance company and she said the spina bifida? definitely isn't covered, and the lab was appealing.

Has anyone else had an experience like this and it's worked out? Or knows more about how these things are paid out? Like I said, I called my doctor about it (because she and the nurse were the ones who talked to me about the costs of these things) but I have not been able to concentrate.

Update: So I talked to my doctors office, who gave me the number to the lab. I talked to the billing people there and they said they appealed, but they are expecting the appeal to be denied, and in the end I'm only going to be charged $50. I seriously started balling. I'm actually sitting here still crying. Can't stop. The woman on the phone probably thinks I'm crazy. I actually said "Sorry I'm pregnant!".

AllTheTeaInChina · September 2014

Sorry you are going through this. Even if most ins cover the tests, doesn't mean yours will. My office gives a list of procedure codes to check ins coverage for screening tests. I don't think there will much you can do if your ins denies the claim. You might be able to work something out will the lab to lower the cost but ultimately it is your responsibility to know your ins coverage. Good luck

blessdtxas · September 2014

I don't have specific experience with the testing, but I did receive a bill for $500 from my OB and called to talk to them about it. They said it was an error and that I owed nothing. Hopefully it was just a mistake and you do no owe $14,000!

Cryssteen · September 2014

Call billing at your OBs office. My insurance didn't cover the Harmony genetic testing, but out of pocket expense is going to be 150. Basically, the doctor's office and the company have a deal that if it isn't paid by insurance, the patient will not be charged over that amount. It's like a marketing thing...

Apsalartoll · September 2014

I'd also suggest that if you've talked to the doctor and the insurance company and can't make any headway, call the labs directly and explain. They might charge you much less than they'd charge insurance.

kimba1976 · September 2014

I am really sorry you're having to deal with this. In my experience, many insurance companies will automatically deny bills over a certain amount in hopes that you don't appeal, but if appealed they will often pay. After the birth of my daughter I was told by my doctor's office that my insurance had denied all claims relating to the birth because they were over $30,000. (I had some complications, which is why the bills were so high.) I too almost had a meltdown and was stressed for days, but ultimately upon appeal they paid most everything.

If you really feel as though the expenses should be covered and the insurance company isn't paying, then perhaps you can consult your (or your SO's) employer's HR department? Often they will get involved and help advocate on your behalf.

[Deleted User] · September 2014

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Shortstack06 · September 2014

My OB office gave me a break down of what the tests will cost without insurance and that told me that most insurances do not cover the costs of the testing. It wouldn't have changed our minds, so we opted out of any other testing.

norweigan · September 2014

Update: So I talked to my doctors office, who gave me the number to the lab. I talked to the billing people there and they said they appealed, but they are expecting the appeal to be denied, and in the end I'm only going to be charged $50. I seriously started balling. I'm actually sitting here still crying. Can't stop. The woman on the phone probably thinks I'm crazy. I actually said "Sorry I'm pregnant!".

Thank you for all the advice.

nolanova85 · September 2014

Sorry you had to deal with that! Glad it sounds like it will work out in your favor. We're still in the process of working through our bill for the panorama. We didn't need it, but opted for it after talking to our provider, to Aetna, and to Natera (the company that makes the test) about how the claims process would work and what our OOP expense would be. Welp, we neglected to ask and certainly no one informed us that the test had to be sent directly to Natera. Our provider sent it to Natera but through Quest Diagnostics...who is now billing us $2000. Quest has told me not to pay, that they're working on an adjustment...but I can't get any info as to what that adjustment will be. $2000 is more doable than $14,000 and though we would hate to have to pay it, it wouldn't break us financially. Just so frustrating!!

erynpdx · September 2014

Mostly what pregnancy has taught me so far is that insurance is frustrating and confusing, and that it's impossible to get the same answer from two different people about what is or isn't covered.

I'm looking into the breast pump thing now, and 3 different people have told me 3 different things (1 says they'll cover a single electric, 2 says they'll cover a single but would also apply that amount towards a double, 3 says a double is fully covered).

So annoying.

amieeyoung · September 2014

erynpdx said:

Mostly what pregnancy has taught me so far is that insurance is frustrating and confusing, and that it's impossible to get the same answer from two different people about what is or isn't covered.

I'm looking into the breast pump thing now, and 3 different people have told me 3 different things (1 says they'll cover a single electric, 2 says they'll cover a single but would also apply that amount towards a double, 3 says a double is fully covered).

So annoying.

Yes I have go to put that call in ... yuck I'm sure they will give the run around. Since they couldn't send me a list of general pregnancy things covered and estimated costs for uncovered things I dread having to figure the breast pump out. I don't know why they have to keep it so confusing.. grr.... Glad things worked out for the poster though-had to be scary!

amieeyoung · September 2014

LadyThrice said:

amieeyoung said:

erynpdx said:

Mostly what pregnancy has taught me so far is that insurance is frustrating and confusing, and that it's impossible to get the same answer from two different people about what is or isn't covered.

I'm looking into the breast pump thing now, and 3 different people have told me 3 different things (1 says they'll cover a single electric, 2 says they'll cover a single but would also apply that amount towards a double, 3 says a double is fully covered).

So annoying.

Yes I have go to put that call in ... yuck I'm sure they will give the run around. Since they couldn't send me a list of general pregnancy things covered and estimated costs for uncovered things I dread having to figure the breast pump out. I don't know why they have to keep it so confusing.. grr.... Glad things worked out for the poster though-had to be scary!

@amieeyoung, I'd make that call sooner rather than later! I've spent weeks trying to nail this topic down with my insurance company.

Boooo!! I was afraid of that... sigh. I have a doc appt. Friday so I will talk to my ob/gyn and then call insurance next week.

on the bright side I am sending in my FMLA paperwork tomorrow so that is one thing off my to do list

Cheekers2010 · September 2014

Holy crap! That's insane. I'm so glad you got it worked out.

JunkieBrewster · September 2014

amieeyoung said:

erynpdx said:

Mostly what pregnancy has taught me so far is that insurance is frustrating and confusing, and that it's impossible to get the same answer from two different people about what is or isn't covered.

I'm looking into the breast pump thing now, and 3 different people have told me 3 different things (1 says they'll cover a single electric, 2 says they'll cover a single but would also apply that amount towards a double, 3 says a double is fully covered).

So annoying.

Yes I have go to put that call in ... yuck I'm sure they will give the run around. Since they couldn't send me a list of general pregnancy things covered and estimated costs for uncovered things I dread having to figure the breast pump out. I don't know why they have to keep it so confusing.. grr.... Glad things worked out for the poster though-had to be scary!
---
you don't really even have to do that. Just go to ByrAm Healthcare's website, or yummymummy. Com

you select your insurance, and it shows you what they will cover it, you fill out the form and they contact the insurance company for you.

LSauer21 · September 2014

I got an explanation of benefits n the sequential screen was just under $8,000... Luckily I didn't owe a dime! Glad you got it figured out! Those huge bill notices are scary.

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