12 week screen (bloodwork) not covered by insurance?

stephaniejfree · November 2014

I got the 12 week bloodwork screen for genetic abnormalities, through quest, which I'm capitated to through my insurance plan (aetna). I got a statement today of an explanation of benefits that makes it seem as though Aetna did not cover this test and it's listed at $2,762, which I guess Quest will be billing me for. I got the u/s bloodwork combo with my son, which was covered in full, so this test was new for me and I'm super confused as to why it wouldn't be covered. Anyone else experience this? My midwife said she put it in with the generic high risk code for billing. Thank you in advance!

stephaniejfree · November 2014

Yes, it's like the Harmony test, but Quest actually does it now too. I did call the insurance beforehand, so I'm super confused. rsaj0807, did they tell you why you weren't covered?

picklesx · November 2014

The insurance EOBs always confuse me. I always call the insurance company in instances like this to have them explain it to me. If they are saying that yes, you do owe such an such, I would ask for an explanation why. It could be a coding error on your midwife's end and you may need to then get in touch with her.

NutritionChick · November 2014

Can you see if quest will help

stephaniejfree · November 2014

I emailed my midwife's office manager and am calling Aetna first thing in the morning. I hope this is just a simple coding error. I'm so stressed out right now, there's no way I am paying that bill!

NutritionChick · November 2014

Oops sorry hit reply too quick- I did panorama and they said would be like 2000 if not covered but they only would charge 200. I'm not AMA or high risk and was covered. Good luck !!

stephaniejfree · November 2014

I'm going to call quest if Aetna can't help me out. ;(

topaz7777 · November 2014

Call testing company directly. Almost all of them have a cap on how much they will charge someone who is paying out of pocket. I have seen this happen to a lot of people and they greatly reduce the cost. Definitely call.

Sharon&Paul · November 2014

Are you sure it is a bill. I got a statement from the lab with the total cost, but it said the bill was being submitted to my insurance. If it is just a statement, wait and see how much your insurance will cover.

topaz7777 · November 2014

My insurance did cover a portion of it and sent me a check directly so that I can pay the full amount to the out of network provider.

stephaniejfree · November 2014

I did call and they said they could set me up on a payment plan. My midwife resubmitted the claim with a new code, so fingers crossed.

juliaandpatrick · November 2014

Good luck! Mine went completely towards my ridiculously high deductible. I was in the same boat and no one would help me. I hope someone helps you out!

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