Unexpected baby bill....

AHughes33 · May 2015

Turns out we revived a HUGE bill for our blood work recently to find out the sex of our baby girl back in February. The doctors and nurses said it would be covered. It was clearly not. The insurance covered what it could but now we're facing a ridiculous bill for something we could have just waited for at 20 weeks. We were not told any of this info. What to do?!?!

misty7281 · May 2015

They almost did this with me. They only had one test kit left and couldn't find my vein. So lucky they didn't because they called me the next day to tell me my insurance wouldn't cover it and it was $400! And they said they'd made the mistake with several women because they thought the insurance would cover it. I'm not sure what you could do but I would definitely call your ob and complain like crazy, maybe they'll cover it since they didn't warn you. Seems like they'd do something. It's their fault they didn't give you correct info.

kedbach · May 2015

You could try to dispute the claim with your insurance so they would cover it. It shouldn't really matter since you would have found out at 20 weeks anyway and some doctors do the bloodwork then, in addition to the gender scan. Unfortunately, your insurance will most likely refuse your appeal because they will say it's standard to wait until 20 weeks. Insurance is such a hassle sometimes- I feel your pain!

kjandericka · May 2015

Did you call your doctor's office and ask about the bill? My doctor originally said that mine would only be $25, even if insurance didn't cover it, because of some special thing that they had worked out for all their patients. I chose to go ahead with the test because of previous mc. I was shocked when I got a letter (explanation of benefits) from my insurance company saying that they didn't cover anything and that the "remaining balance" was over $4000. I thought I was going to have a heart attack! When I called my doctor's office, the receptionist explained to me that what I had received wasn't actually a bill. We ended up not being billed for anything. It's definitely worth checking into before you stress yourself out!

GirlOnTheBeach · May 2015

If the test was solely to find out the sex of the baby, I doubt you'll get insurance to cover it as it wasn't medically necessary. Unfortunately, it's up to the patient to figure out in advance what is covered or what isn't, so you can ask your doctor and your insurance, but they will likely tell you that it was your job to check your policy and they aren't obligated to cover it. Even if someone told you it was covered, unless you got it in writing, you may be stuck.

CaliforniaDream87 · May 2015

This is why it's so important to call your insurance YOURSELF to see what is and isn't covered. I would never ever expect my Dr. office to "know" what my particular plan covers. Also, I'm guessing you're talking about the Mat 21 test? Yea, definitely not done to find out the sex of your baby. Smh.

jadetree1080 · May 2015

My husband and I had the panorama test done at about 14 weeks. Its a blood test for me and a cheek swab for him to isolate the baby's DNA and test for all sorts of stuff, including gender. Test cost about 7k. We were told it was covered, then I got an insurance statement saying they would only pay $300 of it, but I never received a bill. So I didn't bother with it. 2 weeks later I got a revised statement, saying they paid for it. Not sure what happened, but if you didn't get a bill, I would wait and see it It works out. It could have been coded wrong, maybe you will need to call your insurance and ask what they need in order to get it covered (what code) then have the doc send that one.

mamaloaf · May 2015

I, unfortunately, learned this the hard way as well when pregnant with DD1. It is up to you as the patient to find out the procedure and diagnosis code for whatever test you're having and call your insurance to find out how it'll be covered. You should also keep a log of the name of the person you spoke to at your insurance company and the date/time.

lbpete13 · May 2015

mamaloaf said:
I, unfortunately, learned this the hard way as well when pregnant with DD1. It is up to you as the patient to find out the procedure and diagnosis code for whatever test you're having and call your insurance to find out how it'll be covered. You should also keep a log of the name of the person you spoke to at your insurance company and the date/time.

I work for BCBS and I can confirm this is exactly the way to do it. Never trust your MD/OB when it comes to what your insirance will or will not pay for. Call your insurance and ask. Your MD/OB cannot possibly know what will or will not be covered as there are numerous plans housed under each insurance umbrella (with its own set of rules). I specifically opted out of the blood test at 10 weeks as I called my insurance telling me no medical necessity-not covered. Hope this can be worked out for you.

holli0801 · May 2015

You can try the billing office through your hospital or clinic and request financial assistance for the bill. They may or may not be able to help, but it's worth a shot. At the very least they could help you with a payment plan.

jenandbrett · May 2015

Yeah, it's completely up to the patient to do the research. It's annoying and time-consuming as all get out, but it's your responsibly. I got the materniti21 test (and needed to because of our history) and it still wasn't covered. We're facing that bill as well. Then, I need progesterone shots bc of my previous preterm baby and I called from insurance to dr for over a week trying to figure out the cost and in the end found out my cost would be $1800. After a financial evaluation, I got it down to $900. It's still outrageous, but at least we know gong in. I think you're best chance right now is to call your dr and talk about a payment plan. Some places will also offer a significant discount for pay in full.

irohspupil · May 2015

I had the panorama blood work done around 10 weeks. A few weeks after finding out the sex of the baby, my insurance (BCBS) sent me an explanation of benefits on what they would cover for the test. Turned out BCBS wouldn't cover any of it, so I was staring at more than $11,000.

I called my OB's office ready to give them an earful for telling me it'd be covered, but the office manager put me in contact with a representative from Progenity (the company that processed my lab work). The representative explained to me that they were in the process of working with different insurance companies to get this sort of lab work covered. Because the tests are so new, insurance company's aren't sure what to do with them. She told me the most I will be billed from Progenity is $50. Sure enough, a couple weeks after that phone call, I received a bill in the mail from Progenity for $25.

I just thought I'd share my story! If Progenity is the company your OB's office used, I'd ask to talk the OB office's Progenity representative.
I hope everything works out! So sorry you are going through this kind of stress.

emmacake08 · May 2015

The ol' wait and pray that your insurance revises and just covers it is the stupidest advice ever. Just be a grown up and call you insurance and talk to them directly. Sheesh

laurasuzanne2006 · May 2015

Sorry unfortunately you gotta talk to your insurance about coverage not your provider. You are likely stuck with it

irohspupil · May 2015

emmacake08 said:
The ol' wait and pray that your insurance revises and just covers it is the stupidest advice ever. Just be a grown up and call you insurance and talk to them directly. Sheesh

I had contacted BCBS about it before getting in touch with the Progenity rep. BCBS told me that the test wasn't covered, but they'd love to help me figure out how to pay for it over time. That was as far as I got with them. No explanation like what Progenity gave me.

emmacake08 · May 2015

Sorry didn't mean you. Someone else offered advice along the lines of wait and see if it all works out. Obviously you did all the things you're supposed to for it to get sorted out.

bpwife&mama · May 2015

AHughes33 said:
Turns out we revived a HUGE bill for our blood work recently to find out the sex of our baby girl back in February. The doctors and nurses said it would be covered. It was clearly not. The insurance covered what it could but now we're facing a ridiculous bill for something we could have just waited for at 20 weeks. We were not told any of this info. What to do?!?!

You didn't mention, did you need this test done or did you just want to find the sex out early?

jorstad1 · May 2015

Call the company/lab and make an offer of lower amount

sandrabrooke · May 2015

Ugh...annoying and sadly your at fault. But at least in my clinic...they basically tell me I should do the tests so it can get super annoying!

SassetteSmurfling · May 2015

Completely 100% your fault. You are responsible for calling and talking to your insurance before doing elective tests to see what if anything is covered. It's really not that hard. Doctors and nurses know very little (usually) about what insurances cover. And I say that as a nurse. There are too many different plans and billing codes for us to know what every procedure will end up costing every patient.

AHughes33 · May 2015

The test was supposed to be included in the down syndrome test, turns out my Dr's office has an agreement with the company who ran the test and whatever my insurance disnt cover there taking care of. What a relief! Thank you all for your responses. I was sweating bullets for a few days!

baker1jm2 · May 2015

Unfortunately it's the patients responsibility to contact their insurance company to see if it's covered. I work in the medical field and every time a patient asks if something is covered i always give them the diagnosis and treatment codes and have them call themselves. Your dr shouldn't have told you it was covered bc there's no way for them to possibly know everything about your insurance plan. Sorry you're going through this!

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