Insane Genetic Testing Bill!!

kaswanson · September 2016

Hi Ladies! I've been around these boards for awhile, but haven't posted as much with baby #3. Hello!

Did any of you have any Progenity genetic testing done? I was told by my Dr that if the claim is denied by insurance, I'd only have to pay $99 out of pocket and the company will write off the rest. Well... I just got an EOB from my insurance company saying I will pay $19,871!!! Yeah that's like TWENTY THOUSAND DOLLARS! After a few hours of freaking out and reading a bunch of online forums, I'm hopeful that I will only have to pay the $99. It sounds like this has happened to other people. Trying to calm down. Anyone heard of this?!?! Trying to sleep and can't stop thinking about it. TIA!

penelope4612 · September 2016

Hi,

I don't have any experience with this company, but in general your insurance will tell you you are responsible for the amount that they are billed a do not cover (i.e. the company apparently billed your insurance $20k). When insurance denies a claim, the company bills you directly and may bill you a lower amount since you are paying out of pocket. If you want to know what you're going to owe, I would call the company directly.

cjt121413 · September 2016

This happened to me and it was an error. I called the company directly (different company), and told them my doctor's office has a contract wherein the patient only pays $20. They said not to worry about it, and they later rebilled the correct amount.

AbriannaO · September 2016

My first doctor recommended that I get it done and said that my insurance would cover it. So I did it, then got the bill for $350. I was confused, called my insurance and they said they never received a claim, called the company and they said that if they billed my insurance that it would be denied since it was out of network and then I would be responsible for the entire $1500 bill and that the $350 was the discounted rate to not bill insurance through. I called the doctors office, asked why they said it would be in network if it wasn't, they told me to call the testing company rep and that he would wait all except $100. I called him, turns out he's the rep of the competitor testing group that the doctors office was no longer using. He said that if it had been their lab, he would waive the fee for me, but that since it wasn't, he couldn't help. Called the doctors office again, and they said they would look into it. They called me back a few hours later saying that they would do a one time courtesy waive of the fee as they should have in fact used a different third party lab for this test that was in my network. I ended up switching OBs at 12 weeks because of not only this issue, but many others with this practice. When I went to meet with my new doctor, turns out that they even did the wrong genetic testing!

So I would say, definitely make calls to check into things. That is a ridiculous amount of money!

KatieJo1205 · September 2016

Whoa! That is crazy. I don't understand how your bill could be that high! On a much smaller scale... I also did the Progenity testing after my OB told me that if my insurance wouldn't cover it that I would only have to pay $99 - $199. Turns out my insurance doesn't work with Progenity at all and I got bills for $1000. I called Progenity and they said that because my insurance (Cigna) won't work with them at all they will not reduce the bills for me. I spoke to three different people and got the same answer. I argued with them that my OB suggests using them because of the supposed "Peace of Mind' program they have and that they even give out Progenity pamphlets for the Peace of Mind program and the guy on the phone said "yeah, I wish they wouldn't do that because we don't reduce the fee to $99 or $199"! I read the pamphlets again and no where in them does it say that they reduce the fee, just that they will work out a payment plan with you, which in my case was to offer me 0% financing for a year. I was really unhappy about the whole thing.

yellingbanana · September 2016

That's definitely an error. Call, asap! We ended up paying about $200 for mine, and $300 for DH (they'd switched to a company that tests for more, which cost more.)

aevan011 · September 2016

Now I'm worried. We had progenity done months ago and still haven't received a bill - which, we were told would be $99.

kattyc-2 · September 2016

I had a similar instance with Harmony. I called my OB's billing department, they said insurance shouldn't have even been notified and to ignore the EOB. 2 months later I received a bill from the Harmony provider for the correct amount quoted by my OB.

KatBH · September 2016

We did Progenity as well. My doctor told us the max was $99, but to be on the safe side I called Progenity as well. They told me it wouldn't be more than $200. I haven't received a bill yet, but I did receive an insurance statement that my portion is about $7k. The person I spoke to at Progenity said that I would likely receive a crazy statement from insurance, but to call them when I received an actual bill and it would be adjusted.

kaswanson · September 2016

Thanks ladies! I made a few calls today, and it turns out they accidentally billed my old insurance plan, so they have to re-submit the bill to my new plan. Then I need to wait a few weeks and see how it plays out. I also called my OB's billing department, and the lady I talked to kind of laughed and said they get calls about it every day and after my insurance goes through again I should get a low bill from Progenity, but if it's high I'm supposed to call them and say that my OB's office is "under contract" with them and they will lower it. She said the highest she's ever heard of anyone actually paying is $300. She said almost every pregnant woman that goes through their office gets this testing and it won't be $20,000.

Fingers crossed! Even if they only charge me $99, I might have even denied the testing just to not have to deal with this. Wish I knew about it up front.

penelope4612 · September 2016

In other news, is it any wonder that healthcare costs so much when companies bill insurance $20k for a test that they charge consumers $100-300 for? Perhaps insurance would cover it if it were $100.

kaswanson · September 2016

@penelope4612, I know... It's mind-boggeling! Doesn't make any sense! Just crazy.

MaggieG183 · September 2016

I was told that I would receive an outrageous bill from Progenity as well. My midwife gave me a number to call that would help me renegotiate it to $99. I am crossing my fingers that I can get this all taken care of, but I have yet to even receive anything from insurance or Progenity and I did this all in The beginning of June. Makes me nervous!!!

littlebirdie28 · September 2016

aevan011 said:

Now I'm worried. We had progenity done months ago and still haven't received a bill - which, we were told would be $99.

I got a Sequenom test (MaterniT21) back in June; I know it was denied by the insurance because I saw the claim denial on my insurance website, but I have yet to pay a bill...We were also told it would be about $200-$250 out of pocket, but isn't there a time limit that they are required to send a bill?

Kacie209 · September 2016

That is a crazy amount! I did not do that genetic test, but the Harmony one. Luckily, it was covered by insurance as I had checked with them first to make sure due to the reasons I was getting it done. My insurance sent me a check for the amount, and then I waited 2 months for the actual bill to pay it.

But, my OB had only said it would be about $150-$200, if we had to pay out of pocket. Thankfully I won't know if that is what it would have been but wow. I was shocked at the size of that bill. I couldn't imagine getting something for $20K!

aevan011 · September 2016

I just looked on my insurance site. I only see a few claims from this entire pregnancy. Which is crazy, considering how many times I've been to the doctor now. I don't know if it's the doctor not billing or the insurance not processing quickly...I'm not going to even ask though.

Honestly...I'm just gonna try not to stress it. If crazy bills come through later, I'll fight them. Not my fault they're not billing in a timely manner!

@littlebirdie28 You would think there would be a time limit, but I'm not sure. I just know what I'm obligated to pay and will deal with them later if needed, I guess.

colleenkevin · September 2016

@littlebirdie28 I had my MaterniT21 test done back in June too and just received the bill a few days ago. If they're processing bills in any sort of chronological order I would guess you should expect to receive something soon. (BTW I'm visiting from J17

)

Kacie209 · September 2016

@aevan011 I have noticed that more recent claims have not been on my insurance website, which also includes actual bills I have received in the mail for the additional U/S I had done. Usually my appointments, which were covered 100%, showed up right away... so maybe when I am actually having to pay some out of pocket, that just takes longer? I just know to pay more attention to what I get in the mail so I don't miss anything.

Toller · September 2016

Kacie209 said:

@aevan011 I have noticed that more recent claims have not been on my insurance website, which also includes actual bills I have received in the mail for the additional U/S I had done. Usually my appointments, which were covered 100%, showed up right away... so maybe when I am actually having to pay some out of pocket, that just takes longer? I just know to pay more attention to what I get in the mail so I don't miss anything.

My mom has a firm rule never to pay the first medical bill that they send- because it's likely to change!!

aevan011 · September 2016

@Kacie209 I see a therapist biweekly and every session is listed on the website as billed, although insurance pays 100%. But there's literally only one claim for my OB clinic....from this month. I haven't had any bills bc everything else is covered 100% as far as I know, but I just find it weird that there's not even a record of stuff. I even got a check when I filed a claim for my breast pump and that doesn't even show up.

@Toller - I should follow that rule. I had surgery under a different insurance two years ago and I swear every time I cut a check they'd mail out ANOTHER bill!

DiFazette · September 2016

Toller said:

Kacie209 said:

@aevan011 I have noticed that more recent claims have not been on my insurance website, which also includes actual bills I have received in the mail for the additional U/S I had done. Usually my appointments, which were covered 100%, showed up right away... so maybe when I am actually having to pay some out of pocket, that just takes longer? I just know to pay more attention to what I get in the mail so I don't miss anything.

My mom has a firm rule never to pay the first medical bill that they send- because it's likely to change!!

@Kacie209 yes! Insurance notifies your provider that something was not covered, your provider then has to change the claim info with patient responsibility then bill you - which most offices do in batches. It takes forever when you owe money.

I agree with @Toller - unless it shows insurance coverage and my responsibility and I can cross check that on my insurance company's website - I pay nothing.

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