Genetic Screenings and Tests - Questions and Experiences

shamrocandroll · September 2019

Have a question or experience regarding NT, NIPT, Amnio, CVS, etc.? Ask it here and/or share your experiences!

shamrocandroll · September 2019

Moving this over to here...

Can we talk about NIPT and/or NT scans? I'm all kinds of confused over here right now. It sounds like my OB only wants to do one or the other, but I'm pretty sure I'm going to have to pay out of pocket for the NIPT, so I should still be able to still do the NT scan through insurance, right? I'm anxious about them making me choose one or the other now. Any insight or experiences appreciated.

mdfarmchick · September 2019

We paid for the NIPT out of pocket. Because it wasn’t covered by insurance, my OB did offer the NT scan for us but it was a little more of a sneak peek at the baby for us since we already had the NIPT back. The other point I have heard is that NIPT does cover the major trisomies but the NT can catch some other things so some people manage to qualify for both.

My recommendation... Have you tried checking with your OB’s billing department? A lot of times they deal with insurance billing so much they can tell you if they have had that covered by that insurance company before or not. And then they can answer if you can pay out of pocket for NIPT and they still run the insurance through for the NT.

emlettuce · September 2019

How much did the NIPT cost? I just talked to my insurance and the lab that my Dr uses is out of network

mdfarmchick · September 2019

@emlettuce my OB used MaterniT21 last time so I called them directly and it was like $150 out of pocket to not run it through insurance at all.

rachelg777 · September 2019

@mdfarmchick wait whaaaat. My OB this time uses MaterniT21 and it is like $600 OOP or $299 if I enrolled in a special program where I take a survey afterwards.

emlettuce · September 2019

@mdfarmchick Thats not too bad. Does anyone have experience with Progenity?

shamrocandroll · September 2019

@mdfarmchick In order to get it at all, I have to be referred to genetic counseling, and I was told they would have more information about cost/options. So I guess I'll find out there? @emlettuce I think it depends a lot on your practice and which brand they use, and what arrangements they have with the company. I've heard a huge range of costs, but I think mine was $200-300 OOP for Harmony.

pirateduck · September 2019

I was quoted $595 out of pocket for progenity. I was quoted $698 for MaterniT21

mdfarmchick · September 2019

@rachelg777 it was in 2017 so it may have changed. They started off higher and we told them that we couldn’t afford that. Also, it was $300 OOP if I did it through the dr’s office. But when I called them on the phone, they were able to negotiate it lower. 🤷🏻‍♀️

rachelg777 · September 2019

@mdfarmchick that's awesome! I feel like they always rip me off and have said it's $600 OOP but the two times I've had it done there has actually mistakes on the insurance end of things (long stories) so it's been free. I can't complain.

mokay19 · September 2019

If anyone has to pay OOP, someone on the April 2020 BMB has mentioned some things about how to pay less. Might be worth a trip over to that thread.
I’m on mobile and a non-tech savvy human being so I don’t know how to link the thread like @shamrocandroll does!

shamrocandroll · September 2019

@mokay19 I gotchu

Link here

jrouge12 · September 2019

@shamrocandroll You are our board goddess!

pirateduck · September 2019

OK, I just learned something important from my insurance rep. With my policy, genetic testing needs to be deemed medically necessary and requires "pre-authorization" in order for insurance to cover it. I have run into pre-authorization issues before, it is not difficult, but very important. Essentially, the billing department or someone at your doctor's office needs to contact the insurance company BEFORE you have the test (or whatever procedure it is) done to obtain "pre-authorization" from the insurance company and make them pay for it. This is a relatively normal thing and if you speak to the billing person at your doctor's office they will know exactly what you are talking about if you ask them to get "pre-authorization" for something.

soprano19 · September 2019

pirateduck said:

OK, I just learned something important from my insurance rep. With my policy, genetic testing needs to be deemed medically necessary and requires "pre-authorization" in order for insurance to cover it. I have run into pre-authorization issues before, it is not difficult, but very important. Essentially, the billing department or someone at your doctor's office needs to contact the insurance company BEFORE you have the test (or whatever procedure it is) done to obtain "pre-authorization" from the insurance company and make them pay for it. This is a relatively normal thing and if you speak to the billing person at your doctor's office they will know exactly what you are talking about if you ask them to get "pre-authorization" for something.

I second this about pre-authorization. I used to work for a dental office doing insurance billing, and we would have to get major procedures pre-authorized in order to guarantee in advance that the insurance would cover it. That way the patient would have all the financial information up front and could make more informed decisions.

rox7777 · September 2019

The NT is covered through my insurance as medically necessary, however because it’s notorious for false neg/pos I think I will opt out of it.

I know it depends on the insurance for most “extra” testing during pregnancy. We had tricare up until last year and getting anything covered outside of the norm was a huge PITA. And when I say norm I mean HR ultrasounds, emergency CS, EVERYTHING. We were dealing with bills for months. We have Aetna now and they cover pretty much everything except NIPT unless you’re HR for genetic issues or over 35.

adventuresawait1 · September 2019

Agree with all of the comments here on checking if you need pre-authorization. I had the NIPT and NT scan “because you’ll be 35 by the time you have the baby,” which was a little absurd since my DD was less than 2 months after my birthday, but insurance was willing to do it with a doctor request. It took like 2 weeks to get the authorization with anthem and that was terrible. Then I had the test over the holidays and the bloodwork sat out someplace for too long without being analyzed and I had to do it again! So fun.

Anyway, NIPT tells you most of what you will want to know imo, but the scan is just fun to see. I will say that once I switched to United everything changed in terms of tests - they covered everything and it made it super easy. Labcorp even stopped asking me for my credit card! But I’m sure it depends more on the plan than the insurer.

lajoliedreamer · September 2019

I just turned 35 so should qualify for NIPT which I’ll ask about at my appt next week. Is it worth calling my insurance before then or is it better to wait until after I get the info at my appt?

mokay19 · September 2019

My insurance website says
“While you are pregnant, we cover:
- diagnostic testing (i.e. ultrasound)
- genetic testing”

Which makes me think they cover it... but, I never did it with my first since my OB didn’t offer it for me at the time and I didn’t push. If it’s covered, I’m thinking I might as well do it since it’s non-invasive anyway!

shamrocandroll · September 2019

@jrouge12

Image: https://us.v-cdn.net/5020794/uploads/editor/j5/ycilzdujydke.gif

shamrocandroll · September 2019

Soooo it sounds like I can only choose to do one or the other. My OB will not do an NT scan and NIPT, even if I pay for NIPT out of pocket. She said the only way I would do both is if the NT scan came back with an elevated risk. I have an appointment on Wednesday to go over the options with a genetic councilor, so I guess they'll tell me for sure. But if there's a chance insurance won't cover the NIPT, then I guess I should just do the NT scan. I know NT looks for a lot more than the NIPT and I just wouldn't want to miss anything else at the risk of getting more definitive answers on a smaller subset of those things.

charmedlifex3 · September 2019

We did the "Harmony" test- it was 100% covered by my insurance based on my husband being over 40. So make sure you talk to your doctor about any risk factors if you want the test.
Honestly, I don't think we'll do it this time. We are going to be having a LOT of ultrasounds (we'll need to make sure the baby doesn't get my heart defect, at an elevated risk since I have it and my grandma had it, and planning to deliver at 37 weeks)
@mokay19 make sure you get the details on it! My insurance covered one blood test, but not the other. My OBGYN actually had to send me to a different hospital because they didn't use the one my insurance covered. I would have had to pay out of pocket for the test they recommended, but it was nearly free for one that gave the same information but was a different brand.

pirateduck · September 2019

I got similar information back as @whatsbumpinpumpkin recently from my insurance. I was told that if I ask my OB to send the test to a different lab (different brand NIPT) that it would be covered by my insurance, but if they send it where they usually do that I will need to pay out of pocket. I have not yet asked my doctor if this is something they do or not.

charmedlifex3 · September 2019

@pirateduck I was shocked at that actually. How easy would it have been to just do the test, assuming you either needed to pay out of pocket or it would be covered, then end up hundreds of dollars OOP you didn't need to be because it was sent here rather than there? #healthinsurancescam

pirateduck · September 2019

Oh yeah @whatsbumpinpumpkin My OB is "in network" and all the blood work I've had drawn at their office and sent to an outside lab for the past few years has also been "in network" I was surprised to find this one test would be out of network because it randomly gets sent to a different lab than normal.

spiderlover25 · September 2019

@pirateduck I have the same problem with my doctors office lab being out of network. I had to tell them specifically which lab I can use and they just send the order over for me. I do have to remind them each time though.

For everyone that has the option of the NT scan, where do you live? I was told for my pregnancies in NC (5 years ago) and NY (2 years ago) that the test was outdated and no longer done. However, lots of my friends in other places had it done as routine. I have an appointment next week with my doctor here in NH and will discuss all of the testing options. Since I’m over 35 I’m assuming I’ll do NIPT. They’ve already told me that my insurance only covers the anatomy scan at 18 weeks so I’m assuming anything else would be subject to deductible.

pirateduck · September 2019

@spiderlover25 Honestly I don't ever expect insurance to pay for anything anymore and when it does it's a pleasant surprise.

mdfarmchick · September 2019

@pirateduck isn’t that the truth?? And it makes me sad that insurance sucks.

pirateduck · September 2019

@mdfarmchick it's a whole broken system in the US. It's sad that I have insurance, through work, that meets the legal requirements, etc. and I still spend $1000s out of pocket every year on medical bills in addition to my insurance premiums. Ugh. So dumb.

pirateduck · September 2019

My husband doesn't even get insurance because of some stupid loophole in the laws.

mdfarmchick · September 2019

@pirateduck yeah. MH’s insurance is one of the perks of his job at least. They are clear on what they don’t cover but they do cover almost all costs associated with having a baby. It costs so much to have a baby in the US.

allie456 · September 2019

has anyone else heard that the NIPT is less accurate with twins?

JordanL1221 · October 2019

I did the Harmony NIPT with my daughter in 2017. I paid $295 OOP. My husband was not impressed. My OB also said that it was "one or the other" between NIPT or NT scan.

mdfarmchick · October 2019

@allie456 I seem to recall that as being one of the disclaimers with the MaterniT last time. But I didn’t have twins so I could be wrong.

catem07 · October 2019

@spiderlover25 my new dr doesn’t do the NT. I think she does serum integrated screening instead. I haven’t had my intake yet so I’m not sure about all that, but I know she said she doesn’t do NT.

babyodo · October 2019

Since I'm active duty military, Tricare only covers so much in terms of prenatal scans & tests. Here's what they'll cover:

Amniocentesis
Chordocentesis
Chorionic villis sampling
Fetal stress test
Electronic fetal monitoring

So, I have no idea if that means they'll be doing a NT, NIPT, or CVS at my first ultrasound next week. They didn't specify when they scheduled my appointment. We'd like to find out the baby's sex as soon as possible, but with Tricare I'm not sure how to go about requesting that. I guess I'll have to wait and see how it goes next week. I hate being in the dark on this stuff.

pirateduck · October 2019

allie456 said:

has anyone else heard that the NIPT is less accurate with twins?

Yes. I’m not sure if you can do this test with twins. Definitely ask your doctor and ask your insurance company.

shamrocandroll · October 2019

@yodamama That sounds like they will only be doing scans. They won't do a CVS or amnio unless your NT scan or bloodwork comes back with elevated risk because they are invasive tests. NT is usually not done until around 12 weeks, since the baby isn't developed enough to take the measurements needed for an NT scan before then. Your scan next week is likely just an early scan to verify due date. NIPT is not typically covered unless you're high risk or over 35. Usually wanting to know the baby's sex sooner is not a good enough reason for them to do NIPT, unfortunately.

babyodo · October 2019

Blaaahhhh! LOL

Since I'm over 35, they may put in me in for additional screening, but I'm not going to get my hopes up.

shamrocandroll · October 2019

@yodamama I would use that as your reason over wanting to know sex sooner when you ask them about it.

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