DNA Screening (Harmony, Materniti21 etc...)

[purpledaisy923]

I had the Materniti21 test done at 18 weeks. I had turned the testing down during first tri because my insurance would not cover it because I am under 35 and I am carrying twins. When I met with my MFM for the first time at 18 weeks, he ordered the test because I have a rH negative blood type and he wanted to see if at least one of the twins had an rH positive blood type or not. My insurance still denied the claim, but sequenom (the company that does the materniti21 test) only charged me $30 for the entire test. My health insurance is Anthem BCBS.

[bluefairy5]

I have been searching around for the names of these tests everywhere! Thank you! My SIL had one of these done in each of her pregnancies. Wow, purpledaisy923, hearing it only cost you $30 with insurance denying the claim is really surprising. I guess I hear about this kind of thing and just assume it's incredibly expensive.

[purpledaisy923]

bluefairy5, my insurance sent me a denial letter that stated I would owe over $1000 for the test. I panicked and called my MFM's office. They told me to call sequenom. Sequenom told me that since my claim was denied by insurance, the bill I would get from them would only be $30. I was skeptical about the whole thing, but in the end, the bill was only $30. I'm not sure if my rH negative blood type situation helped get me the discount or not.

[bluefairy5]

Mar 7, 2015 7:48:46 GMT -5 purpledaisy923 said:

bluefairy5, my insurance sent me a denial letter that stated I would owe over $1000 for the test. I panicked and called my MFM's office. They told me to call sequenom. Sequenom told me that since my claim was denied by insurance, the bill I would get from them would only be $30. I was skeptical about the whole thing, but in the end, the bill was only $30. I'm not sure if my rH negative blood type situation helped get me the discount or not.

Ah, gotcha, that makes sense.  Thanks for the info!

[IFinTN]

If you are over 35, your insurance should cover it. I think you can call your insurance company to ask yourself before your dr. appt. It's also true that these genetic testing companies often only charge a set amount if your insurance denies the claim--but not all of them. So it's also good to determine which company your Dr. will use and call to ask them about it first as well. I know because I used to work in the genetic testing industry and it was common practice to "write off" charges when insurance denied or only covered part of the test.

For example, we did the Good Start genetics testing before IVF and even though the bill was $6000 and my insurance only paid a paltry amount, I paid nothing.

[IFinTN]

Oh, to add...one reason they write off these charges is they want this type of testing to become standard of care that is covered by all insurance companies in all pregnancies. So they need customers to show the data obtained is clinically useful!

[ruthie]

I just met with my OB and we discussed this test. She said it is standard to offer it in patients >35 and that it will eventually be offered to all patients, regardless of age. I don't meet the age criteria, so my insurance will not pay. My sister was 37 at the time of conception and this test was covered by insurance. I think she had it done at 12w. It did determine the gender of the baby and he did test positive for DS. A friend recently requested the test, despite being under 35. Her provider told her insurance would not cover it, but she went ahead and did it. She hasn't gotten the bill yet, so I guess we will see how much it really is!

With my previous pregnancy, my OB did my Rh, CBC, HIV... work up at my first prenatal appointment, but I declined the NT scan, so that was the only bloodwork she needed. This time, they'll do all that at 12 weeks since they'll be drawing the standard NT scan work up as well. I'm also Rh negative and other than the first round of blood work and the shots at 28w and after delivery, she never mentioned a thing about it. (They tested the boys after birth and, because my baby A is positive, I needed the shot.)

[jessimi06]

We opted not to do it because insurance wasn't going to cover it. they would have if I had 2+ losses due to chromosomal abnormalities or if I was over age 35, so yours might. That being said, I'd call your insurance company and whatever test company you decide to go with to see how the billing/pricing will work. A friend had hers covered by insurance, but her deductible still applied.

[sunshinedaisies]

We did the Harmony test at 12w. I was told that if insurance denies it, we only pay a set amount (I think less than $200) because, like others have said, they want it to become the norm, so the actual company won't charge you full price. We are still waiting for the bill - although we did get a request from the insurance company for more information for that date, so I am assuming it's for that test (we did the NT scan that and a new OB appt on that day as well). We are still trying to figure it out.

[hbanana18]

We did not as I am under 35 and had no history to suggest chromosomal abnormalities. They did offer it to me after my A/S screen had a soft marker for downs. We only had one marker that changed our risk to 1 in 4000 chance so we decided to pass on the test at that point. If I was offered it in first tri, I probably would have just because it would make me less nervous about future scans. It gives you so much information in a time where you feel like there are so many unknowns.

[sunnyb]

I'm not sure what we did. It was just a standard blood test that they do with the NT scan. They didn't tell us the name. Insurance covered it from what we can tell at this point!

[Deleted]

We did the Counsyl test and it was 100% covered by my crappy, self employed insurance through Anthem BCBS. I was surprised I didn't have to at least cover part of it. I'm am over 40 but we used a 21 year old donor. Insurance only looked at my age when approving it.

[gsancho]

We did M21 at 10 weeks. My insurance covered it and my OB used it to take the place of my NT scan. I think if you're over 35 your insurance should cover it.

[purpledaisy923]

Mar 7, 2015 8:14:21 GMT -5 @buttmonkey said:

purpledaisy923 thanks for that info! So how does that work...the Dr. orders the test and they correspond with the insurance, or would I need to call my insurance directly? I'm also Rh neg so maybe I can add that to my criteria

@buttmonkey, I would talk to your doctor first. See what company they do their testing through. I would then call insurance to figure out if they would cover it or not. If it's not covered, definitely call the testing company. Sequenom was very helpful and friendly. They answered all my questions and put my mind at ease. Hopefully it will all work out for you! 

[vballbaby]

I was going to have the harmony or the verifi test right after 10 wks. No idea if it was covered. Didn't care. At my age I would not skip it and I would have it done as early as possible. I think it's around 300 if it's oop. Good luck!

[viola]

I didn't do it, I'm not sure if my insurance would cover it. I hope you get it covered if you decide to do it though! Good luck!

[pintobean]

I did the materni21 test even though we did PGD testing. I called my insurance co to verify coverage before because the test is $2700 OOP through quest diagnostics. My ins paid 100% because I'm 40 and have had 2 genetically abnormal pregnancies but I think they classify it as routine testing now. I saw the EOB and the ins co paid $1700 after the discounts. I would definitely call to verify coverage before because it's an expensive test.

[radiantly]

My midwife said I had to see a geneticist to discuss it so we did. She took our family history and talked about the various tests. We did MaterniT21 which was covered by ins as I'm over 35 she said it is a brand like Kleenex. The test is generically called Cell-Free-DNA test. It came back normal and we are opting to not know the sex even though they know now because they look at the X and Y chromosomes.

Edit typo