Tests not covered by insurance? What's up with that?

Hi Ladies,
So, good news, I had my first appt today and the doctor confirmed I have a viable pregnancy and we even saw the heartbeat! yay!

Then, the overwhelming part. I got a bunch of prescriptions for tests and they told me to confirm they are covered by my insurance (Cigna). This evening I called Cigna about screening for Fragile X, SMA, the Panorama test, and the Sequential Screen 12 week ultra screen.

Well, according to Cigna I need a pre-authorization for Fragile X and SMA - is this hard to obtain? I'll call my doctor tomorrow, but if she has given me a scrip for it, doesn't that already mean she thinks its necessary?

then, for the Panorama and other screening tests, I need to fit in some criteria, which I do not. I'm not over 35, etc etc. So, does that mean they aren't covered? Why is my dr giving me prescriptions for things I can't have access to?

It makes me feel uneasy that my doctor has recommended I have these tests done, but my insurance company deems them unnecessary??

Anyway, any insight or advice is much appreciated. So overwhelming!! TIA!

ETA - is there no recourse? Can my doctor's office call and argue it / will they?

Message edited 9/22/2014 9:42:59 PM.

Re: Tests not covered by insurance? What's up with that?

Preauthorization should be relatively easy to get and your OB's insurance dept should handle that.

For the other tests, maybe the dr was just recommending them, but doesn't deem them necessary. If she thinks they are necessary, then again, her office will have to fight the insurance company and prove their necessity. Otherwise, if you want them, they'd be OOP.

Tests not covered by insurance? What's up with that?

I had the panorama and if its not covered by my insurance then i dont have to pay. my doctor just sent me for the blood work and said if i get a bill to ignore the first one...if i get a second one to call their billing department and they'll take care of it. either way i wont be paying

Re: Tests not covered by insurance? What's up with that?

Message edited 9/23/2014 1:05:16 PM.

Re: Tests not covered by insurance? What's up with that?

So, I just spent some time on the phone with my dr (they won't call in pre-auth for SMA or fragile x since they aren't "required") but they urged me to get the Panorama test since they say it will cover everything, including SMA and fragile x - is that right?

They also said that they might send me a bill for it, but "they won't haunt you for it" . . . how much is this bill?

Lastly, it seems that the "Sequential Screen" test is part of the NT scan, it's the second part. I've been on the phone with the various labs all afternoon and it will either cost me $95 or $280. They can't tell me.
How is that possible?? Anyway, either way, I guess it's necessary!!

Also, how does this work with Panorama? They just "won't haunt me" and I should take their word for it?

Tests not covered by insurance? What's up with that?

I only ever had the NT scan. I think it's pretty normal for insurance to only cover additional testing if you meet certain requirements. With my first, I was offered the NT scan and that was it. This time, the doctor mentioned additional testing but I immediately brushed it off since I hadn't had it last time and the doctor was perfectly fine with that. Maybe see if you can wait to decide until you have the results of the first part of the NT scan. I didn't see a need to push for other tests unless that one came back with some red flags.

Re: Tests not covered by insurance? What's up with that?

I had genetic testing that included SMA and fragile X done through my RE and it was not covered so I paid. My ins will only cover if I had a family history. As for panorama, my ins will only cover if I have a genetic disorder or if I am over 35 which I am not so I did not bother with it. All screening through the NT scan (Down syndrome and spina bifida) is usually covered by insurances being that it's routine. I only opted for the NT scan and no other testing.

Re: Tests not covered by insurance? What's up with that?

Thanks ladies - my dr's office is telling me that the sequential screen test is actually part of the NT done at 16 weeks and the results are read together for a full picture.

Is the NT called the 12 week "ultrascreen"?

Re: Tests not covered by insurance? What's up with that?

Re: Tests not covered by insurance? What's up with that?

Re: Tests not covered by insurance? What's up with that?

I seriously need a glossary of all these terms.

So, that's a good idea. I go for the NT scan at 12 weeks and if everything is clearly fine I can talk to the dr about the necessity of the 16 week test, not covered by insurance. My next appointment I will be about 13 weeks and they want to do the Panorama then too, so that should also provide some info.

I wish this all weren't so confusing. And scary. I just want to be excited. :(

Tests not covered by insurance? What's up with that?

I wouldn't be comfortable with just not paying a bill and hoping they wouldn't come after me. If they have a patient assistance program or tell you you don't have to pay then ok, but I wouldn't want to have a collectable bill hanging out there.
As for prices, they told me the test without microdeletions was $2957 or a cash pay of $795; the test with microdeletions was $5478 or a cash pay of $1190. They told me I had to decide up front if I was doing the cash pay option.
Again, I would call Panorama before deciding. Maybe they started an official policy of forgiving balances.

Re: Tests not covered by insurance? What's up with that?