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I got the MaterniT21 test done and was told the same thing. The lab they sent it to was out of network though, and I got a bill for $2,000, and I AM going to be over 35 when I deliver (considered high risk).

I just called my insurance to follow up on what was covered and what wasn't. I specifically asked about first trimester testing and she looked up the clinic and said everything was covered. I asked about ten different ways and she said yes every time. She said as long as your provider is in network, EVERYTHING is covered relating to prenatal care. I only start paying co-insurance after the baby is out.

I'm still not 100% sure this is true. I'm going to call again to confirm.

I think it's very insurance company dependent. We have good insurance imo (Blue Cross Blue Shield state employees' PPO), and they would only cover it if you're AMA or have a risk factor. I'm not AMA but I had a soft marker on my ultrasound so they covered it. I was basically told that as long as my doctor deems it medically necessary, they would cover it. My perinatologist's office also contacted my insurance to ensure it was covered. I had to pay my coinsurance percentage but it wasn't that bad.

It was not included in my "global prenatal coverage" - for me, that only covers my OB care. Blood tests, visits to the perinatologist, etc. are still subject to coinsurance/copays, at least under my plan. I don't pay copays or anything to my OB for my regular prenatal care though.

This was a few months ago.

@reverie: It also depends on what your employer chooses to cover above the standard. Highmark's BCBS plan's standard is to cover the test if you're AMA, but if you're not, they won't cover it. Your best bet is to get the procedure code from your provider, then call your insurance company and ask them to send you something in writing if that procedure code is covered and if there are any risk factors. The other piece is to find out where your provider would be sending the lab work to be processed. If the lab is out of network, then you're responsible for your out of network deductible first.

@reverie: I'm BCBS PPO too. Why does it have to be so confusing!?!

I talked to my insurance about it and they said NIPT is *potentially* covered. It seemed to me like I would either need to be over 35 or screen positive on my first trimester screenings for insurance to deem it "necessary."

@reverie: Thanks!
The women I talked to was friendly, but I didn't get the feeling she understood what I was asking. I even said, so anything my doctor orders will be covered 100% until I give birth and she said yes. I'm planning to get billing codes to confirm, but I feel like it shouldn't be this confusing!

@reverie: Not at this point. We had my NT scan and haven't gotten the results back yet. The geneticist recommending do the basic test and thinking about other tests after we get those results.

Thanks for all the information! I really appreciate it! Hope it come back soon with no concerns!

@reverie: ya, the deciding factor for me was timing. I have my First Tri scheduled for 8/27 - my panorama blood draw would not be until Sept 14 (then a week for results). So...8/27 vs 9/21....no brainer for me!

@reverie: I'm 99% sure the NT was covered 100%. I'll see in a few weeks if I get a bill. Silly insurance.

I was looking at my claims the other day and checked the claim for my MaterniT21 test, just out of curioustiy. The cost for the text was $2300. My insurance paid $470, which the lab accepted for payment! So the claim was approved and I am not getting a bill.

Long story short, insurance and our health care system are so effed up.