2 different bills for $10k EACH for “standard” genetic panel during pregnancy, how do I contest?
Hi – I don’t know how to navigate this situation and would greatly appreciate advice. I am on my partner’s health insurance (Blue Shield California), and we proactively opted for the most comprehensive ($$$) plan because we were expecting a baby this year.
Early in pregnancy (around 12-15w) my OBGYN asked if I would like to opt into a standard genetic screening panel, typically done first trimester. I was told this panel should be covered by insurance but still typically costs a few hundred $ out of pocket. I agreed to the blood draw, which I expected to be sent to the same lab from which I had already received several bills for pregnancy bloodwork (all <$20 owed after insurance).
My doctor called back a few days later to say I screened positive for a few potential recessive genetic conditions, so they recommended my partner also get screened to check for overlap. He went back that week for the same blood draw.
We are now getting billed $10,000 EACH for this “standard” blood draw, of which Blue Shield offered to pay $180. Unbeknownst to us, the panel was sent to a different genetic lab that might have been out of network, which we had no idea might be an issue based on prior bloodwork. I tried to appeal through Blue Shield but they rejected the claim, saying they don’t cover the billing code for a test I was told was standard pregnancy care.
This bill feels outrageous and totally out of our control, we obviously can’t pay $20k when we were expecting a total out of pocket cost ~$600. I feel like my doctor is at fault, but I have no idea how to contest the billing and I’m so worried about my lack of power in this situation. Does anyone have any advice for how to fight back?
