Issues with Natera bill for genetic carrier screening… who do I need to talk to?
Apologies in advance for the long post. I've been dealing with this issue for months, and am starting to get very frustrated.
My husband and I have been working with a fertility clinic to try and get pregnant, and we got some genetic carrier screening done via Natera back in January/February of this year. We both got the exact same Horizon 421 panel.
We did my screening first, and at that point, we had not yet met our deductible (we have a high deductible plan), so we were responsible for paying 100%. The bill came out to about $500 (although there was an issue where Natera had entered it in as $5k, which I was able to get resolved pretty quickly by giving them a call).
When my husband got his screening done, we had already met our deductible, so we are now only paying 20% (insurance pays 80%). I think it's pretty reasonable that we expected the bill to be around $100… However, we were surprised to see his bill came in at over $600 (the total amount paid was about $3k, with insurance paying about $2.4k of that since they pay 80%).
This made no sense to me, considering we got the exact same genetic carrier panel done. I've called my doctor, my insurance, and Natera, and everybody just keeps saying everything is correct on their end and blaming somebody else.
My doctor says they fill out a standard Natera form with the blood sample, and emailed me a PDF copy. The form has the exact same Horizon 421 panel selected, for both me and my husband. They've told me that is all they are responsible for doing.
Insurance says they just take the amount Natera sent them, and make their adjustments from there. Even before any insurance adjustments, the amount that Natera billed insurance was significantly higher for my husband (~$13k) than for me (~$8k). Mine had 4 CPT codes listed, and my husband's had 25. They told me that is just the information they received from Natera.
Every time I call Natera, I get told something different from a different representative (mainly passing the blame back to either my doctor or my insurance, or just insinuating that I don't understand how insurance works). The most recent representative I spoke with said everything is correct on their end based on the codes they received from my doctor — but my doctor says all they submit is the standard Natera form, which I have a copy of, just showing that they selected the Horizon 421 panel.
Nobody can give me an answer as to why his is coming out to be so much more expensive than mine, or who I need to speak with to get that answered. I understand there may be slight differences between the male vs female testing, but $3,000 vs $500?? That makes absolutely no sense to me, and honestly, it freaks me out a little that my insurance says the bill would have been the full $3,000 if we had not met our deductible (which, again, is insane considering the bill was $500 for mine when we had not met the deductible).
This last call with Natera, I just gave in and told the representative I'd agree to pay their self-pay rate of $300-something. It's still more than the $100-ish I had expected to pay, but at this point, I just don't want to deal with this anymore. The representative said he'd put in that request, and to call back later this week to see if it's been approved.
(To add onto this, we got an email back when we ordered the tests saying Natera would contact us to let us know if the self pay cost would be lower than our insurance cost, and give us that option — which they never did, for either me or my husband)
So, I guess I'm just wondering what on earth went wrong here. Is there any way of knowing exactly why my husband's test came out to be so much more than mine, and any way to make sure this doesn't happen again in the future? (Aside from just refusing to use Natera for any more tests in the future, that is)
submitted by /u/4_anonymity
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