Genetic blood tests during pregnancy can be cheaper if you do not use your insurance: gunshots

When Mara Varona was pregnant, she decided to pass a common prenatal blood test to detect genetic conditions. It was part of a proactive approach that she and her husband adopted in pregnancy.

“We are only information people,” explains Varona, who works in finance and lives in Miami, Florida. “We prefer to have as much information as possible.”

Pay $ 349 now or …

Shortly after its blood sample, the Natera testing company sent an email and sent it an offer to pay its price in cash – $ 349 and completely jump insurance. The offers said that it was out of network and that Varona’s cost estimates that the balance of her frankness more than $ 100 at $ 200, according to a Natera statement.

But Varona does not remember having seen the offers when they were sent. She found them in her files because NPR reported this story. The email and the text forced him to click to see the details. She let the invoice go to her insurance assuming that she would collect most of the tab.

The results of the blood tests came back with good news – no sign of genetic concern.

But a few months later, other news arrived: an invoice of $ 750, the amount of his unsettled insurance deductible. According to the explanation of the services, Natera billed her insurance company $ 4,480. The insurer paid only 45 cents.

“I tend to be the type to pay it and move on,” she said. “But something in me told me that it just seemed unreasonably high. It was probably the biggest medical bill I had received throughout pregnancy.”

Varona tried to call Natera and her insurer to understand the accusation, but were not clarity. She put the bill aside until a short time after giving birth. It was then that she received an opinion that if she did not pay the bill, she would go to the collections.

“I wanted to take care of it,” she said.

Then she came across a Reddit thread. Other women shared a tip: call Natera and ask to pay the cash rate instead of going through insurance.

A counter-intuitive trend

Although Varona’s experience may seem unusual, this is not the case. In fact, it reflects a reality of the American health care system: payment of cash prices can sometimes be cheaper than using health insurance.

This dynamic became more visible in 2021, when a new federal rule required hospitals to publish their online prices. Since then, researchers have noted that for a wide range of services, such as laboratory tests, X -rays and even joint replacements – many hospitals charge patients in cash than what they charge insured.

A study published in Jama Network Open in 2021 revealed that for half of the hospitals questioned, cash prices were lower than the median prices negotiated by insurance companies.

Ge Bai, professor of policy and health management at Johns Hopkins University and co-author of the study, said that she was interested in the subject after her own experience. She discovered that the use of her insurance for a blood test for her son would have cost three times more than paying in cash.

“We always think that insurance companies exist to use their negotiation power to get better prices,” said Bai. “But that ruined my faith in this idea.”

Bai says that there are some reasons for this price inadequacy. One is administrative – providers are more willing to offer a discount when they do not have to deal with insurance documents and delayed payments. Another market behavior: consumers who pay species are more likely to go around the best price.

There is also a reason for profit in play for insurers. Insurers are authorized to maintain up to 20% of the premiums they receive for administrative costs and profits.

This means that lower medical expenses can actually reduce an insurer’s income.

And that is why, says Bai, insurance companies cannot be completed to get us the lowest prices.

“Proactive approach”

NPR contacted Varona’s insurer, independence Blue Cross, who confirmed that she was a member and has access to the Florida Blue network where she lives. The two insurers refused to answer questions about his case and explain why they only reimbursed 45 cents for his test.

NPR also interviewed Natera about its price policies.

“We recognize that health insurance can be difficult to navigate, and we provide patients with clear and initial information on coverage and costs,” wrote Brian Symmons, main vice-president of the experience of Natera patients. “We provide cost estimates before invoicing of insurance as much as possible. If Natera is out of network with the insurer of a patient, or if our estimate shows that their cost would probably exceed the cash price, we inform them and offer the possibility of paying the lower rate. Natera was one of the first in the industry to adopt this proactive approach.”

Natera did not answer NPR questions about the frequency to which he provides cost estimates to patients, but said that the company needed valid contact information for patients to send estimates.

A phone call that saved $ 400

Varona has tested the theory she read on Reddit on Natera’s call and the request for what is described on the company’s website as a “Treasury Price invites”. To his surprise, it worked.

“I thought it was b ****** t that they could simply find another amount,” she said. “But I was also happy to have saved $ 400.”

In the declaration, Symmons writes that “before invoicing, we contacted it by e-mail and text, explained our off-network status, estimated that its cost is between $ 100 and $ 200 After his franchise was met“This sum has proven to be $ 750, which was its unseat franchise.” In conversations with our team, Ms. Varona expressed her confusion about her insurance services, and we therefore made a courtesy adjustment. “”

Varona said that her experience by paying for cheaper cash flow rate has completely changed the way she addresses medical invoices.

“I question the invoices now,” she said. “I don’t pay them right away.”

A high insurance price and prosecution

Part of the problem for consumers is the list of insurers. In the situation of Varona, it was the price of $ 4,480 from Natera. With such a high price, anyone in a high franchise plan using their insurance could easily have their complete deductible on an out -of -network blood test – hundreds of dollars, as in the case of Varona, even thousands. Natera did not answer the NPR question by asking why she defines this list of the list to more than 10 times what it was ready to accept as cash payment in the case of Varona. Symmons said in a press release that Natera offers patients to patients with high deductibles or uninsured, but this is not the main way that the company is paid for these tests.

The company is faced with legal challenges for its billing practices.

A patient who paid more than $ 1,000 for these tests with insurance is part of a project for collective appeal against Natera. The pursuit was filed in December 2023 in California. A conclusion of previously proposed collective appeal alleged that the company was misleading as to its prices was rejected in 2023. It was because the plaintiff never ended up paying the full medical bill that it alleged was hundreds of dollars more than the bill up to $ 249 that it had planned. By rejecting this trial, the judge noted that the declarations intended for the public that Natera provided for patients said that “some patients will in fact pay more than $ 250 for a genetic test”.

The Natera spokesperson Symmons wrote in a press release: “We strongly refuse allegations in the pending trial. Our billing policies reflect our concentration on transparency, the choice of patients and affordability.”