How much does a Maternal21 test cost out of pocket? Does insurance ever cover it if you are <35?

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[Post New]03/21/2013 08:39
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Anonymous
We are pregnant with our second and there is a very specific serious genetic disorder that runs in my bloodline. I would really like to get the test but I am only 29. Does insurance ever cover it if you are under 35? What is the out of pocket price for anyone who has done it?
[Post New]03/21/2013 08:54
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Anonymous
My doc said that the company actually won't do the test for under 35, even if I wanted to pay out of pocket. I'll be just a few months shy of 35 when I deliver; he said I was out of luck.
[Post New]03/21/2013 08:57
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Anonymous
Anonymous wrote:We are pregnant with our second and there is a very specific serious genetic disorder that runs in my bloodline. I would really like to get the test but I am only 29. Does insurance ever cover it if you are under 35? What is the out of pocket price for anyone who has done it?


Materniti21 probably doesn't cover a rare condition. It only covers the big trisomies/common disorders. If you have a real risk of a serious condition, you can have a CVS instead. Talk to your doctor and you should be able to get it covered by insurance because of the family history.
[Post New]03/21/2013 09:08
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Anonymous
Maternit21 tests for trisomy 18, trisomy 21, and possibly turner's syndrome I think. If you have a history of one of those things, you will be able to get the test but it's up to your insurance whether they pay or not.
[Post New]03/21/2013 09:09
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jindc
Member Offline
like 08:54, my OB said M21 isn't FDA approved if you are under 35.
Maybe the Wilson Genetics Center at GW can help you?
[Post New]03/21/2013 09:13
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Anonymous
If you are in VA, I'd suggest talking to Genetics and IVF. The genetic counselors are great. And as others said, if you want to test for something rare, your looking at a CVS or amnio.
[Post New]03/21/2013 09:19
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Anonymous
jindc wrote:like 08:54, my OB said M21 isn't FDA approved if you are under 35.
Maybe the Wilson Genetics Center at GW can help you?


M21 and its competitors are not FDA approved at all.
Most diagnostic tests are not.

Also, I think that it is approved (through clinical validation) for some women with a history of the disorders it tests for. So OP, if you have a history of trisomy 13 miscarriages, you m ight qualify for the test if under 35.

finally, call the company if you qualify but insurance won't cover. I think they have discounts for the un or under insured.

[Post New]03/21/2013 09:26
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jindc
Member Offline
Anonymous wrote:

M21 and its competitors are not FDA approved at all.
Most diagnostic tests are not.



hm, ok then - sorry for the misinformation! thanks for the correction, PP!
[Post New]03/21/2013 09:53
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Anonymous
OP - do you mean the Counsyl test? M21 tests only for chromosomal disorders, not genetic disorders. The Counsyl test checks to see if you and your DH are carriers for ~100 genetic disorders.
[Post New]03/21/2013 10:14
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Anonymous
JinDC:

It's my job to know random stuff like this.
[Post New]03/21/2013 10:16
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Anonymous
I believe it cost $250, and was not covered by insurance.
[Post New]03/21/2013 10:37
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Anonymous
I did Verify (M21 will not perform the test at all if you are under 35). I paid $495 out of pocket.
[Post New]03/21/2013 10:47
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Anonymous
Not sure why there is so much misinformation about MaternitT21.

Absent a family or personal history of chromosomal abnormalities, you cannot get M21 if you are under 35 even if you are willing to pay the full cost out of pocket. I am under 35 and was able to get it due to family history on DH's side. I'm told I will pay somewhere between $0 and about $250, with the latter number being the case if my insurance decides not to cover it. It's been a few months and I haven't received a bill yet.
[Post New]03/21/2013 11:20
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Anonymous
Anonymous wrote:Not sure why there is so much misinformation about MaternitT21.

Absent a family or personal history of chromosomal abnormalities, you cannot get M21 if you are under 35 even if you are willing to pay the full cost out of pocket. I am under 35 and was able to get it due to family history on DH's side. I'm told I will pay somewhere between $0 and about $250, with the latter number being the case if my insurance decides not to cover it. It's been a few months and I haven't received a bill yet.


It's a very new test, and people rely on information they receive through various channels. Not everyone goes directly to Sequenom's website to find the information you describe above: http://www.sequenomcmm.com/Home/health-care-providers/Trisomy-21/About-the-Test

So, you can get the test if you're under 35 and lack a personal history of chromosomal abnormalities, but then you'd need either an ultrasound suggesting abnormalities or a positive serum screen.

I'm not criticizing anyone who didn't have the correct information, btw, I think it's extremely common and understandable. I work in a related field, so am comfortable with looking up stuff like this, but if I didn't, I don't know that I would.
[Post New]03/21/2013 11:25
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Anonymous
MaterniT21 is not the only company that does this testing. Everyone is correct that it's only recommended/clinically validated for women under 35, but Verinata (verifi test) will accept samples if you are under 35 years old with the caveat that they cannot guarantee the same detection rates because data is still forthcoming. Also, like many PPs said, the materniT21/Verifi is only for Down syndrome, Trisomy 13, Trisomy 18, extra X or Y chromosomes. If there is a rare genetic disease you need testing for, this test will not find it. I recommend you make an appointment with a genetic counselor.
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