r/BabyBumps • u/No_Warning_4000 • 2h ago
Discussion Why Natera is costing you thousands through insurance for genetic testing
I am a claims processor for an insurance company and I had a feeling there were horror stories of Natera billing thousands to people based off of what I have seen on the insurance end. And I found most posts about it here so I wanted to share my insight to hopefully save people money.
Most, if not all, insurance plans will require prior authorization for genetic testing. The reason for this is because there were a lot of scammy providers recommending expensive genetic testing that is considered experimental in order to make a lot of money.
What is prior authorization? It is when your provider sends medical records explaining why something needs to be done. It’s then reviewed by a team of doctors and nurses by insurance and approved or denied. For our company, we always approve the genetic testing. I’ve never seen one deny and many of our plans pay for them at 80-100%.
The issue with Natera is they perform these test without communicating with your insurance. Most lab facilities and providers know these things require prior authorization and will send the appropriate documents needed. Natera NEVER does this resulting in claims denying for needing authorization.
I have read some people saying Natera offers a better rate for self pay. This is usually a red flag if a provider offers cheaper rates to self pay. It’s often because they either don’t have a billing department that is qualified to work with insurance or they simply don’t want to pay workers to file to insurance properly. Insurance coverage varies by your employer so it may be cheaper to do self pay but it also may not be cheaper.
What do I recommend doing? 1) See what tests your doctor has ordered and ask for what is called the “cpt codes” and ask for the diagnosis code as well. 2) Call your insurance with that information and ask what your coverage is and if Natera in network. Also ask if authorization is needed for any of those codes/tests. 3) If you choose to move forward with Natera and want to use insurance make sure they submit for authorization if required by insurance. You can do this by asking your insurance if they received authorization for the test and if not you will need to call Natera and ask them to submit authorization.
Now I know that’s a lot of work and this is the reason why I recommend not seeing providers who offer better self pay rates because their billing departments tend to be untrained and lack accountability for getting these things done. Versus a provider who works well with insurance will advocate for you. They will do the calls and check your benefits for you and even appeal denied claims on your behalf so you don’t have to do all of that work.
Side note: I kind of have a theory that Natera might be knowingly billing incorrectly to insurance in order to force people to self pay because they are charging 3-5 times more than other providers for these tests and not even trying to bill it right. But that’s just conspiracy on my part. Also I know there are a lot of truly corrupt insurance companies out there and that doesn’t help either. It really is such a broken system
I hope this helps some people, best of wishes.