Genetic test for cystic fibrosis unexpectedly appears on OB lab invoice
September 10, 2017 3:51 PM   Subscribe

I am pregnant and at my very first OB/GYN appt they gave me what I was told a routine blood test. The blood test was run at an independent QuestDiagnostics lab. I received an invoice from Quest for the correct amount of my co-pay ($20), but I see a list of things they tested for, including a genetic screen for cystic fibrosis!

The invoice lists all the tests run and includes "CFTR CMN VAR ACMG/ACOG" which, according to a Google search, is a genetic screen for cystic fibrosis. $1,230 was billed to insurance (but not yet definitely paid by my insurer) for this single test. Other line items include "RUBELLA," DRUG SCREEN" billed at $624 to insurance, etc. So my Question is: What the hell. At my OB/GYN the nurse practitioner (didn't see the doctor that day) just said it was a blood test and never mentioned genetic screening or cystic fibrosis. I never filled out a form opting into a genetic screen for cystic fibrosis. Is this cystic fibrosis screen routine for pregnant women or should I have been asked to opt into it in writing? Is there a chance the insurer will question why it was run? Is it possible the Quest lab just ran the test WITHOUT being instructed to in order to bill more? My insurance is very generous (platinum ACA plan in California), so does that impact the sleaziness of health providers or the lab? I guess my main worry is that insurer will deny this genetic test and then try to add it to my out-of-pocket max, even though my co-pay for all lab tests should only be $20.
posted by KatNips to Health & Fitness (16 answers total)
Is it possible the Quest lab just ran the test WITHOUT being instructed to in order to bill more? My insurance is very generous (platinum ACA plan in California), so does that impact the sleaziness of health providers or the lab?

To answer this part of your question, no. This is not how this works.
posted by fluttering hellfire at 3:58 PM on September 10, 2017 [1 favorite]

This is a screening test looking for a certain number (tests vary) of the known mutations for cystic fibrosis (which as a recessive trait you could be a carrier for without being affected). It's a prenatal screen which should be *offered* to all pregnant patients who haven't been screened before. They should have gotten your consent to do it as it is a genetic screen. However, it should be covered by insurance as a pretty routine test.
posted by eglenner at 4:06 PM on September 10, 2017 [1 favorite]

From what I understand those are all standard - I'm pregnant and have gotten tested for everything under the sun without my knowledge or express consent. The first time I was asked for consent was when I opted for NIPT at 12 weeks. I actually did genetic testing prior to trying to conceive and since I'm Jewish they did the 128 panel test; we were billed about $350 after insurance. That's the only bill I've received so far. Also just a heads up your OB office may make you pay the balance due for your delivery well before your due date. We are on a payment plan for a couple hundred a month leading up to about a month prior to my due date.
posted by tatiana wishbone at 4:11 PM on September 10, 2017 [1 favorite]

those are all very standard prenatal labs but you are correct that the NP should have explained what she was ordering--for all the labs.
posted by The Elusive Architeuthis at 4:12 PM on September 10, 2017 [2 favorites]

I'll echo answers above that this is extremely likely to be covered and I wouldn't worry about the financial aspects.

That said, although carrier screening for CF is very common, the official recommendation of the American Congress of Obstetricians and Gynecologists is that "Information about genetic carrier screening should be provided to every pregnant woman. After counseling, a patient may decline any or all screening." (much more information about CF screening there).

There is no requirement to obtain consent in writing, but as a matter of professionalism and ethical medical practice, it should have been discussed with you and you should have been given the opportunity to decline.
posted by telegraph at 4:15 PM on September 10, 2017 [5 favorites]

Well at least you got it done. It's a 1 in 25 and if you don't know you have it you run the risk of your kid having cf. Ask me how I know. Over here it has to be requested, although there's no cost as we're not in the US. I would say you should be pleased to know one way or the other at least with your first.
posted by tillsbury at 4:16 PM on September 10, 2017 [1 favorite]

The problem with "routine blood tests" is that can mean anything, and once you've said yes to the blood draw you've consented. Being pregnant means you're going to be dealing with this kind of bullshit for a while. You can practice being proactive about your health care: for each test or procedure ask exactly what this involves and how much it will cost.
posted by medusa at 4:17 PM on September 10, 2017 [7 favorites]

Both CF screening and a test for rubella antibodies are standard for US obstetric care. They should be covered by your insurance. If your rubella antibodies are not present at sufficient levels, they will likely recommend a booster shot. Your NP should have discussed vaccination with you at the visit. In fact, the entire scope of the testing should have been discussed with you prior to the draw. Not just waved off as "routine blood tests."
posted by muddgirl at 4:35 PM on September 10, 2017 [6 favorites]

Yes, these are absolutely routine for obstetric care (and should be covered by your insurance), but being pregnant is not routine for *you*, so the practice should have let you know. As others have noted above, the "this is just what we do" attitude is sadly prevalent amongst those treating pregnant women, and it can also extend into newborn care. If it troubles you--and from your post, it sounds like it does --you may want to look at some resources that will (a) give you detail on All the Medicine you're about to encounter, and (2) offer insight into your decisionmaking role where appropriate. Emily Oster's Expecting Better is usually the first and best recommendation here.
posted by LadyInWaiting at 7:34 PM on September 10, 2017 [4 favorites]

A follow-up for those who seem to know about the medical field: does the lab really and truly expect the insurer to pay the listed price for all these tests? I mean $1,200+ for the cystic fibrosis screen? Over $600 just to see if there were drugs in my system? Or will the insurer pay a lower price in the end?
posted by KatNips at 9:41 PM on September 10, 2017

The insurer almost always pays a much lower price - sometimes an amazingly small fraction of the original price. By the way, even if you had a high deductible plan and had to pay for the tests yourself, you would still get the benefit of the negotiated rate. One of the many oddities and pricing distortions that is American health care.
posted by metahawk at 9:47 PM on September 10, 2017

No, they don't. The lab submits the bill to the insurer. The insurer pays part or all of it depending on the negotiated rate between those two entities. Depending on that rate and the terms of your plan, you are on the hook for a portion of it. What is actually being paid to the provider from the insurer is not the same as the original entity submitted billed rate you see on the EOB statement.

Medical providers are not out to cheat you. You seem really hung up on this for some reason. Educate yourself as to how insurance billing works. The rates negotiated have nothing to do with you personally.
posted by fluttering hellfire at 9:53 PM on September 10, 2017 [8 favorites]

A medical professional put it this way to me - think I'd insurance like a store card or discount club or Costco. By being a member, you get a lower rate.
posted by k8t at 10:39 PM on September 10, 2017 [1 favorite]

I just pulled my Explanation of Benefits from when I had the CFTR Gene Analysis done. Here's how it worked for my insurance:

Amount "Charged": $1,230.00
Insurance Network Discount: $145.97

Meaning that between insurance and the patient (me), we owed the hospital only $1,084.03. Not a huge discount for this particular test - 12%.

Here's another one from that same OB blood draw:
Amount "Charged": $47.60
Insurance Network Discount: $41.52

This one was entirely "out of pocket" for me, but with the discount I only paid $6. That's an 87% discount.
posted by muddgirl at 9:16 AM on September 11, 2017

The state of NY has very strict licensing guidelines for laboratories. Informed consent for genetic testing must be given, and the lab must have the form signed before proceeding with testing. California has stringent laws as well, but they do not require informed consent for genetic testing.
posted by txtwinkletoes at 11:44 AM on September 11, 2017 [1 favorite]

Just a quick correction in response to muddgirl's post: if you do not test positive for Rubella (meaning you are rubella non-immune, or in other words your childhood MMRs aren't still producing an adequate immune response to protect your from rubella) you *should not* be given the MMR during pregnancy. It is a live virus vaccine which you would be offered after you deliver.

What you should be offered during the later part of your pregnancy is a TDaP (tetanus, diphtheria, acellular pertussis) booster which will not only boost your antibodies, but also give some protection to your kiddo.
posted by eglenner at 10:40 PM on September 11, 2017 [1 favorite]

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