Patients who order an expensive prenatal genetic test from Sequenom are being told that they will not be held responsible for the vast majority of the bill if it is denied by insurance.
This policy may appear to benefit patients, but may also be considered as a false claim that could result in legal action against the company. Similar behavior played a key role in .
Sequenom bills insurance companies $2,762.00 for the MaterniT21 test, which is a less invasive test for both common and rare chromosomal abnormalities, including Down syndrome. However, on a requisition form for the test obtained by CardioBrief (see the image below), patients are told that if their insurance company denies coverage they will be responsible for only $200, less than 10% of the amount billed to the insurance companies.
This billing issue has been a topic of discussion on internet maternity bulletin boards. Many contributors to the discussion boards advise patients to talk with their doctor or call the company. The consensus advice is that the company will accept dramatically lower payments for the test, in some cases as low as $140. On the , for instance, patients have shared stories about numerous cases in which Sequenom accepted payment ranging from $100 to $250. Insurance companies are unlikely to reimburse for the test unless the patient has a high-risk pregnancy.
One patient in the forum offered to another forum member who had expressed concern about being liable for the full cost of the test:
"I had the same test done because I will be 35 when I deliver and they told me the most I would have to pay is $180. My insurance is considered out of network and it is not covered but it is the policy of the company that performs the test. I would definitely call them."
In 2013, when the test was still being introduced to the market, Sequenom was sued by a shareholder for similar practices. Sequenom, the suit alleged, dropped the price to drive market acceptance of the test. , though the reason was never disclosed.
Sequenom was by Laboratory Corporation of America. I have requested a response from Sequenom about this billing practice. I will update this story with any response I receive.