Offered a cash price for a prenatal genetic test? It may be your best bet

The institution Natera offers a humor trial to pregnant women that checks for fetal abnormalities. Natera offers what it calls a "prompt-pay rate price" for these tests. Halfpoint Images/MomentRF/Getty Images hide caption

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Halfpoint Images/MomentRF/Getty Images

When Mara Varona was pregnant she decided to return a communal prenatal humor trial to surface for familial conditions. It was portion of a proactive attack she and her hubby took to pregnancy.

"We're conscionable accusation people," says Varona, who useful successful finance and lives successful Miami, Florida. "We'd alternatively person arsenic overmuch accusation arsenic we can."

Pay $349 now aliases ...

Shortly aft her humor draw, nan testing institution Natera emailed and texted her an connection to salary its rate value — $349 and skip security altogether. The offers said she was retired of web and estimated Varona's costs would beryllium nan equilibrium of her deductible positive $100 to $200, according to a connection from Natera.

But Varona doesn't callback seeing nan offers astatine nan clip they were sent. She recovered them successful her records arsenic NPR was reporting this story. The email and matter required her to click done to spot nan details. She fto nan measure spell to her security assuming it would prime up astir of nan tab.

The humor trial results came backmost pinch bully news — nary signs of familial concerns.

But a fewer months later, different news arrived: a measure for $750, nan magnitude of her unmet security deductible. According to nan mentation of benefits, Natera had charged her security institution $4,480. The insurer paid conscionable 45 cents.

"I thin to beryllium nan type to conscionable salary it and move on," she says. "But thing successful maine told maine this conscionable seemed unreasonably high. It was astir apt nan highest aesculapian measure I'd received passim nan pregnancy."

Varona tried calling some Natera and her insurer to understand nan charge, but didn't get clarity. She put nan measure speech until soon aft she gave birth. That's erstwhile she received a announcement that if she didn't salary nan measure it would spell to collections.

"I wanted to return attraction of it," she says.

Then she came crossed a Reddit thread. Other women were sharing a tip: Call Natera and inquire to salary nan rate complaint alternatively of going done insurance.

A counterintuitive trend

While Varona's acquisition mightiness sound different it's not. In fact, it reflects a reality of nan U.S. wellness attraction system: Paying nan out-of-pocket rate value tin sometimes beryllium cheaper than utilizing wellness insurance.

This move became much visible successful 2021, erstwhile a caller national norm required hospitals to people their prices online. Since then, researchers person recovered that for a wide scope of services—like laboratory tests, X-rays, and moreover associated replacements—many hospitals complaint cash-paying patients little than they complaint insured ones.

A study published successful JAMA Network Open successful 2021 recovered that for half of nan hospitals surveyed, rate prices were little than nan median value negotiated by security companies.

Ge Bai, a professor of wellness argumentation and guidance astatine Johns Hopkins University and co-author of nan study, said she became willing successful nan taxable aft her ain experience. She discovered that utilizing her security for a humor trial for her boy would person costs 3 times much than paying successful cash.

"We ever judge security companies beryllium to usage their bargaining powerfulness to get amended prices," Bai says. "But this ruined my religion successful that idea."

Bai says location are a fewer reasons for this value mismatch. One is administrative — providers are much consenting to connection a discount erstwhile they don't person to woody pinch security paperwork and delayed payments. Another is marketplace behavior: Consumers paying rate are much apt to shop astir for nan champion price.

There's besides a profit motive astatine play for insurers. Insurers are allowed to support up to 20 percent of nan premiums they cod for administrative costs and profit.

That intends little aesculapian spending tin really trim an insurer's revenue.

And that's why, Bai says, security companies cannot beryllium relied upon to get america nan lowest prices.

"Proactive approach"

NPR contacted Varona's insurer, Independence Blue Cross, which confirmed she is simply a personnel and has entree to Florida Blue's web wherever she lives. Both insurers declined to reply questions astir her lawsuit and explicate why they only reimbursed 45 cents for her test.

NPR besides asked Natera astir its pricing policies.

"We admit that wellness security tin beryllium difficult to navigate, and we supply patients pinch clear, upfront accusation astir sum and cost," Brian Symmons, Natera's elder vice president of diligent acquisition wrote successful a statement. "We supply costs estimates earlier billing security whenever possible. If Natera is out-of web pinch a patient's insurer, aliases if our estimate shows their costs would apt transcend nan rate price, we notify them and connection nan action to salary nan little complaint instead. Natera was 1 of nan first successful nan manufacture to adopt this proactive approach."

Natera did not reply NPR's questions astir really often it provides costs estimates for patients, but said nan institution needs valid interaction info for patients to nonstop nan estimates.

A telephone telephone that saved $400

Varona tested retired nan mentation she publication connected Reddit astir calling Natera and asking for what's described connected nan company's website arsenic a "prompt-pay rate price." To her surprise, it worked.

"I thought it was b******t that they tin conscionable abruptly travel up pinch different amount," she said. "But I was besides happy I conscionable saved $400."

In nan statement, Symmons writes that "Before billing, we contacted her by email and text, explained our out-of-network status, estimated her costs would apt autumn betwixt $100–$200 after her deductible was met." That sum turned retired to beryllium $750, which was her unmet deductible. "In conversations pinch our team, Ms. Varona expressed disorder astir her security benefits, and we truthful made a courtesy adjustment."

Varona said her acquisition paying nan cheaper rate complaint has wholly changed really she approaches aesculapian bills.

"I mobility nan bills now," she said. "I don't conscionable salary them correct away."

A precocious security value and lawsuits

Part of nan problem for consumers is nan database value for insurers. In Varona's situation, that was Natera's $4,480 price. With a value that high, anyone successful a precocious deductible scheme utilizing their security could easy beryllium their afloat deductible connected 1 out-of-network humor trial — hundreds of dollars, arsenic successful Varona's case, aliases moreover thousands. Natera did not reply NPR's mobility asking why it sets this database value astatine much than 10 times what it was consenting to judge arsenic a rate payment successful Varona's case. Symmons said successful a connection that Natera offers nan complaint to patients pinch precocious deductibles aliases nan uninsured but it's not nan superior measurement nan institution gets paid for these tests.

The institution is facing immoderate ineligible challenges for its billing practices.

One diligent who paid much than $1,000 for these tests pinch security is portion of a projected people action lawsuit against Natera. The suit was revenge successful December 2023 successful California. An earlier projected people action suit alleging that nan institution was deceptive astir its pricing was dismissed successful 2023. That's because nan female plaintiff ne'er ended up paying nan afloat aesculapian measure she alleged was hundreds of dollars much than nan measure of up to $249 she had anticipated. In dismissing that lawsuit, nan judge noted that nan public-facing statements Natera provided to patients said "some patients will successful truth salary much than $250 for a familial test."

Natera's spokesperson Symmons wrote successful a statement, "We powerfully contradict nan allegations successful nan pending lawsuit. Our billing policies bespeak our attraction connected transparency, diligent choice, and affordability."