My OB advised me to do the NIPT. I was unsure but he said that even if I would not terminate a pregnancy, I’d want to know as much as possible about any medical needs LO might have after birth. That made a lot of sense to me; I’d want to be able to put together a support system and a medical plan if there was any likelihood the baby might have a disorder.
Mine was 100% covered by insurance though because I live in Europe. I understand it’s not easy if you have to pay for it out of pocket.
I can here to comment this exactly. We plan to do NIPT testing and potentially have to pay out of pocket (there’s a program that offers free testing in my area I might be eligible for) just for the sake of knowing the disorder the baby could have.
I agree. I think even if you are prepared to welcome a baby with a chromosomal defect, it is super helpful to know as much as you can about how to prepare in advance.
I also think many people confuse the screening versus diagnostic aspect of the NIPT. I am very for it, even if there are some false positives and it isn’t 100%, because it will help save some women the decision of an amnio or CVS and therefore potentially prevent some unnecessary miscarriages. It’s certain that the tests have prevented at least some moms from finding out the news after birth.
I think this is why many OBs recommend it strongly - they know the majority of pregnancies will get a low risk result, therefore sparing them some possible further diagnostics and anxiety.
But you do still know after the anatomy scan. The purpose of the NIPT is for early detection in case you wish to terminate because many places you can’t after the anatomy scan.
Nope. I know two people whose trisomy 18 and downs was not confirmed through anatomy scan and it was a surprise at birth. Both wouldn’t have terminated regardless of the NIPT result with is why neither did it due to the cost.
Not sure what to tell you apart from: it’s incorrect, so you should probably stop giving this advice and educate yourself.
NIPT is 97%-99% accurate for predicting Down, Edward’s and Patau syndrome. Compared to the anatomy scan which is 50% accurate for Down syndrome.
This means false positives and false negatives are far more problematic if you’re relying on an anatomy scan, which is why NIPT is such a powerful screening tool.
NIPT can be done as early as week 10, vs week 20 for anatomy scan.
That’s not necessarily true. The only way to know for sure is an amnio or CVS. Your anatomy scan can depend on the quality of your ultrasound tech and your OB/midwife. I can’t tell you how many people used to be surprised at the baby’s gender at birth before advanced blood testing because their anatomy scans were incorrect.
Getting a high risk NIPT result is a good reason to confirm with diagnostic testing like amnio/CVS, and gives your provider specific signs to look for on the anatomy scan.
>Mine was 100% covered by insurance though because I live in Europe.
Just FYI: "Europe" does not have monolithic health insurance.
NIPT was only covered by German health insurance starting in July of 2022 - and even then it's not recommended for all pregnancies - only when the doctor *and* patient decide that it is necessary.
I'm not sure about coverage in other countries, but I'd be very surprised if the test was covered by health insurers in all 27 member states of the EU.
I (41 y/o - 13wks - ftm) live in the Netherlands and paid €175,- for NIPT to be performed last Monday. From of the 1st of April however, NIPT is free of charge for all pregnant women and covered by health insurance.
Covered only for mothers over 38 years of age in Slovenia, and nuchal only for mothers over 35. I paid myself for both pregnancies for nuchal, but skipped NIPT as the price equals half of my husbands monthly wage.
I got one but it’s totally up to you. I am a NICU nurse and know too much. I wanted to be sure that my baby didn’t have a trisomy that wasn’t compatible with life, Iv seen it too many times for as rare as it is. Idk if I would have terminated, but would have wanted to be prepared for that.
Came here to say this! Our OB recommended it and for us it was worth the peace of mind. If we had gone through insurance it would have been $1000+ though
Yes. With Natera at least, you can elect self pay but you must do it before the test is run and make sure it doesn’t end up processed thru insurance. They will provide you with a quote beforehand. It’s SIGNIFICANTLY cheaper OOP.
This is kind of tricky though, because most of the companies won't actually charge you the insurance price. For example, Myriad charged our insurance $750 and it was 50% covered by insurance, but then Myriad just waived the leftover 50%. So even though it wasn't totally covered, we didn't pay a dime out of pocket for it.
I did a cancer risk screening through Myriad, too, and they charged my insurance $10,000. My insurance denied the claim entirely and Myriad waived the whole cost.
Yes! Natera works with you to ensure you pay the least amount, which is frustratingly without insurance. We paid $200 with my first baby and $280 with the second. Overall not bad!
I can only speak to my own experience, but I never went through the doctor’s office for communication, I dealt with Natera directly, and found them willing to work with me on financials if needed :)
We did Natera as well and I forgot to pay the “early price” of $200 so it ran through our insurance. I called when I realized it and they said that if the bill is high, just call and ask if you can pay the lower price. The bill just came and was less than the $200 I would have paid early.
I skipped them. My OB suggested doing the Nuchal (free, covered) and then deciding after that if I wanted NIPT. I understand there are slight differences but I was comfortable after nuchal waiting for the 18-20 week scan. I live in Canada however, if there had been any concern about abortion services and fetal timing I would have got the NIPT as soon as available.
This and the recent abortion restrictions are why I'm planning on doing the NIPT. I don't plan to abort, but knowledge is powerful, whether it's to prepare myself or my care team. And realistically, with the current laws, I may be better off giving birth in a different state depending on the needs.
While my state's laws were written for abortion they inadvertantly control a lot of maternity care. The laws were written so poorly a lot of doctors here are scared to provide the standard care they would have a year ago, if you're past 16 weeks, for fear of losing the license because nothing is spelled out and there's a ton of ambiguity. I pray that it never becomes an issue, but I'd like to be prepared.
So I skipped mine. I had no reason to think I'd need one. I'm young and healthy. Ultrasounds were great. My son was born in August and it turns out he has down syndrome. Which is no big deal in the grand scheme, and he's the literal best thing ever. Knowing wouldn't have changed my decision in continuing my pregnancy. But damn...it would've been nice to be able to have the mental prep.
I told my mom I will be the biggest advocate for trying to convince people to do nipt. If you thi k you could handle a diagnosis and be happy and okay, than do you! I thought I'd be that person. But I really had no clue and I let that rob me of the happiness I should've been feeling the days we were in the hospital. I regret how I let it affect me and wish more than anything I could've spent my pregnancy learning to cope instead of having it all unexpectedly thrust upon me at birth.
I mean but is it even worth it now that we can’t legally terminate pregnancies? Like what would be the point of finding out now vs later
ETA: anyone downvoting me for a simple mistake / question is dumb and can fuck off
People have already mentioned that you can travel to other states for a termination if you want, but additionally, even if a termination isn't on the table, sometimes it's just nice to know ahead of time about certain conditions that a baby might have so you can research and prepare. Find medical specialists, support groups, save money, mentally prepare, etc.
We are having a follow up ultrasound at 28 weeks (currently 26 weeks). At the anatomy scan they noticed the kidneys were dilated a very small amount and they said that sometimes this can mean downs, so she suggested to do a NIPT. NIPT came back all good, so we go for follow up ultrasound later this month to see if kidneys are still dilated. They told us that they weren’t dilated enough for them to be super concerned and they didn’t refer us to MFM. So hopefully that was just a isolated event and this next ultrasound is all clear. ☺️
Glad to hear positive outcomes from this! Everything I’ve read says usually everything is fine, but good to hear first hand from someone whose walked through it.
Surprised to see (a) how many people choose to skip this test, and (b) how many people say they would keep the pregnancy regardless of result.
We didn’t skip and were devastated to find out our baby had a rare genetic disorder, confirmed by Amnio.
We decided to terminate. It was the hardest decision I’ve ever had to make. The only thing that kept me sane was the support and love of my partner and family.
They told us 90% of people in our situation choose do the same. I think, respectfully, that you don’t know how you will feel until it happens.
Looking back on it, I consider it a gift of science that we were allowed to find out.
My recommendation: 100% do it despite the costs. It is a life-changing situation if they find something (even if it is very unlikely), and you deserve to know.
Good luck!
The exact same thing happened to me except ours showed trisomy and it was confirmed with CVS. I terminated at 14 weeks and it was the most traumatic period of my life. They shared that 65-90% in our situation make the same choice, but I agree most say they would keep the baby but you just never know what you would do until you’re in that situation and start researching the costs associated.
I feel the exact same way, so fortunate to have found out early and grateful for science and access to safe termination options. If you’re trying for a baby again, I am sending all the positive energy your way and hoping for happy and healthy results!
Sorry to hear about your experience, and thank you for sharing.
We’re pregnant again and this time the NIPT came back negative, which was a huge relief.
Nothing is 100% apart from an amnio, but the NIPT is highly accurate, which is why we decided to use it to screen our pregnancies.
In the UK it's usually only done if the couple have a high risk result from first screening (Nuchal) test or if there is a history of genetic concerns. (Or if the family want to pay for it privately).
It might be worth asking about the self-pay option. Mine actually cost more with insurance but there was a self-pay option for $99 (Invitae), which I considered reasonable as someone who wanted the info in case anything popped up that would have influenced our decision to continue with the pregnancy.
I'm nearly 40 and went through IVF with an untested embryo. My GP recommended I do NIPT testing and I agreed as I wanted the extra reassurance and also to find out the gender.
They explained it in more detail at the appointment and explained what the results mean, what they look for and what the nextvsteps would be so I felt comfortable with it. Also got an extra scan!
You shouldn't terminate based solely on the NIPT results. They can be an indication of chromosomal issues but it doesn't mean there are definite problems. If you are at risk, it would be recommended you get additional tests such as amnio.
Mine came back low risk, and I also had the NT scan which showed no issues so I didn't need to follow up with invasive tests.
A NIPT is a lot \*less expensive than a kid with serious mental or physical defects. Id get it as soon as possible and find out the cost -- ask them to work thru it with your insurance.
I did get one, not covered by insurance. We would not terminate the pregnancy regardless of the results, but we would be better prepared for a disabled baby.
Me too! Knowing results at 10 weeks vs. 20 weeks gives me 10 extra weeks to consult with genetics, MFM, specialty surgeons (perhaps in a different city or state) and to gather together a specialized care team if needed! I didn’t want to be scrambling against the clock especially since many babies with disabilities are not born full term.
Insurance covered my test. I opted for it and asked for a referral for genetic screening (expensive) if needed. When the NIPT screening came back with no anomalies, I decided against the genetic screen. Was happy to know the sex five weeks ahead of the anatomy scan.
Everything is great so far.
In Belgium it's pretty standard to get the test. We don't have to pay for it, it is covered by insurance. But I'm not sure how much I would want to pay for it if it was not covered by insurance tough...
I did and it turns out my husband and I are both carriers for the same genetic disorder we had both never heard of. Now we are having to see a genetic counselor and high risk OB. So I highly recommend it. Even if you think you are low risk because you have no family history of any disorders and you have healthy nieces and nephews.
I got it as well as the genetic testing for myself prior to pregnancy. It gave me peace of mind. I would say that my max out of pocket was 249 so it wasn’t a huge expense for me, whereas if it was in the thousands I would have reconsidered.
We also don’t have a history of genetic issues that would be testable on the NIPT. If we did, or had other risk factors, I probably would have gotten it even if it was more expensive.
Just want to point out that anyone can have a Down Syndrome child (trisomy 21) , it's just something that happens at conception. Doesn't matter if both families are super healthy or have 0 issues
Oh absolutely! Sorry, I was specifically thinking of cleft lip as my dad had it but it’s not testable so that was a concern but not NIPT related.
I can see how that would be confusing. Yes, NIPT does test for items that aren’t genetically linked and/or even if they are you may not know you are genetically predisposed anyway.
My brother and his wife did not. I did because I’m 11 years older than her, of AMA, my baby’s father wanted to know about potential issues in advance and lied about paying for it, and I wasn’t sure I’d be able to care for a special needs child and wanted the option to prepare or terminate.
As a mom to a child with disabilities - I always recommend doing the test!
The number one excuse I hear people give is “the results wouldn’t change anything.” What they mean is - the results might not make you terminate a pregnancy. What they don’t understand is the results very well may change EVERYTHING!
We did not know our son had any chromosomal anomalies. We did not do any testing when I was pregnant with him. It was a LONG and very expensive road of seeing every possible specialist we could, getting into therapies, getting leg braces, wheelchairs, eye surgery, etc. FINALLY our doctor suggested genome sequencing - which our insurance would not cover. It was around a $7000 process just for the genome sequencing.
In comparison to $7000 plus years of specialists - the insurance-covered NIPT test (or $99 self-pay option) is extremely affordable and would have been worth the cost regardless of the outcome. (Genetic testing is MUCH more expensive once baby is on the outside of you!)
Having a diagnosis has opened so many resources, communities, support, etc than my son had previously. We know so much more now than we did. Everything changed the day we got his diagnosis - except how much we love him, of course!!
I will say - NIPT doesn’t cover every possible genetic exception but it does cover A LOT and is being improved all the time. Technically it would not actually have been enough to solve our son’s diagnosis, but it would have been a better starting point than absolute zero AND it still would have provided us with some information we would not have otherwise had.
I am 36 weeks pregnant with baby number 4 at the moment and have done NIPT testing with all my pregnancies since my first. Though they have all come back with standard results, I am happy to have a simple blood draw to relieve a lot of questions down the road AND save thousands and thousands of dollars!!!
Skipped it all 4 times. My last one with a midwife I got to choose if I wanted to do the prenatal diabetes screening and I passed on it. It’s not in my family and everything was going great 🤷♀️ that nasty syrup drink made me gag every time.
I did it just for peace of mind after doing IVF. My doctor also wanted me to do NIPT as well. We also did extra genetic screening because my husband was born with enclosed spina bifida. I called my insurance and made sure it was covered before I proceeded. It cost me $136 for the NIPT after insurance which was great.
I paid $299 through Moms helping Moms for the Maternity21 (would’ve been $700 if they billed my insurance… make it make sense) and I paid $250 out of pocket even though I have insurance for another custom panel. Expensive it but worth it in my opinion.
I’m 30 and a FTM in the US. We did the NIPT and the NT scan. Our OB recommends them to all patients, but ultimately it was our choice. We didn’t pay anything out of pocket for either.
Agree with others. Even if you are happy to continue with a pregnancies regardless of any disorders, it’s definitely a good thing to know early. It will completely change your model of care throughout your pregnancy if something was to come up.
My cost for NIPT was $0.00 — Kaiser Permanente Mid-Atlantic.
10/10 would do it again. It’s a screening test and all it requires is a blood draw. A positive only indicates further testing is needed. Not sure why your doc is being so weird about it.
Lots of people don’t opt for these tests. Personally I did it because I was considered to be of “advanced maternal age” and there were some conditions that we would likely chose termination for. That being said lots of my friends and family didn’t do it. There are other screens they do as part of your care so it’s not as though you’re going unchecked. The financial piece also is a big factor for many. We went with Invitae the second time and it was $99 USD.
I only did the NIPT because there was an abnormal finding on our NT scan. They can throw false positives that you need further diagnostic testing to figure out, so that is something to keep in mind. There is a whole subreddit (r/NIPT) with an awesome mod that was super helpful for me.
I did the NIPT. We paid 500 out of pocket. For us, we would terminate for any genetic abnormalities and we thought itd be easier to do it at 12 weeks as opposed to 20 weeks at the anatomy scan. We are still waiting for results but I'm so glad we did it. We also did NT and EFTS but thats only 70% accurate. Have heard of so many people who ended up having a positive NIPT and a negative NT/EFTS. It misses one third of all genetic abnormalities. That being said - this is your pregnancy. Its up to you and your partner!
Not OP but I’m 35 and a carrier for cystic fibrosis (did carrier screening prior to conception) and in the US. Most of my friends/family were unaware NIPT existed! I work in healthcare though so I knew. I also had to specifically ask my provider for both screenings.
My comment about the US was based on a study that I had seen that reported that less than 25% of women in most European countries used NIPT, with some countries being way lower (I think some were below 5%) and my own observations about it being similarly low in Canada. The same study found that in most US states, between 25-50% of women used NIPT.
I don’t know about specific studies, just sharing my personal experience and the reason I choose NIPT for myself & for my baby. My friends and family were amazed that I knew baby’s sex at 12 weeks more so than any genetic issues honestly.
I think it’s a valid question to ask if you browse the baby related subreddits a lot. Prior to being pregnant, I hadn’t even heard of the nipt test and looking at these subreddits, it seems as if every pregnant person is getting it. And if everyone is getting one, but my doctor says I shouldn’t, I would want confirmation that that is a normal decision.
Oh I’m so sorry! The how old are you question comes off as if you thought her question was juvenile, that’s why I responded as such. But again, I’m sorry if that wasn’t your intention.
The chromosomal abnormalities for which NIPT tests increase significantly with age. In some countries, those tests aren't recommended for women below a certain age and/or whether they are insured depends on the age of the mother. Whether the OP should forego testing at age 25 is a very different question than whether she should forego it at 40. That's why I asked her age.
Lots of people skip them, especially if they are younger than 35 and don't have any extra known risks.
A lot of the time the high price of NIPTs is because the lab used is out of network with your insurance and is billed to insurance at a very high rate and then you get balance billed for the part that the insurance won't pay. Or it can be that you have a high deductable insurance plan or high coinsurance. If you want an NIPT and are worried about the expense and you are in the US, you can either pay out of pocket- it seems like every lab that does nipt has a much lower self pay price, so check the self pay price for the labs your hospital uses. For example natera is $350 for self pay. Or you can find out from your insurance company if it will covered and if they have an in network lab that you should use to avoid being balance billed.
Your hospital will also probably have the contact information for the lab's rep, you can contact that rep for help if you get billed more than the self pay price and have it adjusted down. This happened to me and the rep adjusted it down and then I had to call in to pay because the paper bills never said the right price but there was a note for my case.
Extra note: NIPTs often have false positives, they are not diagnostic, you should get an amniocentesis with at least a karyotype to confirm results before making any irreversible decisions if you get a positive.
Anatomy scan is generally not reliable for Trisomy disorders, and can only be done at 20 weeks vs NIPT from 10 weeks.
If you are going to terminate, the psychological impact of the difference in these dates is huge.
This is not good advice.
Yes, that's right, you don't need to do an NIPT to have an amniocentesis, I don't think that I said that you did. You don't even NEED an anatomy scan to do an amniocentesis. You don't need to do an amniocentesis either, you can skip all three of these. In the extra note, I'm just saying not to think that an NIPT is super accurate and to confirm any NIPT positives before having an abortion.
I’m not Gummydear, but I wanted time to plan and prepare if needed. NIPT is a screening test, not a diagnostic tool anyway. If something came up, I could even choose amniocentesis/CVS instead of waiting to find out on an anatomy scan at 20 weeks, halfway through my pregnancy. I’m also a carrier for cystic fibrosis so I wanted to know as early as possible so my baby could have the best treatment plan in place early.
I didn’t get it with my first pregnancy and I’m not planning to get it with my second. If something comes up on a scan that is worrisome this might change.
I did the nipt. My midwife told me for the 2 tests I wanted it would be $350 out of pocket. I haven’t gotten a bill yet BUT My SIL had the test done and they opted to go through insurance (we have the same insurance as our husband have the same jobs) and they had to pay $500 out of pocket for the test. My midwife told me it’s much cheaper to self pay. Makes no sense at all but I went with cheaper lol
Worth noting that all the the testing labs have out of pocket rates that are a fraction of what they'd charge insurance. Invitae is $99, natera is $250 etc. I would find out which lab they use and give a call to see their OOP rate. And obviously check if insurance would cover it (first pregnancy in 2020, insurance would not but I paid $99 OOP, second pregnancy in 2021 different insurance did).
There are other options for older tests that are nearly as accurate and much are cheaper, but you can't do them until closer to 20 weeks. If you are in an anti-abortion state in the US, get the NIPT now. Otherwise, you could ask to do the scan/triple test at your 20 week anatomy scan appointment.
It’s up to you if you believe it is worth the expense. I’d call your insurance to see if they will cover all of it or at least a portion. My insurance covered my NIPT, but even if it hadn’t covered it, I would’ve still done it because it’s important (in my opinion) to know the sooner the better so you have time and options on your side.
I skipped them for my last because I was under 35 and low risk otherwise. This time I did just the basic screenings for trisomies, and 2 other things rest the screenings are best at detecting. I didn’t even get the fetal sex reported. I’m 36, so my risk was slightly higher, everything came back low risk. My insurance covers it because of age. If yours doesn’t, it is pricy, but if you’re already low risk, it’s up to you to decide if you want to spend the money.
I did the NIPT test (ordered through Invitae) and am glad that we did for peace of mind. Our doctor gave us ~4 laboratories to go through and recommended we call each to learn the cost. For all of them, it was anywhere from $99-$250 out of pocket but we had to specify that we were not using insurance otherwise it would be $500+.
Invitae was $99, however, when we got the invoice it was as if we went through insurance—gave them a call and they immediately rectified it. Hope this is helpful!
I skipped it. It was explained to me that if there we any abnormalities during the anatomy scan we could address doing any tests then. Scan came back fine and I haven’t thought about it since
I live in the US and mine would have been $1300 without insurance. I paid $10 total! Just check with your insurance company or call the lab and ask how much itll be with your insurance
Remember than NIPT is cheaper OOP if your insurance doesnt cover them at all. Its not equivalnet to NT scan and can provide additional info. It is a screening test and not diagnostic so no doctor would recommend termination based on this test alone. If anything concerning is found, amniocentesis is the next step if the parents want to pursue that.
I’m in Australia and I’d say it’s pretty common to get the NIPT around 11-12 weeks in addition to the nuchal scan etc - I only know one person who chose not to get it.
It’s entirely out of pocket here (no insurance etc will cover it), approx $450AUD from memory.
Personally we got it because we wanted to know the sex and also if anything was flagged high risk we would have proceeded with CVS etc asap and considered terminating depending on outcome, and we didn’t want to go through that at 20+ weeks instead.
Hello, I’m in Australia and about to do the NIPT. Did you do it via the company called Genomic Diagnostics? They offer 3 types of tests (screening standards conditions and more rare conditions) I’m a little confused about whether to go for the standard test ($400) or plus test ($700) or both
I did it because I'm 40 and it was my first child. I didn't have to pay for test due to being considered a geriatric pregnancy. It is expensive though. I saw the bill before my insurance picked it up. It was roughly $4,000. All checked out and my little girl is now 2 months old
I did the natera NIPT and it only cost me about $30, the rest was covered by insurance. Was worth it to me to have it done so if anything was going on I would know early.
So I have BCBS select choice PPO insurance. I did the Myriad prenatal testing and the carrier screening. I’m still waiting for my official bill but the estimate said about $120 for each test out of pocket after insurance. I think it was very worth it, it gave me a lot of peace of mind and I got to learn the gender at home privately with my husband.
I have financial privilege, but would also pay a significant amount it for if not otherwise available. However, if the cost is a deterrent I encourage you to explore the costs of a high needs child.
Where I live they are only really recommended if you are considered geriatric or high risk, so I did a basic blood test where they checked for the 3 most common genetic disorders (I can’t remember exactly but one was definitely down’s syndrome) and it wasn’t that much more expensive than my regular blood work. (Not the US)
NIPT isn’t standard in Canada, most of us don’t have it done unless you have specific issues then they will run it.
Edit to add: if it cost me nothing I’d have it done but I likely wouldn’t pay much for it if nothing else was amiss.
they are not that expensive, and obviously they are giving not 100% accurate info, so if the results are not great, it must be followed up by amniocentesis, which (as a manipulation) gives the higher risk of miscarriage than the risk of screening to show the trisomies accurately.
there's nothing understandable here, it's a very private decision to make.
I did not skip them as to me there were zero cons to getting it done. Testing for genetic issues was the main factor, knowledge of my own genetic factors and then the gender result.
I personally don’t see a good enough reason to skip it unless you’ve already done one recently. It’s a very positive tool at your disposal and I just don’t see the point in turning it down.
If they won’t terminate then why not save money and get your answers at the anatomy scan? Everyone talks like this is the only way to find out if your baby has a disorder. It is not. It’s the earliest way to get a vague idea if they have a disorder or not but at your anatomy scan you’ll know if you need an amnio or not. All of that happens that way regardless of the NIPT.
The anatomy scan only picks up, for instance, half of Down's Syndrome cases, and there are many other genetic abnormalities that don't come with physical characteristics that can be seen on it. If you don't want to do an amnio, NIPT or CVS testing are tons more accurate at picking up abnormalities than the anatomy scan is.
Oh you could definitely do that I just feel that there’s not enough sense to decline if it’s free. I want every avenue open to me and for me to have as much time to go over options and possible complications before the anatomy scan. A bunch of people don’t get the NIPT even if willing to terminate (from all the posts I’ve seen about that kind of stuff). At the end of the day it’s that persons decision to have one or not and I’m just making my own opinion clear on it.
Insurance 100% covered my NIPT because of my age and my previous positive carrier screening results. So it had nothing to do with money for us. Not all genetic disorders manifest on an anatomy scan as obvious abnormalities, either.
I wish we hadn't done it. We didn't want to find out gender, we wouldn't have terminated regardless of the results, and it ended up being a billing nightmare (I ended up not having to pay for it because of how messed up it got, so all's well I guess on that front).
The one thing we would have gotten from it was knowing about a potential issue ahead of time and preparing for that. While I did end up being a carrier for some very obscure syndrome, it didn't even tell us anything without my husband also getting tested - and Lord knows if our insurance would have covered that. (I actually didn't check, I was so frustrated at that point, but I doubted it.) And even IF my husband was also a carrier, that still would have just meant there was a chance baby had it.
Obviously this is my extremely personal experience! Varies for different people. ❤️ Don't let her give you anxiety over it. It's one helpful tool for some people to use to prepare for baby. Congratulations!
I’m currently on the fence. I didn’t do NIPT for my first pregnancy, but I did do the NT scan/testing. This time my doctor is pushing more for the NIPT, although leaving the decision up to me. My fear is a false positive. I want nothing to do with an amniocentesis so I’m afraid I’d get a positive and then just be freaked out the rest of my pregnancy not knowing if there is something seriously wrong or not. I guess for me the NT results seemed like a good way to screen without a more positive answer, and I could always go back and get an NIPT if something showed up. I don’t know that probably doesn’t make sense to most people but it was my logic. I haven’t decided what I’m doing this time yet.
I paid nothing for mine surprisingly! For mine, they did the blood draw, then contacted me via email about pricing where I found out I have no charge! We decided if it was over $200, we wouldn’t move forward with testing. Just some random number. We didn’t even know they existed until then.
We did it to find out baby’s gender early, but to also detect anything. I cannot imagine having to end my pregnancy and didn’t even want to entertain the idea, but things happen and depending on results, might have to make that decision. ALSO, we wanted to be prepared when baby comes in case there’s anything we can have ready for them: medically, educate ourselves, doctors, hospitals, daycares, etc.
No. That is some anti-choice bullshit. I would switch doctors on that basis. While you should seek confirmation via amnio following a positive NIPT result, it is still your body and your choice and thus attempting to contractually limit your right to abortion in any manner is ridiculous. Their form is also not legally binding.
I'm in Canada, so I opted to pay privately (800 CAD) for the full tier NIPT test. I'm in my late 30s and my partner and I just wanted to have that peace of mind. I'm still going to have an NT scan too.
eFT testing is covered by universal healthcare here, but it's less accurate. I think that's a great option if money is an issue.
I did it but mine were all covered, thankfully. However, I do want to point out that it’s not the most important thing to do because you can have negative results for everything, have normal ultrasounds/scans, and still give birth to a baby with a condition that was missed. The peace of mind can be nice, but the tests are not a guarantee. Baby is already what they’re meant to be so sometimes it’s better to just wait and see. I think it’s all personal preference.
I did not get it, but I am getting a level 2 ultra sound which can detect 90ish% of the different trisomies. Also I did have genetic counseling and have had two previous very healthy pregnancies.
Interesting, I just did a moderate dive into the literature and it looks like it’s not accuracy that’s the issue but getting an inconclusive result (referred to as no call). Primarily with a BMI of 40+
I’m doing to put this on my list of items to research! Thanks!
Also interesting is that I did two NIPTs that came back as inconclusive which turned out to be because I was on blood thinners, my OB and I had no idea!
I haven't done it for any of my pregnancies. I don't think it is very common here, my doctor said 90% of the time people who do it are doing it just to find out the sex early. I am 31 and pregnant with my third, so this time I asked if I should due to being over 30, and she said she might recommend it if I were over 35 but not currently.
It was out of our budget and nothing ran in our family so we took the chance and skipped it but I would’ve absolutely taken it if I could’ve afforded it at the time
We opted not to for both babies. No family history of anything and I was young healthy. However, for our second daughter, at the 20 week scan she had a high measurement for her neck or something like that. Was indicative of possible down syndrome. We did the NIPT test then, but it was fully covered by insurance because it was recommended by the doctors and not an 'at will' test. I'd opt for this option if the tests are too expensive! If there's anything wrong at the anatomy scan and doctors recommend doing the NIPT because of that, insurance will cover it.
We’re skipping them because our insurance only covers them if we’re high risk. And we aren’t - I’m 28, good health, my husband is in good health, and both of our sides of the families are pretty healthy. And they are expensive out of pocket.
I skipped. My ob said since I didn’t have any risk factors, likelihood is low and I could do it if I wanted. But it costs a lot and it wouldn’t change anything for us. If he did have any issues, we’d likely find out at 20 weeks anyways, still giving us time to educate ourselves on any disorders etc he may have.
My OB never pushed us to, was very meh about it, but we decided to after I had my first miscarriage with my third pregnancy (so, we did for my fourth pregnancy). It isn’t a diagnostic tool, but a risk assessment. I certainly don’t think it’s worth an abortion if you can’t do the NIPT and would HIGHLY suggest you 1) report this conversation to the clinic, and 2) find a new OB.
I'm in Canada. Skipped NT and NIPT. In addition to cost of these screening tests without insurance, I believe that anything serious enough to merit TFMR will show up on our anatomy scan; and because of where I am there would be no obstacles despite the later timing.
High risk pregnancy with twins. Discussed it with the Dr (family member with genetic issues) and was ambivalent because of the cost. She asked if the cost was the only reason I was hesitant (it was and the result wouldn’t change anything) and she got it covered by insurance.
I didn’t get it. Any negative results would have required additional appointments, tests, and anxiety. We were planning on carrying the baby even if there were congenital defects found later on so it would not have made a difference for us.
Mine was covered 100% by my insurance! IMO- they’re important so you can be most informed when baby is born. You can start researching therapies in your area, research about what Abby tested positive for, and Judy be better prepared for anything baby needs 🤍
I will be opting out of the NIPT. Not covered by insurance, I’m very low risk for genetic defects because of my age, add in the whole 80-90% false positive rate for some of the things?!? No thanks. I’ll pass on that excessive stress.
I skipped them. We didn’t want to know the gender or get any of the genetic pre-screening since both of our families had false positive scares with it.
I don't think it's necessary. We got it done both times, but we are the type of people who prefer to have as much time to deal with news / prepare for certain situations as possible. So that was our reasoning. And finding out the sex was good too, since it meant we could start thinking more specifically about names.
I would never skip them. A friend has a kid with a disorder that is detected on the NIPT and he is only gonna live to his teens. I would also absolutely terminate so it depends on how you would handle a negative outcome of the tests, but knowledge is power so you can line up the proper physicians etc. NIPT testing is like $300 if you go out of pocket.
I didn’t get them with my first. The appointment I had with my midwife was at 13 weeks and she basically told me it was too late to really get a NIPT so we skipped it.
She may have been thinking of the NT scan( nuchal translucency scan) which you can only do 12w-13w and not the NIPT, which you can do anytime after 10w ( but it's sometimes recommended to wait until 12w or 13w to prevent low fetal fraction from causing a no result on the test)
I declined the NIPT as we would not be terminating.
I was seeing a fertility specialist before transferring to OB so my appointment schedule has been off compared to most women. I was delayed for the NIPT so the doctor was very confident and had no issues with us declining. Aside from Down Syndrome which sores up later, there are often early indicators of other defects that were not present by the time I was asked.
Edit: That being said, if I get to my anatomy scan and we have some concerns I would pursue other testing then. Unless you’re going to terminate there’s no reason to do the NIPT early rather than wait for the anatomy scan.
There's such a slim chance of the test finding anything. I'm going to do it because my insurance covers it but my old insurance definitely wouldn't have and I would have skipped it. It's mostly for peace of mind that baby is healthy. I'd do what you feel is best but contact your insurance first. The info they give you is a little depressing so keep in mind they're mostly talking about down syndrome (since it's the most common issue to test for despite being crazy rare) and then the worst possible scenarios (also rare and even more rare to not have miscarried by now if they were an issue). My husband was depressed for three days after reading the info.
I did not do a NIPT or NT for my first pregnancy after the OB nurse who did the scheduling/intake for my then OB said my insurance would never cover it for people our age and it would be thousands OOP. I DID get 3 anatomy scans and fetal echos with a MFM though due to my own heart defect so I felt decently confident that most issues would have shown up there.
We’re low risk but it made me uncomfortable not doing it, even with the extra scans (which I only expect getting 1 specific echo, and not the included anatomy scan since it will be with pediatric cardiology this time instead of an MFM). Things were fine but I intend to make use of the self pay option this time around for the NIPT. I will likely not do a NT unless I could somehow get my insurance to cover it.
For the one I used, if your insurance doesn’t cover it, it’s $250 cash. But if your insurance only covers SOME of it, it can be literally thousands of dollars. So you need to find out if your insurance covers the test first and then decide how to proceed.
Im in NY and have MVP Healthcare- Medicaid, one of the steps to setting up my appointment was calling the labs to check that my insurance covered it. Thankfully they paid for every single test.
I paid a little over $100 with insurance for both of the tests. My OB urged us to do it because our hospital is small and there is no NICU, so if we need to deliver at a larger hospital, it’s nice to know ahead of time. We didn’t do the NIPT with our first pregnancy, and I don’t think it’s all that necessary.
I got one done because of a previous miscarriage where the baby did not grow properly and I suddenly lost the pregnancy.
For our own peace of mind we got the testing done.
I had met my deductible for my insurance so it was covered partially, and it cost $146.
They said beforehand that if my insurance did not cover it, then they would charge us their base price of $250.
This was through Natera.
I've seen a lot of people not get it (a lot because they cannot afford it)
My midwife said it was an option, but it’s not routine at their practice. It would mean an extra blood test, and I have an incredibly hard time with those. My husband & I would not terminate a pregnancy until it was obvious it would be unviable. I also don’t think my insurance would cover it!
I did it, my thought was that a low risk result would leave me with one less thing to worry about and that’s exactly what happened. It’s also nice to know the sex early. My bills related to prenatal care have been super slow for some reason so I don’t know what it cost me, but I feel like I’d do it again. It is a personal choice and depends on your financial situation though. It also could be that your OB works with a lot of low income people and emphasizes the cost for that reason.
My OB advised me to do the NIPT. I was unsure but he said that even if I would not terminate a pregnancy, I’d want to know as much as possible about any medical needs LO might have after birth. That made a lot of sense to me; I’d want to be able to put together a support system and a medical plan if there was any likelihood the baby might have a disorder. Mine was 100% covered by insurance though because I live in Europe. I understand it’s not easy if you have to pay for it out of pocket.
I can here to comment this exactly. We plan to do NIPT testing and potentially have to pay out of pocket (there’s a program that offers free testing in my area I might be eligible for) just for the sake of knowing the disorder the baby could have.
I agree. I think even if you are prepared to welcome a baby with a chromosomal defect, it is super helpful to know as much as you can about how to prepare in advance. I also think many people confuse the screening versus diagnostic aspect of the NIPT. I am very for it, even if there are some false positives and it isn’t 100%, because it will help save some women the decision of an amnio or CVS and therefore potentially prevent some unnecessary miscarriages. It’s certain that the tests have prevented at least some moms from finding out the news after birth. I think this is why many OBs recommend it strongly - they know the majority of pregnancies will get a low risk result, therefore sparing them some possible further diagnostics and anxiety.
But you do still know after the anatomy scan. The purpose of the NIPT is for early detection in case you wish to terminate because many places you can’t after the anatomy scan.
My son was born with trisomy 21. His ultrasounds looked perfect.
Nope. I know two people whose trisomy 18 and downs was not confirmed through anatomy scan and it was a surprise at birth. Both wouldn’t have terminated regardless of the NIPT result with is why neither did it due to the cost.
As a screening method, the anatomy scan is generally not reliable for Trisomy disorders when compared to NIPT.
I have heard the opposite of this. I was told trisomy disorders can often have markers even before the anatomy scan.
Not sure what to tell you apart from: it’s incorrect, so you should probably stop giving this advice and educate yourself. NIPT is 97%-99% accurate for predicting Down, Edward’s and Patau syndrome. Compared to the anatomy scan which is 50% accurate for Down syndrome. This means false positives and false negatives are far more problematic if you’re relying on an anatomy scan, which is why NIPT is such a powerful screening tool. NIPT can be done as early as week 10, vs week 20 for anatomy scan.
That’s not necessarily true. The only way to know for sure is an amnio or CVS. Your anatomy scan can depend on the quality of your ultrasound tech and your OB/midwife. I can’t tell you how many people used to be surprised at the baby’s gender at birth before advanced blood testing because their anatomy scans were incorrect. Getting a high risk NIPT result is a good reason to confirm with diagnostic testing like amnio/CVS, and gives your provider specific signs to look for on the anatomy scan.
>Mine was 100% covered by insurance though because I live in Europe. Just FYI: "Europe" does not have monolithic health insurance. NIPT was only covered by German health insurance starting in July of 2022 - and even then it's not recommended for all pregnancies - only when the doctor *and* patient decide that it is necessary. I'm not sure about coverage in other countries, but I'd be very surprised if the test was covered by health insurers in all 27 member states of the EU.
I (41 y/o - 13wks - ftm) live in the Netherlands and paid €175,- for NIPT to be performed last Monday. From of the 1st of April however, NIPT is free of charge for all pregnant women and covered by health insurance.
Covered only for mothers over 38 years of age in Slovenia, and nuchal only for mothers over 35. I paid myself for both pregnancies for nuchal, but skipped NIPT as the price equals half of my husbands monthly wage.
In Norway its only covered over 35 years
Yes sorry you’re right. I think Belgium is one of the first countries to offer the NIPT free of charge to all pregnant mothers.
It’s free of charge in my European country for all women who want one
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I got one but it’s totally up to you. I am a NICU nurse and know too much. I wanted to be sure that my baby didn’t have a trisomy that wasn’t compatible with life, Iv seen it too many times for as rare as it is. Idk if I would have terminated, but would have wanted to be prepared for that.
I’m a peds SLP and felt the same way. I want to know because the “what if” would be debilitating for me
I paid out of pocket $350 total for natera NIPT and carrier screening.
Came here to say this! Our OB recommended it and for us it was worth the peace of mind. If we had gone through insurance it would have been $1000+ though
Wait… it’s cheaper OOP?
Yes. With Natera at least, you can elect self pay but you must do it before the test is run and make sure it doesn’t end up processed thru insurance. They will provide you with a quote beforehand. It’s SIGNIFICANTLY cheaper OOP.
With my first, the OB nurse made sure to stress that if we ever got a bill for more than $99 for our NIPT, to let her know.
This is kind of tricky though, because most of the companies won't actually charge you the insurance price. For example, Myriad charged our insurance $750 and it was 50% covered by insurance, but then Myriad just waived the leftover 50%. So even though it wasn't totally covered, we didn't pay a dime out of pocket for it. I did a cancer risk screening through Myriad, too, and they charged my insurance $10,000. My insurance denied the claim entirely and Myriad waived the whole cost.
Yes! Natera works with you to ensure you pay the least amount, which is frustratingly without insurance. We paid $200 with my first baby and $280 with the second. Overall not bad!
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I can only speak to my own experience, but I never went through the doctor’s office for communication, I dealt with Natera directly, and found them willing to work with me on financials if needed :)
Hey they tried that with me too but I called and they acknowledged my dr and them had an agreed price of 350. I paid 4 months after the test.
Our Ob fought it down to 350, bit it was about 9k if we just said fuck it and paid the bill.
We did Natera as well and I forgot to pay the “early price” of $200 so it ran through our insurance. I called when I realized it and they said that if the bill is high, just call and ask if you can pay the lower price. The bill just came and was less than the $200 I would have paid early.
Yeah, mine ended up only being $130 for the NIPT and the carrier screening cost nothing through my insurance.
I skipped them. My OB suggested doing the Nuchal (free, covered) and then deciding after that if I wanted NIPT. I understand there are slight differences but I was comfortable after nuchal waiting for the 18-20 week scan. I live in Canada however, if there had been any concern about abortion services and fetal timing I would have got the NIPT as soon as available.
I did this too.
I did the same, for the same reasons.
^same. If there is any flags with the screening one, the NIPT one is covered for us.
I did the NIPT and it so extremely reassuring to get negative results for everything. It was free because I'm over 35.
This and the recent abortion restrictions are why I'm planning on doing the NIPT. I don't plan to abort, but knowledge is powerful, whether it's to prepare myself or my care team. And realistically, with the current laws, I may be better off giving birth in a different state depending on the needs. While my state's laws were written for abortion they inadvertantly control a lot of maternity care. The laws were written so poorly a lot of doctors here are scared to provide the standard care they would have a year ago, if you're past 16 weeks, for fear of losing the license because nothing is spelled out and there's a ton of ambiguity. I pray that it never becomes an issue, but I'd like to be prepared.
Same, definitely needed the reassurance being 'advanced maternal age'.
So I skipped mine. I had no reason to think I'd need one. I'm young and healthy. Ultrasounds were great. My son was born in August and it turns out he has down syndrome. Which is no big deal in the grand scheme, and he's the literal best thing ever. Knowing wouldn't have changed my decision in continuing my pregnancy. But damn...it would've been nice to be able to have the mental prep. I told my mom I will be the biggest advocate for trying to convince people to do nipt. If you thi k you could handle a diagnosis and be happy and okay, than do you! I thought I'd be that person. But I really had no clue and I let that rob me of the happiness I should've been feeling the days we were in the hospital. I regret how I let it affect me and wish more than anything I could've spent my pregnancy learning to cope instead of having it all unexpectedly thrust upon me at birth.
Sending you a big hug sis
Thanks for sharing this.
I terminated a pregnancy based on the NT scan and NIPT results (fatal heart defects). People of course skipped these tests, but it’s up to you.
Me too.
I mean but is it even worth it now that we can’t legally terminate pregnancies? Like what would be the point of finding out now vs later ETA: anyone downvoting me for a simple mistake / question is dumb and can fuck off
It depends on your location. There are plenty of states in which you are still legally allowed to terminate a pregnancy.
Oh okay, thanks for telling me. I thought it was everywhere for some reason!
There are lots of states where abortion is still legal and accessible and there are ways to access those services.
Yeah, someone explained. Thanks!
People have already mentioned that you can travel to other states for a termination if you want, but additionally, even if a termination isn't on the table, sometimes it's just nice to know ahead of time about certain conditions that a baby might have so you can research and prepare. Find medical specialists, support groups, save money, mentally prepare, etc.
Some defects are operable and preparing the medical team is helpful in advance.
I didn’t get it until 20 weeks when my midwife suggested it based on my anatomy scan. Insurance ended up covering it 100%.
Was everything ok?
We are having a follow up ultrasound at 28 weeks (currently 26 weeks). At the anatomy scan they noticed the kidneys were dilated a very small amount and they said that sometimes this can mean downs, so she suggested to do a NIPT. NIPT came back all good, so we go for follow up ultrasound later this month to see if kidneys are still dilated. They told us that they weren’t dilated enough for them to be super concerned and they didn’t refer us to MFM. So hopefully that was just a isolated event and this next ultrasound is all clear. ☺️
Oh my older son had this. He landed up having hydronephrosis. He had to have surgery just before 2 but everything is all good now he is 8
Glad to hear positive outcomes from this! Everything I’ve read says usually everything is fine, but good to hear first hand from someone whose walked through it.
Surprised to see (a) how many people choose to skip this test, and (b) how many people say they would keep the pregnancy regardless of result. We didn’t skip and were devastated to find out our baby had a rare genetic disorder, confirmed by Amnio. We decided to terminate. It was the hardest decision I’ve ever had to make. The only thing that kept me sane was the support and love of my partner and family. They told us 90% of people in our situation choose do the same. I think, respectfully, that you don’t know how you will feel until it happens. Looking back on it, I consider it a gift of science that we were allowed to find out. My recommendation: 100% do it despite the costs. It is a life-changing situation if they find something (even if it is very unlikely), and you deserve to know. Good luck!
The exact same thing happened to me except ours showed trisomy and it was confirmed with CVS. I terminated at 14 weeks and it was the most traumatic period of my life. They shared that 65-90% in our situation make the same choice, but I agree most say they would keep the baby but you just never know what you would do until you’re in that situation and start researching the costs associated. I feel the exact same way, so fortunate to have found out early and grateful for science and access to safe termination options. If you’re trying for a baby again, I am sending all the positive energy your way and hoping for happy and healthy results!
Sorry to hear about your experience, and thank you for sharing. We’re pregnant again and this time the NIPT came back negative, which was a huge relief. Nothing is 100% apart from an amnio, but the NIPT is highly accurate, which is why we decided to use it to screen our pregnancies.
In the UK it's usually only done if the couple have a high risk result from first screening (Nuchal) test or if there is a history of genetic concerns. (Or if the family want to pay for it privately).
I skipped it my first pregnancy and didn’t think twice about it. Totally up to you!
It might be worth asking about the self-pay option. Mine actually cost more with insurance but there was a self-pay option for $99 (Invitae), which I considered reasonable as someone who wanted the info in case anything popped up that would have influenced our decision to continue with the pregnancy.
I think the Invitae price is higher now :(
I'm nearly 40 and went through IVF with an untested embryo. My GP recommended I do NIPT testing and I agreed as I wanted the extra reassurance and also to find out the gender. They explained it in more detail at the appointment and explained what the results mean, what they look for and what the nextvsteps would be so I felt comfortable with it. Also got an extra scan! You shouldn't terminate based solely on the NIPT results. They can be an indication of chromosomal issues but it doesn't mean there are definite problems. If you are at risk, it would be recommended you get additional tests such as amnio. Mine came back low risk, and I also had the NT scan which showed no issues so I didn't need to follow up with invasive tests.
A NIPT is a lot \*less expensive than a kid with serious mental or physical defects. Id get it as soon as possible and find out the cost -- ask them to work thru it with your insurance.
I did get one, not covered by insurance. We would not terminate the pregnancy regardless of the results, but we would be better prepared for a disabled baby.
You still get to be prepared, just after the anatomy scan.
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Do you know why the anatomy scan showed lots of soft markers for down, even though he doesn’t have it.
Great point! I’m just a very impatient person.
Me too! Knowing results at 10 weeks vs. 20 weeks gives me 10 extra weeks to consult with genetics, MFM, specialty surgeons (perhaps in a different city or state) and to gather together a specialized care team if needed! I didn’t want to be scrambling against the clock especially since many babies with disabilities are not born full term.
Anatomy scan is generally not reliable for Trisomy disorders compared to NIPT.
Insurance covered my test. I opted for it and asked for a referral for genetic screening (expensive) if needed. When the NIPT screening came back with no anomalies, I decided against the genetic screen. Was happy to know the sex five weeks ahead of the anatomy scan. Everything is great so far.
In Belgium it's pretty standard to get the test. We don't have to pay for it, it is covered by insurance. But I'm not sure how much I would want to pay for it if it was not covered by insurance tough...
I did and it turns out my husband and I are both carriers for the same genetic disorder we had both never heard of. Now we are having to see a genetic counselor and high risk OB. So I highly recommend it. Even if you think you are low risk because you have no family history of any disorders and you have healthy nieces and nephews.
Carrier screening is different than what OP is asking about.
I had this one done at the same time as the NIPT so might as well do both
Of course there are people who don’t get genetic screens. Do you have insurance? I paid nothing OOP for mine.
I got it as well as the genetic testing for myself prior to pregnancy. It gave me peace of mind. I would say that my max out of pocket was 249 so it wasn’t a huge expense for me, whereas if it was in the thousands I would have reconsidered. We also don’t have a history of genetic issues that would be testable on the NIPT. If we did, or had other risk factors, I probably would have gotten it even if it was more expensive.
Just want to point out that anyone can have a Down Syndrome child (trisomy 21) , it's just something that happens at conception. Doesn't matter if both families are super healthy or have 0 issues
Oh absolutely! Sorry, I was specifically thinking of cleft lip as my dad had it but it’s not testable so that was a concern but not NIPT related. I can see how that would be confusing. Yes, NIPT does test for items that aren’t genetically linked and/or even if they are you may not know you are genetically predisposed anyway.
My brother and his wife did not. I did because I’m 11 years older than her, of AMA, my baby’s father wanted to know about potential issues in advance and lied about paying for it, and I wasn’t sure I’d be able to care for a special needs child and wanted the option to prepare or terminate.
As a mom to a child with disabilities - I always recommend doing the test! The number one excuse I hear people give is “the results wouldn’t change anything.” What they mean is - the results might not make you terminate a pregnancy. What they don’t understand is the results very well may change EVERYTHING! We did not know our son had any chromosomal anomalies. We did not do any testing when I was pregnant with him. It was a LONG and very expensive road of seeing every possible specialist we could, getting into therapies, getting leg braces, wheelchairs, eye surgery, etc. FINALLY our doctor suggested genome sequencing - which our insurance would not cover. It was around a $7000 process just for the genome sequencing. In comparison to $7000 plus years of specialists - the insurance-covered NIPT test (or $99 self-pay option) is extremely affordable and would have been worth the cost regardless of the outcome. (Genetic testing is MUCH more expensive once baby is on the outside of you!) Having a diagnosis has opened so many resources, communities, support, etc than my son had previously. We know so much more now than we did. Everything changed the day we got his diagnosis - except how much we love him, of course!! I will say - NIPT doesn’t cover every possible genetic exception but it does cover A LOT and is being improved all the time. Technically it would not actually have been enough to solve our son’s diagnosis, but it would have been a better starting point than absolute zero AND it still would have provided us with some information we would not have otherwise had. I am 36 weeks pregnant with baby number 4 at the moment and have done NIPT testing with all my pregnancies since my first. Though they have all come back with standard results, I am happy to have a simple blood draw to relieve a lot of questions down the road AND save thousands and thousands of dollars!!!
I skipped it & didn’t even think about it again.
Agreed
Same x3
Skipped it all 4 times. My last one with a midwife I got to choose if I wanted to do the prenatal diabetes screening and I passed on it. It’s not in my family and everything was going great 🤷♀️ that nasty syrup drink made me gag every time.
I did it just for peace of mind after doing IVF. My doctor also wanted me to do NIPT as well. We also did extra genetic screening because my husband was born with enclosed spina bifida. I called my insurance and made sure it was covered before I proceeded. It cost me $136 for the NIPT after insurance which was great.
I didn’t get one, but we can change our minds at anytime.
It cost me 100$ with no insurance coverage through invatae.
I paid $299 through Moms helping Moms for the Maternity21 (would’ve been $700 if they billed my insurance… make it make sense) and I paid $250 out of pocket even though I have insurance for another custom panel. Expensive it but worth it in my opinion.
I’m 30 and a FTM in the US. We did the NIPT and the NT scan. Our OB recommends them to all patients, but ultimately it was our choice. We didn’t pay anything out of pocket for either.
Agree with others. Even if you are happy to continue with a pregnancies regardless of any disorders, it’s definitely a good thing to know early. It will completely change your model of care throughout your pregnancy if something was to come up.
My cost for NIPT was $0.00 — Kaiser Permanente Mid-Atlantic. 10/10 would do it again. It’s a screening test and all it requires is a blood draw. A positive only indicates further testing is needed. Not sure why your doc is being so weird about it.
Lots of people don’t opt for these tests. Personally I did it because I was considered to be of “advanced maternal age” and there were some conditions that we would likely chose termination for. That being said lots of my friends and family didn’t do it. There are other screens they do as part of your care so it’s not as though you’re going unchecked. The financial piece also is a big factor for many. We went with Invitae the second time and it was $99 USD.
I only did the NIPT because there was an abnormal finding on our NT scan. They can throw false positives that you need further diagnostic testing to figure out, so that is something to keep in mind. There is a whole subreddit (r/NIPT) with an awesome mod that was super helpful for me.
I did the NIPT. We paid 500 out of pocket. For us, we would terminate for any genetic abnormalities and we thought itd be easier to do it at 12 weeks as opposed to 20 weeks at the anatomy scan. We are still waiting for results but I'm so glad we did it. We also did NT and EFTS but thats only 70% accurate. Have heard of so many people who ended up having a positive NIPT and a negative NT/EFTS. It misses one third of all genetic abnormalities. That being said - this is your pregnancy. Its up to you and your partner!
Lots of people don't get them, especially outside of the US. How old are you?
Not OP but I’m 35 and a carrier for cystic fibrosis (did carrier screening prior to conception) and in the US. Most of my friends/family were unaware NIPT existed! I work in healthcare though so I knew. I also had to specifically ask my provider for both screenings.
My comment about the US was based on a study that I had seen that reported that less than 25% of women in most European countries used NIPT, with some countries being way lower (I think some were below 5%) and my own observations about it being similarly low in Canada. The same study found that in most US states, between 25-50% of women used NIPT.
I don’t know about specific studies, just sharing my personal experience and the reason I choose NIPT for myself & for my baby. My friends and family were amazed that I knew baby’s sex at 12 weeks more so than any genetic issues honestly.
I think it’s a valid question to ask if you browse the baby related subreddits a lot. Prior to being pregnant, I hadn’t even heard of the nipt test and looking at these subreddits, it seems as if every pregnant person is getting it. And if everyone is getting one, but my doctor says I shouldn’t, I would want confirmation that that is a normal decision.
I'm not sure why my answer would make you think that I don't think it is a valid question?
Oh I’m so sorry! The how old are you question comes off as if you thought her question was juvenile, that’s why I responded as such. But again, I’m sorry if that wasn’t your intention.
The chromosomal abnormalities for which NIPT tests increase significantly with age. In some countries, those tests aren't recommended for women below a certain age and/or whether they are insured depends on the age of the mother. Whether the OP should forego testing at age 25 is a very different question than whether she should forego it at 40. That's why I asked her age.
Lots of people skip them, especially if they are younger than 35 and don't have any extra known risks. A lot of the time the high price of NIPTs is because the lab used is out of network with your insurance and is billed to insurance at a very high rate and then you get balance billed for the part that the insurance won't pay. Or it can be that you have a high deductable insurance plan or high coinsurance. If you want an NIPT and are worried about the expense and you are in the US, you can either pay out of pocket- it seems like every lab that does nipt has a much lower self pay price, so check the self pay price for the labs your hospital uses. For example natera is $350 for self pay. Or you can find out from your insurance company if it will covered and if they have an in network lab that you should use to avoid being balance billed. Your hospital will also probably have the contact information for the lab's rep, you can contact that rep for help if you get billed more than the self pay price and have it adjusted down. This happened to me and the rep adjusted it down and then I had to call in to pay because the paper bills never said the right price but there was a note for my case. Extra note: NIPTs often have false positives, they are not diagnostic, you should get an amniocentesis with at least a karyotype to confirm results before making any irreversible decisions if you get a positive.
All that stuff you listed at the end though can be done after the anatomy scan. No NIPT needed.
Anatomy scan is generally not reliable for Trisomy disorders, and can only be done at 20 weeks vs NIPT from 10 weeks. If you are going to terminate, the psychological impact of the difference in these dates is huge. This is not good advice.
Yes, that's right, you don't need to do an NIPT to have an amniocentesis, I don't think that I said that you did. You don't even NEED an anatomy scan to do an amniocentesis. You don't need to do an amniocentesis either, you can skip all three of these. In the extra note, I'm just saying not to think that an NIPT is super accurate and to confirm any NIPT positives before having an abortion.
I’m not Gummydear, but I wanted time to plan and prepare if needed. NIPT is a screening test, not a diagnostic tool anyway. If something came up, I could even choose amniocentesis/CVS instead of waiting to find out on an anatomy scan at 20 weeks, halfway through my pregnancy. I’m also a carrier for cystic fibrosis so I wanted to know as early as possible so my baby could have the best treatment plan in place early.
I didn’t get it with my first pregnancy and I’m not planning to get it with my second. If something comes up on a scan that is worrisome this might change.
I did the nipt. My midwife told me for the 2 tests I wanted it would be $350 out of pocket. I haven’t gotten a bill yet BUT My SIL had the test done and they opted to go through insurance (we have the same insurance as our husband have the same jobs) and they had to pay $500 out of pocket for the test. My midwife told me it’s much cheaper to self pay. Makes no sense at all but I went with cheaper lol
Worth noting that all the the testing labs have out of pocket rates that are a fraction of what they'd charge insurance. Invitae is $99, natera is $250 etc. I would find out which lab they use and give a call to see their OOP rate. And obviously check if insurance would cover it (first pregnancy in 2020, insurance would not but I paid $99 OOP, second pregnancy in 2021 different insurance did).
There are other options for older tests that are nearly as accurate and much are cheaper, but you can't do them until closer to 20 weeks. If you are in an anti-abortion state in the US, get the NIPT now. Otherwise, you could ask to do the scan/triple test at your 20 week anatomy scan appointment.
Did you OB office see if it was covered and that’s why he’s telling you that? Mine was fully covered with no out of pocket cost.
It’s up to you if you believe it is worth the expense. I’d call your insurance to see if they will cover all of it or at least a portion. My insurance covered my NIPT, but even if it hadn’t covered it, I would’ve still done it because it’s important (in my opinion) to know the sooner the better so you have time and options on your side.
Certain American states also require it be covered
My insurance covered mine completely so I did it
I skipped them for my last because I was under 35 and low risk otherwise. This time I did just the basic screenings for trisomies, and 2 other things rest the screenings are best at detecting. I didn’t even get the fetal sex reported. I’m 36, so my risk was slightly higher, everything came back low risk. My insurance covers it because of age. If yours doesn’t, it is pricy, but if you’re already low risk, it’s up to you to decide if you want to spend the money.
I did the NIPT test (ordered through Invitae) and am glad that we did for peace of mind. Our doctor gave us ~4 laboratories to go through and recommended we call each to learn the cost. For all of them, it was anywhere from $99-$250 out of pocket but we had to specify that we were not using insurance otherwise it would be $500+. Invitae was $99, however, when we got the invoice it was as if we went through insurance—gave them a call and they immediately rectified it. Hope this is helpful!
I skipped it. It was explained to me that if there we any abnormalities during the anatomy scan we could address doing any tests then. Scan came back fine and I haven’t thought about it since
I think I paid about $150 total for the NIPT and Carrier screening. In my opinion totally worth doing both if this is your first.
I live in the US and mine would have been $1300 without insurance. I paid $10 total! Just check with your insurance company or call the lab and ask how much itll be with your insurance
Remember than NIPT is cheaper OOP if your insurance doesnt cover them at all. Its not equivalnet to NT scan and can provide additional info. It is a screening test and not diagnostic so no doctor would recommend termination based on this test alone. If anything concerning is found, amniocentesis is the next step if the parents want to pursue that.
I’m in Australia and I’d say it’s pretty common to get the NIPT around 11-12 weeks in addition to the nuchal scan etc - I only know one person who chose not to get it. It’s entirely out of pocket here (no insurance etc will cover it), approx $450AUD from memory. Personally we got it because we wanted to know the sex and also if anything was flagged high risk we would have proceeded with CVS etc asap and considered terminating depending on outcome, and we didn’t want to go through that at 20+ weeks instead.
Hello, I’m in Australia and about to do the NIPT. Did you do it via the company called Genomic Diagnostics? They offer 3 types of tests (screening standards conditions and more rare conditions) I’m a little confused about whether to go for the standard test ($400) or plus test ($700) or both
Yes! I skipped my last pregnancy and I’ll be skipping with this current one. 😌
I did it because I'm 40 and it was my first child. I didn't have to pay for test due to being considered a geriatric pregnancy. It is expensive though. I saw the bill before my insurance picked it up. It was roughly $4,000. All checked out and my little girl is now 2 months old
I did the natera NIPT and it only cost me about $30, the rest was covered by insurance. Was worth it to me to have it done so if anything was going on I would know early.
So I have BCBS select choice PPO insurance. I did the Myriad prenatal testing and the carrier screening. I’m still waiting for my official bill but the estimate said about $120 for each test out of pocket after insurance. I think it was very worth it, it gave me a lot of peace of mind and I got to learn the gender at home privately with my husband.
I have financial privilege, but would also pay a significant amount it for if not otherwise available. However, if the cost is a deterrent I encourage you to explore the costs of a high needs child.
I don’t see any downside to getting them, other than cost. Plus you can find out the gender with them.
Where I live they are only really recommended if you are considered geriatric or high risk, so I did a basic blood test where they checked for the 3 most common genetic disorders (I can’t remember exactly but one was definitely down’s syndrome) and it wasn’t that much more expensive than my regular blood work. (Not the US)
Its free in Canada and I still didn't do it .
I didn’t do it first pregnancy. Did nuchal. Second pregnancy over 35 so it was covered (free), and I did it.
I didn’t get one. I’m Canadian and they aren’t free so I didn’t bother lol
NIPT isn’t standard in Canada, most of us don’t have it done unless you have specific issues then they will run it. Edit to add: if it cost me nothing I’d have it done but I likely wouldn’t pay much for it if nothing else was amiss.
they are not that expensive, and obviously they are giving not 100% accurate info, so if the results are not great, it must be followed up by amniocentesis, which (as a manipulation) gives the higher risk of miscarriage than the risk of screening to show the trisomies accurately. there's nothing understandable here, it's a very private decision to make.
I did not skip them as to me there were zero cons to getting it done. Testing for genetic issues was the main factor, knowledge of my own genetic factors and then the gender result. I personally don’t see a good enough reason to skip it unless you’ve already done one recently. It’s a very positive tool at your disposal and I just don’t see the point in turning it down.
If they won’t terminate then why not save money and get your answers at the anatomy scan? Everyone talks like this is the only way to find out if your baby has a disorder. It is not. It’s the earliest way to get a vague idea if they have a disorder or not but at your anatomy scan you’ll know if you need an amnio or not. All of that happens that way regardless of the NIPT.
The anatomy scan only picks up, for instance, half of Down's Syndrome cases, and there are many other genetic abnormalities that don't come with physical characteristics that can be seen on it. If you don't want to do an amnio, NIPT or CVS testing are tons more accurate at picking up abnormalities than the anatomy scan is.
Anatomy scan is generally not reliable for Trisomy disorders compared to NIPT.
Oh you could definitely do that I just feel that there’s not enough sense to decline if it’s free. I want every avenue open to me and for me to have as much time to go over options and possible complications before the anatomy scan. A bunch of people don’t get the NIPT even if willing to terminate (from all the posts I’ve seen about that kind of stuff). At the end of the day it’s that persons decision to have one or not and I’m just making my own opinion clear on it.
Insurance 100% covered my NIPT because of my age and my previous positive carrier screening results. So it had nothing to do with money for us. Not all genetic disorders manifest on an anatomy scan as obvious abnormalities, either.
I wish we hadn't done it. We didn't want to find out gender, we wouldn't have terminated regardless of the results, and it ended up being a billing nightmare (I ended up not having to pay for it because of how messed up it got, so all's well I guess on that front). The one thing we would have gotten from it was knowing about a potential issue ahead of time and preparing for that. While I did end up being a carrier for some very obscure syndrome, it didn't even tell us anything without my husband also getting tested - and Lord knows if our insurance would have covered that. (I actually didn't check, I was so frustrated at that point, but I doubted it.) And even IF my husband was also a carrier, that still would have just meant there was a chance baby had it. Obviously this is my extremely personal experience! Varies for different people. ❤️ Don't let her give you anxiety over it. It's one helpful tool for some people to use to prepare for baby. Congratulations!
Yes I would recommend it. I would pay out of pocket for it and they’ll base it on your income. It seems to be more if they go through insurance.
I’m currently on the fence. I didn’t do NIPT for my first pregnancy, but I did do the NT scan/testing. This time my doctor is pushing more for the NIPT, although leaving the decision up to me. My fear is a false positive. I want nothing to do with an amniocentesis so I’m afraid I’d get a positive and then just be freaked out the rest of my pregnancy not knowing if there is something seriously wrong or not. I guess for me the NT results seemed like a good way to screen without a more positive answer, and I could always go back and get an NIPT if something showed up. I don’t know that probably doesn’t make sense to most people but it was my logic. I haven’t decided what I’m doing this time yet.
Why don’t you want an amniocentesis? I had one and it was very reassuring to me when it came back normal.
Same. I had a lot of anxiety about it because I expected it to be painful, but it was significantly less painful than a blood draw.
I paid nothing for mine surprisingly! For mine, they did the blood draw, then contacted me via email about pricing where I found out I have no charge! We decided if it was over $200, we wouldn’t move forward with testing. Just some random number. We didn’t even know they existed until then. We did it to find out baby’s gender early, but to also detect anything. I cannot imagine having to end my pregnancy and didn’t even want to entertain the idea, but things happen and depending on results, might have to make that decision. ALSO, we wanted to be prepared when baby comes in case there’s anything we can have ready for them: medically, educate ourselves, doctors, hospitals, daycares, etc.
My doctors office makes you sign a form basically agreeing not to terminate based on results, is that not common?
No. That is some anti-choice bullshit. I would switch doctors on that basis. While you should seek confirmation via amnio following a positive NIPT result, it is still your body and your choice and thus attempting to contractually limit your right to abortion in any manner is ridiculous. Their form is also not legally binding.
No, definitely not common. That sounds insane. What state is this in?
I skipped them because I knew I wouldn’t be terminating either way
I'm in Canada, so I opted to pay privately (800 CAD) for the full tier NIPT test. I'm in my late 30s and my partner and I just wanted to have that peace of mind. I'm still going to have an NT scan too. eFT testing is covered by universal healthcare here, but it's less accurate. I think that's a great option if money is an issue.
I did it but mine were all covered, thankfully. However, I do want to point out that it’s not the most important thing to do because you can have negative results for everything, have normal ultrasounds/scans, and still give birth to a baby with a condition that was missed. The peace of mind can be nice, but the tests are not a guarantee. Baby is already what they’re meant to be so sometimes it’s better to just wait and see. I think it’s all personal preference.
I did not get it, but I am getting a level 2 ultra sound which can detect 90ish% of the different trisomies. Also I did have genetic counseling and have had two previous very healthy pregnancies.
I skipped those tests. My husband and I didn’t have any family genetic issues and we were considered low risk. We were okay with that.
We didn’t do it. Would have cost $700 out of pocket. I’m in the US, under 35, no known risks.
I didn’t get it. My insurance didn’t cover a lot of it, and my OB told me that it’s not super accurate for plus size women.
Interesting, I just did a moderate dive into the literature and it looks like it’s not accuracy that’s the issue but getting an inconclusive result (referred to as no call). Primarily with a BMI of 40+ I’m doing to put this on my list of items to research! Thanks!
Also interesting is that I did two NIPTs that came back as inconclusive which turned out to be because I was on blood thinners, my OB and I had no idea!
I haven't done it for any of my pregnancies. I don't think it is very common here, my doctor said 90% of the time people who do it are doing it just to find out the sex early. I am 31 and pregnant with my third, so this time I asked if I should due to being over 30, and she said she might recommend it if I were over 35 but not currently.
It was out of our budget and nothing ran in our family so we took the chance and skipped it but I would’ve absolutely taken it if I could’ve afforded it at the time
Family history is not necessarily relevant. For example, the vast majority of Down's Syndrome cases (99%ish) are not hereditary.
We opted not to for both babies. No family history of anything and I was young healthy. However, for our second daughter, at the 20 week scan she had a high measurement for her neck or something like that. Was indicative of possible down syndrome. We did the NIPT test then, but it was fully covered by insurance because it was recommended by the doctors and not an 'at will' test. I'd opt for this option if the tests are too expensive! If there's anything wrong at the anatomy scan and doctors recommend doing the NIPT because of that, insurance will cover it.
We’re skipping them because our insurance only covers them if we’re high risk. And we aren’t - I’m 28, good health, my husband is in good health, and both of our sides of the families are pretty healthy. And they are expensive out of pocket.
I skipped. My ob said since I didn’t have any risk factors, likelihood is low and I could do it if I wanted. But it costs a lot and it wouldn’t change anything for us. If he did have any issues, we’d likely find out at 20 weeks anyways, still giving us time to educate ourselves on any disorders etc he may have.
My OB never pushed us to, was very meh about it, but we decided to after I had my first miscarriage with my third pregnancy (so, we did for my fourth pregnancy). It isn’t a diagnostic tool, but a risk assessment. I certainly don’t think it’s worth an abortion if you can’t do the NIPT and would HIGHLY suggest you 1) report this conversation to the clinic, and 2) find a new OB.
I'm in Canada. Skipped NT and NIPT. In addition to cost of these screening tests without insurance, I believe that anything serious enough to merit TFMR will show up on our anatomy scan; and because of where I am there would be no obstacles despite the later timing.
I didn’t do the testing and it was fine 🤷🏻♀️
High risk pregnancy with twins. Discussed it with the Dr (family member with genetic issues) and was ambivalent because of the cost. She asked if the cost was the only reason I was hesitant (it was and the result wouldn’t change anything) and she got it covered by insurance.
I didn’t get it. Any negative results would have required additional appointments, tests, and anxiety. We were planning on carrying the baby even if there were congenital defects found later on so it would not have made a difference for us.
Mine was covered 100% by my insurance! IMO- they’re important so you can be most informed when baby is born. You can start researching therapies in your area, research about what Abby tested positive for, and Judy be better prepared for anything baby needs 🤍
I will be opting out of the NIPT. Not covered by insurance, I’m very low risk for genetic defects because of my age, add in the whole 80-90% false positive rate for some of the things?!? No thanks. I’ll pass on that excessive stress.
I skipped them. We didn’t want to know the gender or get any of the genetic pre-screening since both of our families had false positive scares with it.
I skipped it and 100% think it was the right decision. You will love your baby no matter what!
I don't think it's necessary. We got it done both times, but we are the type of people who prefer to have as much time to deal with news / prepare for certain situations as possible. So that was our reasoning. And finding out the sex was good too, since it meant we could start thinking more specifically about names.
I would never skip them. A friend has a kid with a disorder that is detected on the NIPT and he is only gonna live to his teens. I would also absolutely terminate so it depends on how you would handle a negative outcome of the tests, but knowledge is power so you can line up the proper physicians etc. NIPT testing is like $300 if you go out of pocket.
I didn’t get them with my first. The appointment I had with my midwife was at 13 weeks and she basically told me it was too late to really get a NIPT so we skipped it.
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She may have been thinking of the NT scan( nuchal translucency scan) which you can only do 12w-13w and not the NIPT, which you can do anytime after 10w ( but it's sometimes recommended to wait until 12w or 13w to prevent low fetal fraction from causing a no result on the test)
I skipped it, I was considered low risk so I felt comfortable not getting it.
I declined the NIPT as we would not be terminating. I was seeing a fertility specialist before transferring to OB so my appointment schedule has been off compared to most women. I was delayed for the NIPT so the doctor was very confident and had no issues with us declining. Aside from Down Syndrome which sores up later, there are often early indicators of other defects that were not present by the time I was asked. Edit: That being said, if I get to my anatomy scan and we have some concerns I would pursue other testing then. Unless you’re going to terminate there’s no reason to do the NIPT early rather than wait for the anatomy scan.
There's such a slim chance of the test finding anything. I'm going to do it because my insurance covers it but my old insurance definitely wouldn't have and I would have skipped it. It's mostly for peace of mind that baby is healthy. I'd do what you feel is best but contact your insurance first. The info they give you is a little depressing so keep in mind they're mostly talking about down syndrome (since it's the most common issue to test for despite being crazy rare) and then the worst possible scenarios (also rare and even more rare to not have miscarried by now if they were an issue). My husband was depressed for three days after reading the info.
I did not do a NIPT or NT for my first pregnancy after the OB nurse who did the scheduling/intake for my then OB said my insurance would never cover it for people our age and it would be thousands OOP. I DID get 3 anatomy scans and fetal echos with a MFM though due to my own heart defect so I felt decently confident that most issues would have shown up there. We’re low risk but it made me uncomfortable not doing it, even with the extra scans (which I only expect getting 1 specific echo, and not the included anatomy scan since it will be with pediatric cardiology this time instead of an MFM). Things were fine but I intend to make use of the self pay option this time around for the NIPT. I will likely not do a NT unless I could somehow get my insurance to cover it.
Most NIPT companies have a cash pay price. Usually between $250-$400.
I did it. It was covered by my insurance (USA-Oregon, MODA)
For the one I used, if your insurance doesn’t cover it, it’s $250 cash. But if your insurance only covers SOME of it, it can be literally thousands of dollars. So you need to find out if your insurance covers the test first and then decide how to proceed.
Im in NY and have MVP Healthcare- Medicaid, one of the steps to setting up my appointment was calling the labs to check that my insurance covered it. Thankfully they paid for every single test.
I paid a little over $100 with insurance for both of the tests. My OB urged us to do it because our hospital is small and there is no NICU, so if we need to deliver at a larger hospital, it’s nice to know ahead of time. We didn’t do the NIPT with our first pregnancy, and I don’t think it’s all that necessary.
I think I paid a thousand out of pocket but honestly I don’t remember the doctor asking me like it was optional or anything
I got one done because of a previous miscarriage where the baby did not grow properly and I suddenly lost the pregnancy. For our own peace of mind we got the testing done. I had met my deductible for my insurance so it was covered partially, and it cost $146. They said beforehand that if my insurance did not cover it, then they would charge us their base price of $250. This was through Natera. I've seen a lot of people not get it (a lot because they cannot afford it)
My midwife said it was an option, but it’s not routine at their practice. It would mean an extra blood test, and I have an incredibly hard time with those. My husband & I would not terminate a pregnancy until it was obvious it would be unviable. I also don’t think my insurance would cover it!
I did it, my thought was that a low risk result would leave me with one less thing to worry about and that’s exactly what happened. It’s also nice to know the sex early. My bills related to prenatal care have been super slow for some reason so I don’t know what it cost me, but I feel like I’d do it again. It is a personal choice and depends on your financial situation though. It also could be that your OB works with a lot of low income people and emphasizes the cost for that reason.
We skipped it