Payment and Billing: Frequently Asked Questions

What is the California Prenatal Screening Program?

The California Prenatal Screening Program is a voluntary statewide program offered by prenatal care providers to all pregnant individuals in California. Prenatal screening uses a pregnant individual’s blood samples to screen for certain birth defects in their fetus. 

Individuals with a fetus found to have an increased chance of one of those birth defects are offered genetic counseling and other follow-up services through state-contracted Prenatal Diagnosis Centers. For more information, please visit our PNS Program home page. 

Is prenatal screening required? 

No. Prenatal care providers in California must offer prenatal screening through the state program to their all pregnant individuals. Prenatal screening can tell whether a fetus has an increased chance of having certain birth defects. Individuals with a fetus found to have an increased chance of one of those birth defects are offered genetic counseling and other follow-up services through state-contracted Prenatal Diagnosis Centers.

You decide whether you want prenatal screening. The alternatives include no prenatal screening or choosing prenatal diagnosis instead. Choosing prenatal diagnosis and getting diagnostic testing may give you a clear answer on whether a fetus has certain birth defects.

Will your health insurance cover prenatal screening?

Yes. If you decide and consent to participate in the California Prenatal Screening Program, Medi-Cal and private insurance must cover all program fees, with only a few exceptions. The only exceptions are self-insured employers and out-of-state health plans. There is no co-payment, co-insurance, deductible, or any other form of cost sharing, required of covered families.

The PNS Program fees are $232 for cfDNA screening and $85 for MSAFP screening. The fees cover the blood tests and authorized genetic counseling and other follow-up services at a State-approved Prenatal Diagnosis Center.

If you do not have insurance or your insurance falls under the exceptions, you will be directly billed for the PNS Program fees.

How do you supply your insurance information?

Please provide your Medi-Cal or insurance information on the order or send a copy of your insurance card with your blood sample. If no insurance information is received with the sample, the California Prenatal Screening Program will mail a bill and insurance form to you. Medi-Cal and private insurance must cover all program fees, with only a few exceptions. The only exceptions are self-insured employers and out-of-state health plans. There is no co-payment, co-insurance, deductible, or any other form of cost sharing, required of covered families. If you don't have insurance or your insurance does not cover program fees, you will be directly billed. 

You submitted insurance information. Why are you being billed?

There are several possible reasons why you are being billed. Your Medi-Cal or insurance information may not have been transmitted to the California Prenatal Screening Program by your medical provider. You may provide your insurance information online or to an agent by calling 1 (800) 597-0832. Your insurance company may not have paid your claim. Contact your insurance company if your claim was denied.

Can you pay using a credit card?

The California Prenatal Screening Program accepts Master Card, Visa Card, Flexible Spending Account (FSA) or Health Spending Account (HSA). You may provide your credit card information online, by filling out the coupon form from your statement, or to an agent by calling 1 (800) 597-0832. 

How can you get a confirmation of payment?

You can log in to our online payment portal or by calling 1 (800) 597-0832

Why is your medical group billed?

Your health plan is contracted with the medical group; please contact your medical group for more information.

Is non-payment or payment delay going to affect your credit?

The California Prenatal Screening Program does not report to any credit bureaus. However, if your claim is not paid by your insurance company or if Medi-Cal denied the claim because it found you were not eligible, you may be referred to the Franchise Tax Board for collection and your income tax return may be garnished for the amount of money that you owe. 

How long does it take to receive a refund?

Refunds are initiated and approved at California Prenatal Screening Program offices. After processing the documents, the accounting office forwards the refund request to the State Controller’s Office to issue the refund check. This process can take as long as 8 to 10 weeks before you receive the refund check.

Are discounts for available for program fees?

You decide if you want prenatal screening. Medi-Cal and private insurance must cover all program fees, with only a few exceptions. The only exceptions are self-insured employers and out-of-state health plans. No discounts are available because the fees are established by state regulation. 

Your insurance paid the program fee. Why are you still receiving a bill?

The California Prenatal Screening Program probably did not receive the payment or insurance information and mailed the bill directly to you or to the primary insured. The California Prenatal Screening Program can investigate further but will need information such as the check payment or a copy of the cancelled check if it was cashed. Please contact us at gdspar@cdph.ca.gov.