1st Trimester

U/S and insurance

We had our first doctor's visit today. Everything went well (basically it was blood work and background information since this is our first pregnancy). The nurse in charge of our chart told us that insurance companies are starting to get grumpy about having "nonessential" procedures done. This includes ultrasounds for low-risk pregnancies. So, if we want to find out what we are having, the cost will have to come out of our own pocket! Has anyone else run into this?

Re: U/S and insurance

  • That doesn't sound right.  I'd call your insurance company.  The 20 week u/s does a lot more than check the sex.  That's just an added bonus.
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  • The 20-week scan (where they can tell you what you're having) is not non-essential - it's the only essential u/s of pregnancy! You may have to pay out of pocket for additional ultrasounds, but the 20-week should be covered (that's an anatomy scan where they check for abnormalities, etc). I would check with your insurance company directly.
  • our dr office does one around 8weeks....date check, then 20 weeks...development and sex, last one 30 weeks...to chek pelvice palcement and position of baby...this one is done in 3d!! 

     I love my ob's office!

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  • I haven't heard that.  Sounds a little ridiculous.  I can understand them not doing an u/s every appointment, but I would assume they would do one to know the sex. 
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  • the 20w u/s is an anatomy scan - not a gender check.  They measure every bit of the baby and look for any warning markers and such.    Finding out the gender then is usually just an added bonus.
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  • I have never heard of this I have and u/s at every appointment.
  • image MaeTyner:
    I have never heard of this I have and u/s at every appointment.

    are you high risk?   I get one at every appt (every 2 - 3 weeks) too, due to being high risk.   But for most normal pregnancies this would not be the case.

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  • image MaeTyner:
    I have never heard of this I have and u/s at every appointment.
    Which seems a little bit too far in the other direction! 

    My insurance covers 3 u/s of my provider's choosing, any above that have to be preapproved.  I think it's a pretty reasonable approach.

    I have never heard of the anatomy scan not being covered.

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  • image staycee:
    the 20w u/s is an anatomy scan - not a gender check.  They measure every bit of the baby and look for any warning markers and such.    Finding out the gender then is usually just an added bonus.

    This.  The wording I received today about fees and procedures "We do not do ultrasounds for the purpose of determining the sex of the baby.  We only perform ultrasounds based on medical reasons."

    Hence, the 20w u/s is for medical reasons not specifically for determining teh sex of the baby.

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  • I've noticed on my statements that my insurance company has different payouts for an u/s before 14w.  My doctor actually billed my last one as medically necessary due to a dating discrepancy and they paid more than they did last pregnancy.  I've paid $25/ea coinsurance for the 2 u/s I've had this pregnancy.  However I am considered "high risk" this time around, so that may also be why they've paid more.
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  • My insurance company covers 1 u/s but will cover others if they're deemed necessary via doctor's orders.

    I've had 1 so far for bleeding, then I have another next week as a follow-up to check vitality. 

  • I'm assuming this WASN'T your 20 week U/S, because your ticker says 8 weeks. I have mine next week and was told that I'm scheduled for a sonogram, actually. I may be higher risk than you, but I wonder if it depends on your insurance and the doctor. See what you can do. Make a few calls. It's worth it to be sure it's not an ectopic, especially if you've never been pregnant before.
  • My insurance, BCBS, only covers 1 ultrasound, unles "medically necessary".  Even with a code of "history of ABs" I still have to pay the $60 copay each time I have one.  I'm having my 3rd tomorrow and the doctor is trying to figure out codes to help.
  • According to the insurance clerk in the company where I work if you are covered by insurance the ultrasound done between weeks 19 - 21 which is considered the anatomy scan is covered fully in agreement with the AMA. This procedure was agreed to between both insurance companies and doctors for medical reasons to protect the mother as well as the child. An added bonus also occurred in that with it they could give within 95% accuracy the gender of the child. But that was not the reason for this scan being done. It was to check for possible problems with the unborn child which could be taken care of before its birth.

    I therefore believe the nurse is incorrect on what she said on this one. She is probably right about other ones being non-essential that are done at each appointment. Most doctors usually want one sometime between 8 - 13 weeks for dating purposes. This gives you and them an approximate date you will deliver your baby.

    As for my company?s policy we are allowed three during a normal low-risk pregnancy with an additional two if high-risk. This does not mean they will require that many. As for the clinic I am using they usually only do one at the 12 week and 20 week interval. A third one is sometimes required on some women but not all. Since I am personally not having any problems with my pregnancy I will only have two done of which I have already had the dating one at 12 weeks - 3 days. My second is scheduled for the 28 of this month - I will be at 20 weeks - 1 day.

    Here again if I were you - I would check with my insurance company for what they provide in services which are covered for you. It would be in your beat interest to find out what you have in the way of coverage. Right?


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  • Wow, I feel really lucky.  We had our first u/s at 7 weeks, will have another at 11 weeks, 16 weeks and 20 weeks.  I don't know what the schedule is after that.  I did talk to my insurance company and everything under pregnancy and child birth is covered 100% and I asked about the 3d u/s and they said that if the doctor requests a 3d ultrasound, it will be covered too.  I had no idea how different coverage could be....
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