2nd Trimester

Insurance doesn't cover anatomy scan?

So, I just found out my insurance doesn't cover the big ultrasound you all have been talking about because it's an elective screening? Anyone else run into this? 
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Re: Insurance doesn't cover anatomy scan?

  • Kaiser requires it, so it's included without a co-pay.
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  • image mrsoh:
    Kaiser requires it, so it's included without a co-pay.

    I believe BCBS is the same.

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  • Have you called your insurance company directly? I would do that before you even glance away from your computer. Triple check, because you never know. It could be a clerical error.

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  • I would definitely call your insurance.  Our insurance tried to deny coverage of our 20 wk u/s with DD.  DH called and got the run around, had to talk to a bunch of people, but eventually they caved and covered it.

    I think they have to cover any referrals from your doc.  So you might need to call the billing dept at your OB's office and see if they can re-submit the bill in a different way.

  • i should definitely NOT be an elective screening. Most drs require an U/S in the second trimester for all of the important measurements and to check on the baby. You should call your insurance and check again and talk to your dr and make sure they deem it as "medically necessary"
  • image mrsoh:
    Kaiser requires it, so it's included without a co-pay.

    I have Kaiser and just had big u/s yesterday.

    How is it "elective"?

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  • It's your 20 week ultrasound and the most important one for the baby.  they check for A LOT of stuff during that U/S i don't see how it COULDN'T be covered under insurance.
  • Is it your OB's office telling you this or the insurance company?  Absolutely do not just believe the OB's office, call the insurance company.  I work for one of the BCBS and I have never seen it not covered unless you don't have maternity care at all.  I've never heard of an anatomy scan billed as an elective screening (ex the non-medical 3D ultrasounds)...routine/preventive a few times but even those were coverable. 

    If you call the insurance company they MAY need you to get the procedure code for the anatomy scan (also called a CPT code) and a diagnosis code.  Some companies can run test claims with those things.  But before you get them I would just call and talk to them and see what they say.  Also it looks like you are in CA?  If you are part of either Anthem BCBSor BS of Cali I would be really hesistant to believe it's not covered.

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  • image sichmek5:

    If you call the insurance company they MAY need you to get the procedure code for the anatomy scan (also called a CPT code) and a diagnosis code.  Some companies can run test claims with those things. 

    Yes! My insurance company asked for this code, calling medical group now. 

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  • I would call your ins as well. I think people refer to this as a gender scan when it is so much more than that. The main purpose is to measure the baby and make sure everything is growing well and there are no signs of trouble.

    How is that elective? If they give you trouble I would ask your ob/gyn to call or write something that says it is a medical necessity. I have Kaiser and they do require it although I had a co-pay on mine. I have had 5-6 u/s at Kaiser, they are great about that..
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  • image KyleTrigger:
    I would call your ins as well. I think people refer to this as a gender scan when it is so much more than that. The main purpose is to measure the baby and make sure everything is growing well and there are no signs of trouble.

    How is that elective? If they give you trouble I would ask your ob/gyn to call or write something that says it is a medical necessity. I have Kaiser and they do require it although I had a co-pay on mine. I have had 5-6 u/s at Kaiser, they are great about that..

     Well they are calling my next appointment a gender scan...but saying the big anatomy scan is elective. 

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  • I've never heard of it being elective.  With my DS, I had to go back 3 times to complete it because they check the kidneys, lungs etc and he kept being in a crazy position so I had to come back until they got all the pictures they needed.  It seems very important to check the organs, and finding out the gender is just a plus. 

  • I'm not that far along, but my doctor said my 20 (or so) week US is actually for her to check the spine and organs to make sure they are developing correctly and while we are in there we can find out the sex.  I would talk to your doctors maybe and see if they can change the "coding" or "name" of the US to something like that instead of just gender.  It's amazing what the switching of a couple numbers can do at an insurance company.  GL!!
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