Calling all insurance experts - cost of extra ultrasound

vrj0522

I know we are all new to our current pregnancy but I'm hoping someone has some insight from past experience.

I have been having red blood spotting since Wednesday. That night all my symptoms went away. I called my OB's office and while they think it's all within the realm of normal, they did schedule a follow up u/s appt for next Tuesday. I am noticing my ms coming back. It went from a 0 yesterday to a 2-3 this morning and now it's up to like a 5 or 6. 

I am still thinking of keeping the u/s appointment though because of the reassurance/clarity it could bring. My biggest concern is that it wouldn't be covered by insurance. If that is the case, does that mean that it wouldn't go toward my deductible even if I pay out of pocket for it? Would it just be a complete oop expense? I don't know if my doctor would code it as medically necessary since I'm the one who pushed for the appt so I'm just wondering how the insurance would work (or not).

kolaloo15

Insurance should cover it because it is for the bleeding and you can always call and make sure it's covered. I would still go and get reassured ms comes and goes and it'll give you peice of mind.

dana2die4

Unfortunately if its not a covered benefit, you would have to pay out of pocket. It also doesn't get applied towards your deductible or out of pocket amounts. I would strongly suggest calling your Dr's office (they should have people there to verify your coverage and benefits) or you call your insurance yourself. If you of call yourself, I also suggest getting the ICD-9 codes as well as procedure codes to ensure you are being quoted correctly. 

KingLED

Because of the spotting being the reason your doctor is having you come in, it should be billed as medically necessary.  I've had 3 different insurances and been in that position and that's been the case with all of them.

Eastie156

If you have to pay put of pocket, it could possibly run you between $750-$1,000, at least that's the cost I've seen billed to my insurance company previously.

kaniela17

I haven't introduced myself on here yet. Still a bit nervous about sharing my news so I hope no one minds me commenting. I just wanted to share my experience.
I cash pay when seeing the dr. so it doesn't go through the insurance companies...ends up being cheaper. I paid $150/ultrasound with my last pregnancy. It can range anywhere from $150-300 depending on the dr. so just call them and ask. But since they are necessary for you call your insurance company to see if they'll cover it. Hope this helps, good luck.

kibylou

This happened with my last pregnancy. I had a previous loss and I really just wanted piece of mind, so I asked for one and I got charged for it. I had been spotting earlier, but it had stopped. It was about $300 I believe. Hopefully you can get them to code it as medically necessary, but it was still worth it to me.

beckybon

We have private insurance with a high deductible & we have to pay $400 for our 20 week u/s up front. I asked about another u/s if it was medically necessary & was told it would still go to my deductible although we would still end up paying it. When in doubt call the insurance, it helps to be proactive so you know your benefits!

hippohat

Call your doctor's office and ask to speak with someone in billing - they will be able to pull up your insurance and give you an estimate. Even if they won't cover it you should be able to get the contracted rate. The estimate I just got for an u/s was $250, but I'm sure it varies by office. 

JennPalmer01

If you do end up paying out of pocket you should at least get the rate that your insurance company has contracted for the procedure which should be considerably less than billed charges.