September 2015 Moms

Health Insurance

Hi ladies,

I was wondering if anyone who is more of an insurance expert can shed some light: I am with United Healthcare and the way they process claims is via every single line item/procedure code that is billed. Therefore, when i go in for my initial OB visit, i pay my copay and then the doctors office bills the insurance company for the visit, my urine sample, and my transvaginal ultrasound. Insurance then says the urine sample and transvaginal are considered as diagnostic/radiology and i am responsible for 20% of those costs. I would think that the urine collection and transvaginal ultrasound are part of the routine office visit for maternity care? Our health insurance is covered by husbands employer (pitney bowes) so I am a bit alarm by the amount of member cost sharing is involved.

I would think that the insurance company would cover all of my maternity visits at 100% to avoid any complications during or post delivery that would be more costly??

Re: Health Insurance

  • I have no personal experience with United Healthcare but with Anthem My labs/ urine test at my first visit were not under the first visit umbrella. I had to pay 20 percent of the costs and that was 30 dollars. I also did not know my ultrasounds are not covered except the 20 week normal one so my 8 week viability US was 149 dollars. My 12 week NT scan was 443 dollars etc... Every time I speak with someone from the company I get a different answer. I was told my 12 week was covered until I got the bill and then called them again and it wasnt lol. US for other things like tumor/ bleeding whatever is covered and you only pay 10 percent but maternity ones other than 20 week are unneccessary and I pay the whole thing. This makes me believe the insurance company is not super concerned about complications if they are willing to only cover one US the whole pregnancy. GL with finding out how yours works- every visit is a learning experience for me
  • Ultrasounds are not part of usual maternity care at all. That's why I was surprised so many people were having multiple U/S before 12 weeks. Usually you can opt for the 12 week sequential screen and the 20 week anatomy is usually required. Mine are performed at an imaging place or hospital, not by the ob.
    BabyFruit Ticker



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  • I was surprised to get a bill for my urine analysis. $72. With my previous insurance I did not pay a dime for anything and when I called our new insurance they said that maternity care is fully covered. I am so confused too.
  • Sometimes its all how the office bills your test to the insurance company. I know my co worker is getting billed for the flu shot she agreed to at the office they said it was covered and this was during her maternity care. What is worse is we get it free at work where she would have gotten had she not thought maternity visits = free.
  • @yiggle09 i am glad you shared your experiences because i thought i was going mental for a second. it is extremely frustrating that insurance companies are sharing costs with members that are paying huge premiums. i think it goes against the principal of preventative care when they make it so costly for expecting mothers to go in for routine visits so the doctor can monitor the fetal growth and development, especially if the expectant mom is a FTM or high risk.

    @bpv101283 why wouldnt people have multiple scans before 12 and 20 weeks? i went in when i was only 6 weeks pregnant to confirm pregnancy and the doctor performed an ultrasound to make sure the pregnancy was implanted in the correct area and not in my fallopian tubes or anywhere else that would be cause for a surgical procedure. 
  • castlec3castlec3 member
    edited March 2015
    I have United Healthcare and I do not have to give a copay for maternity visits nor do I get a bill for my urine samples etc. I do have to pay 20% for ultrasounds though. You should be able to go onto United Healthcare website and see what all is covered under your plan. Their website is actually really helpful IMO.
    Although, we both have UHC that doesn't mean that we don't have different plans through them as they do offer tons of different options and I have a different employer than your husband.
  • bpv101283bpv101283 member
    edited March 2015
    allstagg said:

    @yiggle09 i am glad you shared your experiences because i thought i was going mental for a second. it is extremely frustrating that insurance companies are sharing costs with members that are paying huge premiums. i think it goes against the principal of preventative care when they make it so costly for expecting mothers to go in for routine visits so the doctor can monitor the fetal growth and development, especially if the expectant mom is a FTM or high risk.


    @bpv101283 why wouldnt people have multiple scans before 12 and 20 weeks? i went in when i was only 6 weeks pregnant to confirm pregnancy and the doctor performed an ultrasound to make sure the pregnancy was implanted in the correct area and not in my fallopian tubes or anywhere else that would be cause for a surgical procedure. 
    I'm not sure why some do it and some don't. It seemed that only people were getting U/S who have had previous losses or problems early. If you think about 15-20 years ago, moms didn't get one ultrasound unless there was a problem. I have been surprised on here to see how many people get early U/S and gentic screening (harmony test, not nt scan) because they are optional tests, usually insurance doesn't cover it. My doctor just calls in some bloodwork, they don't confirm pregnancy with an ultrasound. By the time we have a visit they can hear baby's heartbeat.

    Edit to add that it's really rare for someone to have an ectopic pregnancy but I guess it's good more doctors are looking for it? I just hope they aren't charging each patients health insurance for a $1000-$1500 ultrasound that wasn't heccessary. That's exactly why health insurance costs are out of control. Just because it's fun doesn't mean it's out of the kindness of the Dr's heart. They are getting fat paid.
    BabyFruit Ticker



  • I'm surprised your prenatal care isn't covered at 100%. I thought that was standard with most insurance plans!
  • Do you and your husband have deductible outside of your copay?

    I have a huge deductible that I share with my parents (I'm under 26, a student, and my husband is self employed), but I have bcbs and they get me HUGE discounts and I think they have to pay a small portion even though I have a deductible because it's prenatal. Anyway, my lab work was $1200 because they had to do it twice, kind of, because my thyroid is weird and they had to do extra testing. Thankfully, bcbs got the bill down to $270. Which is still unreasonable. But more manageable.
  • Payment and cost share can depend on the diagnosis codes that are billed with each procedure. Clinics usually Bill lab and radiology codes separate, because in most cases those procedures won't be covered if performed by another specialty (obgyn in this case). You can call and ask them what procedure and diagnosis codes are considered maternity care, and at what benefit they will be covered.
  • bpv101283 said:

    allstagg said:

    @yiggle09 i am glad you shared your experiences because i thought i was going mental for a second. it is extremely frustrating that insurance companies are sharing costs with members that are paying huge premiums. i think it goes against the principal of preventative care when they make it so costly for expecting mothers to go in for routine visits so the doctor can monitor the fetal growth and development, especially if the expectant mom is a FTM or high risk.


    @bpv101283 why wouldnt people have multiple scans before 12 and 20 weeks? i went in when i was only 6 weeks pregnant to confirm pregnancy and the doctor performed an ultrasound to make sure the pregnancy was implanted in the correct area and not in my fallopian tubes or anywhere else that would be cause for a surgical procedure. 
    I'm not sure why some do it and some don't. It seemed that only people were getting U/S who have had previous losses or problems early. If you think about 15-20 years ago, moms didn't get one ultrasound unless there was a problem. I have been surprised on here to see how many people get early U/S and gentic screening (harmony test, not nt scan) because they are optional tests, usually insurance doesn't cover it. My doctor just calls in some bloodwork, they don't confirm pregnancy with an ultrasound. By the time we have a visit they can hear baby's heartbeat.

    Edit to add that it's really rare for someone to have an ectopic pregnancy but I guess it's good more doctors are looking for it? I just hope they aren't charging each patients health insurance for a $1000-$1500 ultrasound that wasn't heccessary. That's exactly why health insurance costs are out of control. Just because it's fun doesn't mean it's out of the kindness of the Dr's heart. They are getting fat paid.
    If I had known my first us to confirm pregnancy wasnt covered I would not have dont it. I feel that my office does push the US without counseling you on possible outcomes. Even for my 12 week they gave me the codes to check with my insurance and the best answer was it should be covered because its an US but it wasnt because its elective during maternity which they failed to tell me. Its like maternity has special exemption rules.  My panorama was covered because we have downs in the family but it still cost me 147 dollars because of how my insurance covers labs. Also during my 12 week the US tech said they couldnt see the cervix that well and asked to use the transvaginal. I said sure- That was charged as a completely seperate US apart from the 12 week nt scan stuff again not something I was informed. I am going to fight the office about that because again that was not covered and that was the tech needing to do something not me asking for the additional views of just my cervix. I know total I will have to pay 3000 this year in medical expenses regardless of if its for US now or labor later.
  • my husband have a copay based plan but we have a $1,200 deductive per individual and $4,000 out of pocket maximum. Supposedly, all lab and radiology are cost shared? i think this is pretty unreasonable. the insurance policy is so complicated and makes it difficult for those with good coverage to want to go in for preventative visits. we already pay so much for our premium.

    @yiggle09 definitely question the billing office, they are typically able to make adjustments to the claim. in my experience, if they have the office visit paid for, they are OK.

    @bpv101283 i dont think my doctor was screening for ectopic pregnancies regularly but i have a endocrine disorder which puts my risk for an ectopic pregnancy much higher than a normal person and i was also on birth control at the time of conception and for several weeks afterwards which also puts me at risk for ectopic pregnancy so i needed to have a transvaginal u/s completed to ensure that the embryo had implanted in the uterus and not somewhere else. especially because i had complaints of severe neck and shoulder pains. it is just unfair to me that i have to pay for this diagnosis that could have caught something earlier that could prevent me from having a very involved surgery. i always er on the side of caution but i can understand why some women opt out of seemingly unnecessary office procedures.

    i just seems like in the US there arent many accommodations for pregnant woman be it via health insurance or paid maternity leave. arg!
  • With our Aetena, our OB office gave us a set price to include all doctor visits, ultrasounds, etc, but labs are billed separately.  We have to fulfill our $400 deductible and then pay 20% of the ob price, so that is about $1035.  We are making monthly payments.  I have not gotten a bill for my lab work that was don eon February 10th, so I do not know how that will be handled.  

    I also think we will have a separate hospital bill, which I am sure we will have to pay 20% of as well.

    I am just thankful to have insurance coverage!! I could not imagine paying for the entire pregnancy experience.
  • I had UHC with my daughters pregnancy. Usually maternity care is billed as global healthcare. My OB doesn't bill UA's separate. They include it in the charge. It really just depends on how the clinic bills. Ultrasounds were always billed as diagnostic. In the end I owed over $6000 for DD delivery and I only had a $750 deductible. The out of pocket max was 10,000. DD pregnancy I have many ultrasounds and lots of appt's because of high risk and 2 hospital stays.

    I now have group health and out of pocket max is $2000. This pregnancy my NT scan was abnormal so I have a ton of upcoming tests. Glad I have GH this time around.
  • I have UH too. We had ultrasounds from 6 weeks up until I was released from my RE at 11 weeks. Since the RE office was considered primary care, I only ended up paying 10% going towards the co-pay. I have a pretty high deductible of $2500 and maximum co-pay of $3100. My OB bills as "global billing." I'll end up paying her $1800 not including any ultrasounds. Each ultrasound now is $120 if I elect to do it. I'm doing it at the 20 week appointment and whenever they tell me is necessary. I haven't even asked about the estimated hospital bill yet.
    I wish they would pay maternity 100%. I'm envious of other people who have insurance that will cover 100%.
  • I just read through everyone's stuff here. It's really interesting and surprising seeing how everyone's plans differ and how doctors are coding for the same tests across the board. I am dumbfounded. This is why I would always always vote to do away with this craziness and go to single payer system. Everyone shouldn't have to have a phd in insurance billing! It's cray.
    BabyFruit Ticker



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