Did your insurance cover your "big" ultrasound?

CoreysGal

Mine (Aetna) didn't and I am going to fight it because my doctor ordered it, I didn't ask for it!  I am just wondering if this is common.

laurmar21

It all depends on your plan.  I worked in insurance for a few years, and you can fight it all you want, but if it is not a covered benefit, you are fighting in vain.  I know that isn't a happy answer, and I'm sorry.  That is really annoying. I would call your benefits department (on your insurance card) and just ask if a ultra sound is covered at 20 (or so) weeks.  See what they say so you know if you have ground to stand on.

marycrawford

I am not sure if it is common but I know some insurances wont cover it. The insurance tried to not cover an u/s when I had my daughter cause they deemed it unnecessary, wow I didnt know insurance agents had medical degrees. My doctor said she would fight it. We won. I have already had like 3 this pregnancy.

lilmccann

well I have a deductible that hadn't been reached yet so it technical didn't cover it but they did get the cost negotiated for me.  Do you have a deductible?  Has it been met?

CoreysGal

laurmar21:

It all depends on your plan.  I worked in insurance for a few years, and you can fight it all you want, but if it is not a covered benefit, you are fighting in vain.  I know that isn't a happy answer, and I'm sorry.  That is really annoying. I would call your benefits department (on your insurance card) and just ask if a ultra sound is covered at 20 (or so) weeks.  See what they say so you know if you have ground to stand on.

I tried to wade my way through the entire website and the forms my work provides but I couldn't find anything.  So I called my benefits dept and they said they couldn't find anything either but to call Aetna and if I didn't get anywhere, they would get our company rep involved.  It's worth a try.  I can't believe it isn't covered - and it was $400!

MrsDeHav

good luck fighting it!  i'm no help, mine was fully covered.

Sept1799

I get one U/S per pg so no mine is not covered since they did one to date the pg. But if its medically necessary then they will pay...hense the doc needs to send a letter saying that it is and then they will pay.

scubaspot

Mine did not. We have a health savings account and our insurance will not pay for anything, even if it was ordered by a doctor, until we have payed our $5000 deductible. Anything after $5000 they will pay for.

gypsywitch

yes. But I'm military everything is covered 100%...

CoreysGal

lilmccann:

well I have a deductible that hadn't been reached yet so it technical didn't cover it but they did get the cost negotiated for me.  Do you have a deductible?  Has it been met?

I do have a deductible but it was considered an unapproved cost it doesn't go towards my deductible - at least that is what I think it meant...

lildevil968

Mine was fully covered with BCBS. However DH also has Aetna, and them seem to be a piece of sh*t! I took him to the E.R. a few months ago when he had H1N1 and was having a lot of trouble breathing. They didn't cover it because he never called to get authorization.....lol, the man couldn't breath all that well, and they wanted him to talk to someone!

aknjcp

I had Aetna with my first and for every u/s - even though they were medically required for a medical condition I had - I had to pay $50 for.

x55centsxshortx

I have had 3 level 2 ultrasounds each costing about 800-900 bucks and none of them were covered.  My "big ultrasound" was the first one and not covered even though it was ordered also.  I am sorry this happened to you too.  

slc2b

I have Kaiser, all of my prenatal care is covered 100%, no copays.  Although this did not include an NT scan, but will include the quad screen at 16 weeks as well as the big ultrasound.

danandkelly

Wow, really, I'm sorry. 

I have Kaiser and everything is covered, with no co-pays for any pre-natal care (also no co-pays for all well baby checks up to 24 months).  I've had 5 ultrasounds so far this pg and a NT scan (I had 5 total last time), that were all covered.

Hopefully you get it covered. good luck.

slc2b

danandkelly:

Wow, really, I'm sorry. 

I have Kaiser and everything is covered, with no co-pays for any pre-natal care (also no co-pays for all well baby checks up to 24 months).  I've had 5 ultrasounds so far this pg and a NT scan (I had 5 total last time), that were all covered.

Hopefully you get it covered. good luck.

Kaiser covered your NT scan?  I was told if I wanted one it would be like $400 out of pocket.  Hmmmmph.  (I know I shouldn't complain, I am very lucky to have the benefits I have).

danandkelly

slc2b:

danandkelly:

Wow, really, I'm sorry. 

I have Kaiser and everything is covered, with no co-pays for any pre-natal care (also no co-pays for all well baby checks up to 24 months).  I've had 5 ultrasounds so far this pg and a NT scan (I had 5 total last time), that were all covered.

Hopefully you get it covered. good luck.

Kaiser covered your NT scan?  I was told if I wanted one it would be like $400 out of pocket.  Hmmmmph.  (I know I shouldn't complain, I am very lucky to have the benefits I have).

I'm not sure if Kaiser covered it or the state of CA covered it but I didn't pay anything nor did I get a bill.  I think there was a law passed recently in CA about early screening tests being covered for anyone who opts to have them regardless of insurance. So maybe it wasn't Kaiser.

JulesDiane

I have Aetna also. My Doctor already warned me that Aetna would not cover the full ultrasound, so we already planned to pay for it out of pocket. I think if I remember correctly it would cost around $175 out of pocket for the full ultrasound. We plan on going forward with it. Boo to Aetna. Good luck fighting it. 

Tinkx123x

My insurance covered mine. I have had like ten already for various reasons. BUT they won't cover a breast pump...wtf!

chazlewo

I also have Aetna, and it must depend on the plan... we have our big u/s next week... our Dr. office does a financial check for everyone to see what the insurance will cover for prenatal care.  Mine covers 100% after our deductible plus office co-pays, which we met with the first u/s and bloodwork.  I guess we'll see if that actually pans out to be true- thanks for the warning

JenGK

I haven't read any responses, so I am sorry if someone else answered this.  They denied coverage for my 20 week ultrasound with my son.  I appealed, and I lost.  The ultrasound clinic said that this is very common with Aetna.  My understanding is that they will only cover a not very detailed ultrasound (I forget the CPT code) at 20 weeks.  Because the 20 week ultrasound that I had (and that I understand is what most people have) is a step up from that because it involves a more detailed anatomy scan (and a different CPT code), they deny coverage as "experimental" unless there are indications of problems.  I was doubly ticked because I actually called their maternity line in advance to ask if it a 20 week ultrasound was covered, and they said yes, with no explanation of this twist that often arises.  Their policy on this is buried on their website.  https://www.aetna.com/cpb/medical/data/100_199/0199.html

hydies33

Mine did not cover any U/S with my OB. Because my plan has already "paid" all that they will pay to him, and the U/S was not included in the total. However, I got around it by going to other offices in my network for the U/S's, and then it has been covered. Go figure. Makes no sense to me, but at least they're paying for it!

teelaman

The plan that we have covers two ultrasounds total, and my doctor knew that, so he didn't schedule the first one until 19 weeks when he knew we'd be able to find out the gender. The second one isn't scheduled until mid/late third trimester. I think there's something in our plan that says if we absolutely have to have another for some medical emergency reason (like my sister in law had really high amniotic fluid so they did ultrasounds like every other week or something like that) then it's covered.....but unless it's 100% necessary it's not covered.

mommyrenee

our insurance is changing to Aetna PPO.. it better cover it. Its supposed to be the same level of coverage as our old BC/BS,.. and they covered all but our co-pay when we had it done with DS.

Im going to call & check.

JenGK

mommyrenee:

our insurance is changing to Aetna PPO.. it better cover it. Its supposed to be the same level of coverage as our old BC/BS,.. and they covered all but our co-pay when we had it done with DS.

Im going to call & check.

Just make sure you know what code it is going to be billed under -- my big mistake was just asking generally about 20 week ultrasounds, and not giving them the particular CPT code.

danandkelly

Tinkx123x:

My insurance covered mine. I have had like ten already for various reasons. BUT they won't cover a breast pump...wtf!

Why would they cover a breast pump? 

danandkelly

Tinkx123x:

My insurance covered mine. I have had like ten already for various reasons. BUT they won't cover a breast pump...wtf!

Why would they cover a breast pump? 

mommyrenee

here is the link to aetnas policies on ultrasounds:

https://www.aetna.com/cpb/medical/data/100_199/0199.html

mommyrenee

JenGK:

mommyrenee:

our insurance is changing to Aetna PPO.. it better cover it. Its supposed to be the same level of coverage as our old BC/BS,.. and they covered all but our co-pay when we had it done with DS.

Im going to call & check.

Just make sure you know what code it is going to be billed under -- my big mistake was just asking generally about 20 week ultrasounds, and not giving them the particular CPT code.

 

where would I get that, from the place where Im getting the u/s done? Im not familiar with the codes at all!

thanks!

JenGK

mommyrenee:

JenGK:

mommyrenee:

our insurance is changing to Aetna PPO.. it better cover it. Its supposed to be the same level of coverage as our old BC/BS,.. and they covered all but our co-pay when we had it done with DS.

Im going to call & check.

Just make sure you know what code it is going to be billed under -- my big mistake was just asking generally about 20 week ultrasounds, and not giving them the particular CPT code.

 

where would I get that, from the place where Im getting the u/s done? Im not familiar with the codes at all!

thanks!

Yes, ask the place where the ultrasound will be done what CPT codes (those are procedure codes) they will use and what ICD-9 codes (those are diagnosis codes) will be associated with each.

Basically, if you have a diagnosis of some potential problem (positive screen on your AFP, for example) Aetna will cover a more detailed ultrasound procedure than it would if you are just having a problem-free pregnancy.  I posted above a link to Aetna's general policy on ultrasounds, if you want to skim that for a general feel of their policy.