Insurance coverage for newborn hearing test?

NJinAustin

Newborn hearing test done in hospital. Bill came the other day. Approx $245 with our insurance covering only $45... so we owe approx. $200.  Called my Pedi... she said it is a state law/mandate in state of TX that it be done. We could have had it done either in hospital or at Dell Children's Center. She recommends I call insurance to see why they don't cover more or all since it's something that we have to get done. She said to see if Dell applies a different insurance code to it and maybe it would have gotten covered if we went to Dell.

Anyone experience this and/or protest with success/failure?

Taytee

I seem to recall with both the girls being disappointed/pissed that so little is covered and just ended up paying it so they'd leave me alone

libbyann

They covered about 50% of Will's. It sucks that they don't cover more of an expensive, mandatory test! Probably just a way they know they can get money since you can't opt out of the test.

JayandJack

I remember having to pay for at least half of it if not more. I thought it was strange that I had to pay so much but after dealing with the rest of the billing disasters I just paid it.

mrs.wildman

We also had to pay $200ish which really annoyed me. A colleague of mine then told me that they opted to not have it done which made me wonder if it was mandatory or not. I just assumed that it was - but curious about this since your Dr. said that it's law and he said that they were able to opt out... Hmmm.

oliverncherie

The only tests required in the State of Texas are the heel prick blood test (which can be refused based on religious reasons) and eye prophylaxis (which apparently cannot be refused under any circumstance).

I found this:

State Laws

Thirty-six states, Guam, Puerto Rico and the District of Columbia require hearing screening for newborns, including: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Virginia, West Virginia and Wyoming.

Seventeen states, Guam, Puerto Rico and the District of Columbia require specified or all health insurers to cover the screening, including: Alaska, Delaware, Florida, Indiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, New Jersey, New York, Rhode Island, Tennessee, Texas, Virginia and West Virginia.

At least three states?Massachusetts, Ohio, and West Virginia?have laws that specify who shall pay for the screening if the facility is not reimbursed by a third-party payer and parents are unable to pay.  A number of states have created task forces or advisory committees on newborn hearing screening. 

NJinAustin

thanks ya'll. Forgot to mention that Pedi said that Yes.. it's mandatory but... she made said in a round about way that no one would be motivated to issue a court order to have us do it.

s-a-r-a-h

We checked with our insurance before they did the test and we paid something like $25 OOP. I'm sorry your insurance isn't covering more of the cost. FWIW, I think you can opt out of the test. We told the tech that if insurance didn't cover it, we weren't having it done and they didn't object.