so confused....stupid question(long sorry)

ginogomermisser

Ok so maybe I'm extremely naive but I'm so confused. I have my first appointment at 9 weeks on Monday. The office called today to confirm and I asked them if they were still doing an ultrasound. The nurse stated that they were not because my insurance will not pay for ultrasounds in the first trimester. She stated that I can pay out of pocket and I said that I thought it was odd being that I conceived via IUI with Clomid and I'm 36. She stated that there has to be a problem.

After the conversation, I called Highmark. The lady was very nice and she stated that it seems that I may be advanced maternal age but I'd have to verify through the office if they deem me at 36 to be advanced materal age. she did agree that ultrasounds are covered after 1st trimester.

I then called DH. He stated that it was no big deal and if I wanted to pay out of pocket, we could. He then did the one thing I hate.....He told me that with his other two kids(to a previous marriage) the first appoinmtnet included a sonogram and we will be able to verify twins, growth and heartbeat. I told him that its the same thing. He stated that I'm wrong, so I hung up(hormones).

Question: Is 36 considered advanced maternal age??? Is an ultrasound different than sonogram??? If so, will they do sonogram first appt for heartbeat???

I honestly feel so stupid. I really thought that I was educated on these things, especially after IF. I guess not.

advice??? 

Ms.Jade

Not sure about the sonogram vs. ultrasound thing, but I did learn on here that one cannot actually hear a heartbeat until a certain number of weeks (I think 12) so maybe that has something to do with it. 

ClaraEarlene

The sonogram is the image produced by an ultrasound, so they're basically the same thing.  35 is typically considered "advanced," but your insurance company will rely on your doctor's opinion about what he/she considers "advanced."  Just like my insurance company only pays for one "routine" ultrasound, but will pay for additional "medically necessary" u/s.  It's up to my doctor to determine what is "medically necessary" and to convince my insurance company to agree. 

KZ2010

Sonogram = ultrasound

Advanced maternal age is 35 or older.

RedCamaro

ClaraEarlene:

The sonogram is the image produced by an ultrasound, so they're basically the same thing.  35 is typically considered "advanced," but your insurance company will rely on your doctor's opinion about what he/she considers "advanced."  Just like my insurance company only pays for one "routine" ultrasound, but will pay for additional "medically necessary" u/s.  It's up to my doctor to determine what is "medically necessary" and to convince my insurance company to agree. 

This. While the two may be arugably different, they get you the same results (and by the same method? i.e. scanning.). I don't see why the insurance company would cover u/s only after the first trimester. That just makes me think that someone wasn't thinking when they made up that rule! It would make more sense to have at least one during your first to see that the baby is healthy. Insurance companies

MrsRich0226

I don't know about the maternal age stuff but didn't your RE do an u/s before releasing you to your OB?  My RE wanted to look for the h/b and check for multiples before giving me the green light to move on.

Don't feel stupid!  If you've never done this before, how are you supposed to know?  It's ok, we'll learn as we go!

ldswims

Yeah, 35 is considered advanced age and your doc can say the U/S is medically necessary and that's that.  I would fight this, to be honest, as the stress of not doing the U/S can lead to far worse things than the cost of an U/S - especially for what your ins co pays out.

Is your doc your ob/gyn or is it your pcp?  Because if you're ob/gyn won't say "medically necessary" then you can get your pcp to do so.  I know, without a doubt, if you saw my doc, he'd back you up on this.  So find someone.

MissMex

Generally anything after 35 can be considered high risk, but your doctor needs to make that call.

An u/s and a sonogram are technical terms for the same thing.

I would suggest grabbing a copy if the Mayo clinic's guide to pregnancy and the ACOG guide to pregnancy. You can also sign up for weekly emails from baby center and similar sites with week by week info on the growth of your baby.

It would probably be a good idea to review your insurance policy now, so you know what's covered and what is not, so you don't have any surprises along the way.

there's a ton of info out there and it's really overwhelming, but if you start out with those books you'll have a good foundation of knowledge.

Finally the bump itself is a great resource. Go to the main page and navigate around a little. You'll find great answers to most of your questions there.

MrsRich0226

Oh, one more thing...I had my 1st OB appt on Monday (8 weeks) and she said she wasn't going to do an u/s until 10 weeks since she said it's probably too early to hear anything yet and I have a tilted uterus so it might take longer. 

burghbaby

I live in Pittsburgh and have Highmark coverage.  I was able to have an early u/s to confirm viability due to a previous miscarriage.  I do know it needed to be coded as such.  I imagine being conceived via IUI would be another reason.  Highmark is really pretty liberal on what they pay.  They don't deny much!  At the very least, you should be able to have a NT scan in the 1st trimester between 11 and 13 weeks. 

ClaraEarlene

RedCamaro:

ClaraEarlene:

The sonogram is the image produced by an ultrasound, so they're basically the same thing.  35 is typically considered "advanced," but your insurance company will rely on your doctor's opinion about what he/she considers "advanced."  Just like my insurance company only pays for one "routine" ultrasound, but will pay for additional "medically necessary" u/s.  It's up to my doctor to determine what is "medically necessary" and to convince my insurance company to agree. 

This. While the two may be arugably different, they get you the same results (and by the same method? i.e. scanning.). I don't see why the insurance company would cover u/s only after the first trimester. That just makes me think that someone wasn't thinking when they made up that rule! It would make more sense to have at least one during your first to see that the baby is healthy. Insurance companies

It's actually quite common for healthy women with no past fertility issues not to have an u/s until the 2nd trimester, regardless of what insurance pays for.  My first appointment will be at 12 weeks, when we get to hear the HB, but no u/s unless the doc things something might be wrong.  Otherwise, my first u/s won't be until 20 weeks or so.

jjswife08

My OB's office does a sonogram on a portable machine every visit but will only do three ultrasounds on the mack daddy machine at different stages in the pregnancy.  Maybe DH had a similar experience with portable sonos vs. u/s machines?

MissMex

Ms.Jade:

Not sure about the sonogram vs. ultrasound thing, but I did learn on here that one cannot actually hear a heartbeat until a certain number of weeks (I think 12) so maybe that has something to do with it. 

A heartbeat can be seen as early as 7 weeks via u/s.

It can be heard via Doppler around 9 weeks.

12weeks is the time it should be heard or seen to confirm a viable pregnancy.

mben1119

jjswife08:

My OB's office does a sonogram on a portable machine every visit but will only do three ultrasounds on the mack daddy machine at different stages in the pregnancy.  Maybe DH had a similar experience with portable sonos vs. u/s machines?

I think you're thinking of a Doppler machine, which allows you to hear the heartbeat.  Sonograms are ultrasounds.

ginogomermisser

Thanks ladies for all your input....The hormones are really going strong today. I'm sitting here at my desk at work crying because nobody else is around. I was really hoping that Monday I could at least hear a heartbeat(or two). It has been a long road for us(not that it hasnt for anyone else) and if I dont get an ultrasound until 12-16 weeks then how do I know if baby is growing on schedule and if its heartbeat is normal. If its not at 12-16 weeks then I would be unbearable to go through a D&C that late, especially being that this is our last try.

I have no medical problems other than the issues with undiagnosed infertility and being 36. I think I'm going to go to my appointment as scheduled and discuss this with the doctor, not some rude *ss secretary. So I guess the only reason why I have to go to the appointment is for a internal exam and blood work???

Thanks again ladies...this is just a huge downer. Oh yea, in response to one of the replies. My IF treatment were done through this same practice my OB did the testings and treatment and not an RE. I guess this was mistake #1.

Thanks so very much   

 

MissMex

mabenner1:

jjswife08:

My OB's office does a sonogram on a portable machine every visit but will only do three ultrasounds on the mack daddy machine at different stages in the pregnancy.  Maybe DH had a similar experience with portable sonos vs. u/s machines?

I think you're thinking of a Doppler machine, which allows you to hear the heartbeat.  Sonograms are ultrasounds.

GE and a few other companies have developed portable diagnostic tools that are slowly being brought into more and more offices. They are pretty neat, but not widely used yet.

https://www.gehealthcare.com/euen/ultrasound/products/general-imaging/logiqbook-xp/index.html

Cort711

I'm so sorry you have to deal with those stupid secretaries there! When I was going to the same practice, they said they would only do a heart doppler at 12 weeks and wouldn't do an u/s until after 20 weeks.  Since I conceived via fertility treatment I thought that was unreasonable, just like you.  Not to mention, you are considered higher risk since you are over 35.  I wouldn't be surprised if it was just the secretary getting her information wrong rather than your insurance not allowing it.  Good luck and hope you get some kind of confirmation of a healthy baby in there on Monday! Keep us updated!