So mad about my insurance coverage for ultrasounds.

jenchris05 · August 2009

Apparently I am entitled to only ONE ultrasound for the entire pregnancy unless there are complications or a medical need. UGH! All others will be entirely out of pocket. How much is an ultrasound averaging these days?

Our first one is scheduled for this Friday and I'm 6 weeks. It is to date the pregnancy and plus I had some light spotting around BFP time. The next one will be the NT scan and then they said another around 20 weeks (forgetting the reason right now). This is just so frustrating.

greenclown · August 2009

My ultrasound last week was $255.

ditzydi_2000 · August 2009

The 20 week one is probably to figure out the sex of the baby. It may be dumb but I can't imagine an ultrasound costing more than $100 because I know in my area the 3d ultrasound packages are going for about $125.

canesbaby · August 2009

I have the same coverage, but my doctor led me to believe that an ultrasound for spotting or dating are both considered medically necessary and therefore covered. If not, I'm gonna be getting some unexpected bills in the next couple of week!!

ditzydi_2000 · August 2009

greenclown:
My ultrasound last week was $255.

Yikes!

O'C · August 2009

I don't know how much the average one costs but I would think spotting would make it medically necessary to see what is going on, if your Dr. codes it that way. Then your NT scan would be seperate from a reg. ultrasound I think on insurance, and your 20 week one could be your "one" that you get. Ask your Dr. office how they will code your six week one and explain your situation to them.

Ms.lucky13 · August 2009

We have to pay everything out of pocket till Nov. We've been quoted around $95 to $125.

jenchris05 · August 2009

canesbaby:
I have the same coverage, but my doctor led me to believe that an ultrasound for spotting or dating are both considered medically necessary and therefore covered. If not, I'm gonna be getting some unexpected bills in the next couple of week!!

Yeah, I was told that the first one is covered and *then* each one thereafter must have a medically compelling reason to do so. So there goes the first one down the drain even though I have a reason. I will be looking for one of those 3D/4D places to get one done myself since it will most likely be cheaper than one in a medical setting.

duchessII81 · August 2009

I'm sorry, that stinks.

The NT scan is elective, many choose not to do it. Had it not been covered by insurance, we definitely wouldn't have paid OOP for it.

The 20-wk is the big one used to identify and measure many things. Finding out gender then is really just a bonus.

Good luck!

jenchris05 · August 2009

O'C:
I don't know how much the average one costs but I would think spotting would make it medically necessary to see what is going on, if your Dr. codes it that way. Then your NT scan would be seperate from a reg. ultrasound I think on insurance, and your 20 week one could be your "one" that you get. Ask your Dr. office how they will code your six week one and explain your situation to them.

I just asked my insurance company about the NT scan and they just consider it another ultrasound Sad Looks like we might end up opting out if that's the case. DH really wanted us to do it though so I am not sure...

I am also scared now that all my 3 sets of labwork thus far might not be covered because they're saying it needs to be part of an office visit. Well, the one time w/spotting was just a phone call and they sent me to the lab. Guess we'll see when the bills roll in.

canesbaby · August 2009

I would talk to your doctor... mine said it is not difficult to find a "medically necessary" reason for an ultrasound. NT scan is not covered on my insurance either since I am not at increased risk or over 35, but we didn't plan to have one anyway. Good luck!! Also- my blood work was covered, it was prescribed at my confirmation visit (not considered first OB visit) but I had it done at a different lab... hopefully yours will be covered!

ach427 · August 2009

Mine are $350, sorry to say!

gingerfamily · August 2009

A lot of insurances have this policy. Mine covered 3 early on b/c we were doing fertility procedures. Other than that - they cover one.

J&Jaggies06 · August 2009

When I called my insurance yesterday they led me to believe that all of my u/s and lab work will all go toward my deductible (so I'm paying for them) then once I reach that I will pay 20% of the cost. I couldn't believe none of it was covered, just office visits by my co-pay. Bummer!

Summer20 · August 2009

jenchris05:
canesbaby:
I have the same coverage, but my doctor led me to believe that an ultrasound for spotting or dating are both considered medically necessary and therefore covered. If not, I'm gonna be getting some unexpected bills in the next couple of week!!

Yeah, I was told that the first one is covered and *then* each one thereafter must have a medically compelling reason to do so. So there goes the first one down the drain even though I have a reason. I will be looking for one of those 3D/4D places to get one done myself since it will most likely be cheaper than one in a medical setting.

I think the 20 week one could/should be considered medically necessary. It is an anatomy scan to make sure everything is healthy on the baby. If that's the case, you'd only be looking at paying for the NT scan.

JellymanKelly · August 2009

ditzydi_2000:
The 20 week one is probably to figure out the sex of the baby. It may be dumb but I can't imagine an ultrasound costing more than $100 because I know in my area the 3d ultrasound packages are going for about $125.

The 20 week ultrasound is not to figure out the sex of the baby. It is to screen for and diagnose any problems with the baby. It's called the "anatomy scan" but not because they're looking for the sex organs - they're checking ALL of the baby's anatomy. I know several people who have had serious birth defects diagnosed at the 20w ultrasound. If you have to have only one, this is the one you need to have.

SigmundsGirl · August 2009

I had to pay 10% coinsurance on mine and I paid about $16, so my doctor charges about $160. Like a pp said, if your doctor's office codes it correctly, it can be considered medically necessary.

Mrs.BoomBoom · August 2009

The 6 week with spotting is probably medically necessary as is the 20 week (it does a lot of measurements looking for abnormalities. Often you can also find out the sex but that's just a side effect) The NT is often not covered and you could skip it.

MrsJoanieP · August 2009

ditzydi_2000:
The 20 week one is probably to figure out the sex of the baby. It may be dumb but I can't imagine an ultrasound costing more than $100 because I know in my area the 3d ultrasound packages are going for about $125.

There is no ultrasound to figure out the sex of the baby. It's convenient to also find out at your 20 week ultrasound, but the point of the ultrasound at 20 weeks is to make sure baby is healthy and measuring appropriately with all of its organs working accordingly.

MrsJoanieP · August 2009

BTW, it could be considered medically necessary to have one at 6 weeks to date the pregnancy, 20 weeks to make sure baby is measuring accordingly and growing its organs, and from there on out if complications arise (measuring big, low fluid, etc). I would assume they're meaning OOP to pay for them if it was the NST which as someone mentioned, can be proven as medically neccessary if needed. But, other u/s would not be medically necessary where you just want to see baby, etc. Those are usually done outside of the docs office and do cost oop.

Mikeysbride2b · August 2009

My Dr does them and doesn't tell my insurance company. He did every month in his office with my first pregnancy and will with this one too. Ask your Dr, mine was great about it.

BlueBelle2004 · August 2009

Don't they consider it a "medical need" to date your pregnancy? If they don't, and you know how far along you are, I would cancel it.

Anyway, I actually think that insurance only covering one ultrasound per preg (w/the exceptions that you mentioned) is fairly typical. It seems like people on this board get way more u/s than people I know IRL. Why would you think they should cover something not medically necessary?

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So mad about my insurance coverage for ultrasounds.

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