Are both your NT scan and 20 week anatomy scan covered?

Tropicalbride09 · April 2011

I've been debating whether or not to get the NT scan. I'd like to, but DH doesn't want to do it unless it's covered. We both agree that we would never abort the pregnancy, but I just wanted to make sure everything is going well and if something is wrong, I'd want to be prepared for it.

I was talking with my insurance company, Blue Cross Blue Shield, and the wording they were using was incredibly deceiving. The woman couldn't just tell me if it was covered or not. She's like, "Yes, the NT is totally covered if it's deemed medically necessary." and I'm like, "Well, does 'deemed medically necessary' mean that I'd be over 35 and high risk?" ...."No, not at all. It's covered if it's deemed medically necessary."

What a headache, she just couldn't give me a good definition of what's deemed medically necessary! UGH....I felt stupid for asking the same question 5 times but she couldn't define the term without using the term in the sentence! I assume that it's not covered because there would be nothing urgent about me having it done, except for the fact that I'm interested in knowing if my child has genetic abnormalities!

She did say that I get 2 ultrasounds that are covered. So I proceeded to ask her if one of them is the anatomy scan...she had no idea, just that 2 were covered. I am assuming that the 2 ultrasounds are 1. the dating u/s and 2. anatomy scan.

We'll see....I'm waiting on a call from their maternity coach and hopefully she can answer my questions in more detail.

ldswims · April 2011

If it helps - "medically necessary" is determined by your doctor, not your ins co. So long as your doctor files the paperwork with the right billing codes for medically necessary procedures, then you should be good. Talk to the billing clerk to see how they normally claim that.

I'd imagine you'll be covered. BCBS is pretty good with stuff like that.

jb2rn · April 2011

she said that, because there are other reasons that it could be medically necessary, like a family history of birth defects, etc.

Maybe you could ask them what the cost would be if it's OOP?

Mine is covered. We have Tricare through the military. One thing they are great about is maternity care. Other stuff, not so much.

oliviosis · April 2011

I have great coverage with Cigna but my insurance paperwork says that "genetic testing is not a covered service". I did not call to see if they'd cover it under some circumstances. I wonder now if they would've.

vanessa11411 · April 2011

I have Kaiser and pretty much everything is covered and I don't have to pay a co-pay with anything pre-natal related.

mbgreenwalt · April 2011

I have BCBS and my plan covers anything maternity related 100%. I had 3 u/s w/ my DD and all were covered. I would suppose medically necessary means if your doctor orders it it is covered.

Tropicalbride09 · April 2011

Thanks for the responses

They told me that both scans are $1000-ish each. Hopefully everything works out!

Augustbride · April 2011

oliviosis:
I have great coverage with Cigna but my insurance paperwork says that "genetic testing is not a covered service". I did not call to see if they'd cover it under some circumstances. I wonder now if they would've.

I have Cigna as well of course a different group but they covered everything my doctor suggested we do. If I had elective testing i.e. Amnio without tests indicating it was beneficial they probably would not have covered it.

StefB28 · April 2011

mbgreenwalt:
I have BCBS and my plan covers anything maternity related 100%. I had 3 u/s w/ my DD and all were covered. I would suppose medically necessary means if your doctor orders it it is covered.

This & I had 4 ultrasounds during my last pregnancy & will have 4 this time, unless there's a problem & I need more.

CheriCO · April 2011

oliviosis:
I have great coverage with Cigna but my insurance paperwork says that "genetic testing is not a covered service". I did not call to see if they'd cover it under some circumstances. I wonder now if they would've.

The NT scan is technically not a genetic test, so that statement may not exclude it.

Our insurance policy says only 1 routine u/s is covered. It's really vague and I have no idea whether the NT scan would be covered, but I sort of doubt it. We have a high deductible plan, so would be essentially paying out of pocket anyway.

oliviosis · April 2011

CheriCO:
oliviosis:
I have great coverage with Cigna but my insurance paperwork says that "genetic testing is not a covered service". I did not call to see if they'd cover it under some circumstances. I wonder now if they would've.
The NT scan is technically not a genetic test, so that statement may not exclude it.
Our insurance policy says only 1 routine u/s is covered. It's really vague and I have no idea whether the NT scan would be covered, but I sort of doubt it. We have a high deductible plan, so would be essentially paying out of pocket anyway.

Good point! I just kept thinking it was a genetic test because its in the genetic testing section of my paperwork from the Dr. I really should have looked into it more..I am/was so torn about getting it done.

Snickerdoodle11611 · April 2011

Just wanted to put my two-cents in, even though there have been a lot of replies! I have Blue Cross Blue Shield and so far I have had about 5 ultrasounds (I have not had an easy pregnancy, I originally found out I was pregnant after losing one of my twins that I was carrying- not knowing at all until I had severe unexplained bleeding). Anyways, if your Dr. feels that an ultrasound is necessary, BCBS will pay for it. So far I have not had to pay for any ultrasounds out of pocket. If your Dr. suggested the NT Scan, which mine did, just ask for them to code it as necessary so insurance will pay for it. Mine seems to be very aware of this and so far I have had no problems.

katgracenugget · April 2011

ldswims:

If it helps - "medically necessary" is determined by your doctor, not your ins co. So long as your doctor files the paperwork with the right billing codes for medically necessary procedures, then you should be good. Talk to the billing clerk to see how they normally claim that.

I'd imagine you'll be covered. BCBS is pretty good with stuff like that.

This. I have BCBS and it is the same for me

MooneyDee · April 2011

Agreed with previous posters. Your doctor will know how to code it. Mine said they would code it as necessary. (My previous pregnancy warranted this.)

riagal82 · April 2011

Most insurance companies cover both, the NT scan has a very high rate of false positives which often results in people having more tests. I personally do not have the test. I would hate to worry for no reason and it wouldnt change anything for me but everyone needs to make their own decision

Tropicalbride09 · April 2011

Snickerdoodle11611:
Just wanted to put my two-cents in, even though there have been a lot of replies! I have Blue Cross Blue Shield and so far I have had about 5 ultrasounds (I have not had an easy pregnancy, I originally found out I was pregnant after losing one of my twins that I was carrying- not knowing at all until I had severe unexplained bleeding). Anyways, if your Dr. feels that an ultrasound is necessary, BCBS will pay for it. So far I have not had to pay for any ultrasounds out of pocket. If your Dr. suggested the NT Scan, which mine did, just ask for them to code it as necessary so insurance will pay for it. Mine seems to be very aware of this and so far I have had no problems.

My dr's office won't file it as "medically necessary" unless I'm over 35 or at high risk....So i don't think they will cover it. I spoke with the office and tried to explain that my dr said it was an option and therefore suggested it, but still they won't change the coding to make it necessary. ugh. Oh well, I guess I'll just wait until the 20 week anatomy scan I bought the Sonoline B doppler last night so I think that will put my mind at ease for the next 2 1/2 months. I hope.

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