Feds -- BCBS Basic question

lemonpoundcake · May 2011

If you have BCBS basic and got an NT scan, was it covered? If so, were you AMA and/or did you have a family history of disorder? I'm having a heck of a time figuring out if BCBS will cover it if I got one given that (1) I'm not AMA and (2) we have no family history, but (3) my doctor recommended it because "more information is always good." I called BCBS, but they wouldn't give me a straight answer, and my doctor's billing department won't give me any guidance either (nor would they give me a definitive answer on how much the ultrasound + bloodwork might cost if it wasn't covered, so I'm nervous about getting the scan done and then getting hit with who knows what in medical bills).

WinesNot Whines · May 2011

Mine was covered and I didn't have any additional risk factors. I don't know why BCBS wouldn't give you a straight answer. They told me they'd cover any ultrasounds ordered by my doctor.

alliapistor · May 2011

I have BCBS Basic and mine was covered. I am AMA though. I don't know if that matters. The ultrasound was just billed like a normal ultrasound and the bloodwork like normal labwork. I'm not sure if CVS or Amnio would be covered though. (They have some weird, unclear language about a $75 co-pay for "genetic testing" but do not define what that means.)

My CF test and AFP, which were done at different times, were also covered as routine lab work.

Basically, after initial co-pay for my appointment where they confirmed the pregnancy - the whole pregnancy has been covered except for a colposcopy because it is not considered part of routine maternal care and was treated as an office surgery. I *think* I may have a $150 co-pay for the hospital. We're having a boy and circumcision is charged as a surgery ($150 co-pay).

tomandcourt · May 2011

I'm not sure what AMA is (?) but my NT scan was covered. Like alliapistor, everything was covered for me but the admission fee at the hospital and the circumcision.

SoonToBeMrsDTS · May 2011

tomandcourt:
I'm not sure what AMA is (?) but my NT scan was covered. Like alliapistor, everything was covered for me but the admission fee at the hospital and the circumcision.

Advanced Maternal Age - over 35

Artslvr · May 2011

tomandcourt:
I'm not sure what AMA is (?) but my NT scan was covered. Like alliapistor, everything was covered for me but the admission fee at the hospital and the circumcision.

AMA = Advanced Maternal Age.

I guess I was AMA in my third pregnancy, and I had surgery and extra u/s's, and I don't think my insurance cared how old I was - but I have Aetna. Do insurance companies consider AMA a "risk factor?" I never thought about it.

sarabean · May 2011

We have BCBS basic and no family history/AMA and our NT test was covered. So far everything has been covered except for a co-pay for one unscheduled trip to the OB and the hospital says we have a $150 co-pay for L&D. I feel your pain about calling BCBS because the hospital gave us a list of providers who bill separately (hearing test, anesthesia, etc) and I called to see who was covered and they basically had no clue, would not give me any straight answers. They said dumb things like, "There is no way you will need a radiologist during labor and delivery." Ok, lady, thats fine, I don't having any medical training and am not sure about it, I'm just going on what the hospital told me. It was annoying.

BabyHatch · May 2011

Ditto everyone else...it was all covered. Love me some Fed BCBS maternity coverage! :-)

victoria1212 · May 2011

Artslvr:
tomandcourt:
I'm not sure what AMA is (?) but my NT scan was covered. Like alliapistor, everything was covered for me but the admission fee at the hospital and the circumcision.

AMA = Advanced Maternal Age.

I guess I was AMA in my third pregnancy, and I had surgery and extra u/s's, and I don't think my insurance cared how old I was - but I have Aetna. Do insurance companies consider AMA a "risk factor?" I never thought about it.

I would think AMA would definitely be a risk factor.

lemonpoundcake · May 2011

Thanks for the info! It is reassuring to hear, although I guess ultimately I have to hope my doctor codes it as maternity care and not diagnostic (or some other thing).

alliapistor · May 2011

victoria1212:
Artslvr:

tomandcourt:
I'm not sure what AMA is (?) but my NT scan was covered. Like alliapistor, everything was covered for me but the admission fee at the hospital and the circumcision.

AMA = Advanced Maternal Age.

I guess I was AMA in my third pregnancy, and I had surgery and extra u/s's, and I don't think my insurance cared how old I was - but I have Aetna. Do insurance companies consider AMA a "risk factor?" I never thought about it.

I would think AMA would definitely be a risk factor.

When I was trying to get a sense of whether a CVS and/or Amnio would be covered, my doctor said that usually they are covered but if not, the fact that I was Advanced Maternal Age, was a factor that should make it covered. Thankfully, our NT results were so good we didn't feel the need to do additional testing. But BCBS's plan brochure is very confusing.

belizeitornot · May 2011

if you can get the procedure code, you should be able to give it to them and they tell you whether or not it's covered. i had to do that A LOT with our infertility treatments and i just got in the habit of asking that, in addition to finding out if it had to be done at a certain provider, with referral etc.

Mrs.Handy · May 2011

Jeez, I wish I woud've known this. We didn't have one, because I thought it wasn't covered by our insurance. We have BCBS standard. They definitely weren't very clear on the phone.

We didn't have any risk factors, but I suppose our OBGYN could have ordered it.

lemonpoundcake · May 2011

Seriously, BCBS talks in circles. First they told me that anything coded as "routine maternity care" would be 100% covered. Okay, sounds good, I can ask my doctor's billing deparment about that. However, I have heard of other people whose insurance limits coverage for "routine" ultrasounds (e.g. only covering 2 during the course of the pregnancy), so I asked whether that was true for BCBS. They tell me that they cover "as many that are medically necessary," but could not tell me what "medically necessary" was without using the words in the definition. So I asked if all "routine" maternity care was considered "medically necessary" (because, really, checkups aren't STRICTLY necessary, you know?) and got the same sort of circular response: "routine care is medically necessary if it is necessary that you receive it."

I find it infuriating that it has been impossible to get a straight answer either from the documentation or BCBS customer service regarding whether something will be covered. I mean, its not that big a deal in this case, because even if its not covered its probably only a couple hundred dollars, but what if it was more expensive?? They just expect people to blindly take on the obligation to pay thousands in medical expenses and hope for the best? Insanity.

Sam78 · May 2011

My first ultrasound was not covered (it wasn't the NT scan, it was a dating ultrasound) and BCBS told me that they only covered one ultrasound per pregnancy. This was a change from my first pregnancy. Sorry, don't remember offhand whether we have Basic now or had Basic then.

lemonpoundcake · May 2011

I had a dating ultrasound 4 weeks ago, and I just got my explanation of benefits from BCBS showing it was 100% covered...so maybe you were on the different BCBS plan then? I'm going to be really irritated if they reject my 20-week anatomy ultrasound (since that is a different kettle of fish than the NT scan -- it seems everyone gets one of those for the purpose of checking for health issues, viability, etc.) because "they only cover one per pregnancy" when they refused to answer this question when I specifically asked it.

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