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High-Risk Pregnancy
pixiegirl131415
member
How is it that BPPs and NSTs are NOT considered prenatal care?
pixiegirl131415
member
So frustrating. I'm getting weekly ultrasounds (Bio-Physical Profiles) and Non-Stress Tests per my OB due to being put on meds for GD. Apparently, neither my insurance nor the clinic network that is billing them consider this to be necessary pre-natal care, and code it as Diabetic care, which means my insurance won't cover it. That means we'll be paying for both, at about $200 a week. I'm fairly sure that we will be hitting out out-of-pocket max for the year with my insurance on the delivery anyways, but still! Grr.
x-posted to July 2011 board
This discussion has been closed.
Re: How is it that BPPs and NSTs are NOT considered prenatal care?
DD1 Feb 2010
DD2 Sept 2011
Not only that, but it's the stupid placenta's fault I have GD in the first place! It just seems so dumb. Oh well, like I said, we'll hit our OOP max one way or another with this baby, so in the end, I suppose it really doesn't matter which things we're billed for and what is covered after OOP cap is reached.
Both my insurance and the billing specialist with my care provider told me that's how they code it, and there's nothing they can do. It's considered my medical issue and not part of the pregnancy, which is stupid. *sigh*
Hi Pixie, I'm usually too lazy to post, but I've got to cheer you on here, and encourage you to fight it! I have the unfortunate luck of having run into this and other billing issues before- I swear if there's a human error I've run into it as far as coding/billing- I know way too much about terminology I should know nothing about just because I've fought this exhausting fight before as well! And when it comes to pinching pennies, I have no problem making sure what's right is right. No doubt you've done lots of research already, but may I encourage you to give another call to your insurance (being sure to note dates, names, operator #s, ect.) and explain again (sometimes it is as simple as finally getting a rep on the line that 'gets' what you're talking about, or will go thru the trouble to find out) that these tests have been recommended to you as a medical necessity while pregnant and therefore are considered pregnancy related. Btw this is coming from a 2x mom w. GD as well- and each time I had to correct billing issues, writing letters, making phone calls again and again, ect. I know what you're going thru, and it should be covered. If you are being dunned for a bill currently you can ask them to freeze the account while it is being deliberated so that way you're not in a 'already paid/hoping for reimbursement' situation as that is just stressful. I wish you luck and hang in there!
How frustrating!!!
I can't imagine paying separately for these, as I have NSTs daily, and when one (or both) isn't reactive, I end up in BPP u/s. I've been having these three times a week since 28w, and daily (including weekends) since I was admitted at 29w5d.
I would absolutely fight this. File a grievance with your insurance carrier -- it may take some time to resolve, but to say that this is your medical issue is insane!!!
Thinking of you...
I would call the OB and demand why they are not coding it properly. I do not bill OB/GYN but I do billing and coding. They should be coding it as a complication of pregnancy. There is no way that is should be coded as diabetic care. Calling the insurance company won't help much, depending on the company they may give you the dx code that was used.
The dx typically used for antepartum care is 648.83, Abnormal Glucose Tolerance Of Mother, Antepartum. Antepartum obstetric condition, not delivered during the current episode of care; Conditions classifiable to 790.2; Gestational diabetes. The entire 648 ICD-9 chapter is listed as Other Current Conditions In The Mother Classifiable Elsewhere, But Complicating Pregnancy, Childbirth, Or The Puerperium.
I wish you luck.
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I once had a picture until the trolls showed up.
TTC #1 7/08 PCOS dx 8/28/04 Met 1000 mg and Clomid cycles 1-4 1/6/09-5/2/09 BFN
Clomid 100mg 6/4/09=O'd=BFP on 6/29/09! Beta@14DPO 70.8 Beta@16DPO 152. EDD 3/7/10.
First u/s on 7/13/09 @6w0d heard and saw heartbeat 102 bpm.
K M #1 arrived via c/s 3/1/10 10 lbs, 22 inches long at 39 weeks.
Surprise expecting #2. Med-free BFP on 8/1/11! Beta@15DPO 58.2 Beta@17DPO 198.3 Beta@23DPO 2338. EDD 4/9/12
K M #2 arrived via c/s 3/19/12 9 lbs 2 oz, 21 inches long at 37 weeks.
"If we weren't all crazy we would go insane."
Thats BS! They found that I had GD when I was 6 weeks pregnant. They considered it GD because that is when it was found, in pregnancy. I didn't have a placenta yet but they considered it GD because I was pregnant.
Either way I'd fight that. Keep calling and making appeals. Talk w/ the doctors office to see what they can do for you.
When I was pregnant & needed weekly BPP they coded it that I got them in office. I didn't. I was getting them at a facility through the hospital that the dr's office was offiliated with. If they didn't code it in office I would of had to pay for them out of pocket as well. Good luck. I hope you get it taken care of.