My insurance doesn't cover ultrasounds.... :(

panda10 · October 2011

I called my insurance yesterday and they told me that I have to pay out of pocket for any ultrasounds that are not medically necessary and they said that the NT scan and the anatomy scan are not medically necessary. I checked with the hospital and they said with my insurance and with the reading of the ultrasound it would still cost close to $900! I think this sounds ridiculous. It does go towards our deductible, but our deductible is so high, it would be pointless to do it this year, we're better off waiting till next year to do it.

The thing is, I do have great insurance, I have BCBS Comprehensive, with the maternity plan. They said that this is normal and few insurances cover things such as ultrasounds and lab work. I think this sounds like a giant joke. Now my DH doesn't want to have an ultrasound, and I'm looking into other clinics who will do it for more of a reasonable price. I'm just frustrated. You pay so much monthly and try to plan ahead and it just is frustrating!

Thanks for listening to my vent. I just wish we knew what to do!

Also, we did budget and we have enough money for everything, I would just like to feel insurance kick in as much as we do.

pc150805 · October 2011

That's crazy. I can't believe they don't cover ultrasounds and lab work. I haven't paid a cent and I've had all kinds of test/ultrasounds. I wonder what kind of diagnosis they would need for it to be medically necessary.

iLoveblueberries · October 2011

What??

We have to pay out of pocket for ultrasounds and it is only $60 per ultrasound and $150 if you want 3D/4D.

It will be okay Big Smile

iLoveblueberries · October 2011

I should add the prices are at a private ultrasound clinic and the service was awesome! The techs were so highly trained and it was so enjoyable!

I'm sorry your insurance is being dumb but I totally understand the frustration!

LexiSophie55 · October 2011

I think you should look into what the PP mentioned. What deams it "medically necessary". Would your doctor be willing to work with you?

LexiSophie55 · October 2011

iLoveblueberries:

What??

We have to pay out of pocket for ultrasounds and it is only $60 per ultrasound and $150 if you want 3D/4D.

It will be okay

Yes, that's another good point. Usually the majority of the cost is a "reading" that they perform on the ultrasound. What is the cost if you just want to see a flicker?! and nothing else

lindy27 · October 2011

My office charges $550 for the NT scans, not sure if insurance covers that. Mine does cover lab work and the 20 week ultrasound.

Maybe find one of those shops that specialize in ultrasounds, I would think they would have good prices. They probably won't look for anything medically but you can as least see your baby and probably get a gender.

panda10 · October 2011

They said just the normal black and white ultrasound is $700 plus the reading is $175. I am calling around to ultrasound clinics around me (still 2 hours away to one) to see what they offer. Looks like I have some research to do! Thank you for your help ladies! I'm going to keep looking for different options! I'm in the process of trying to get ahold of my dr.'s office to figure out if it is "medically needed" or not.

Thank you

LilyPotter218 · October 2011

I am lurking b/c work is insanely slow today...

I am not surprised that INS does not cover the NT scan. I have a deductible plan also. I have to pay $1500 OOP and then everything else is covered 100%. They don't really care what the money is for, as long as it is medical. I mean I can't go have a boob job, but if my OB suggests an NT, then that goes toward my deductible.

I have heard a LOT of INS providers only paying for medically necessary u/s, but your OB determines what is necessary. Most OB's will say that the A/S IS a medical necessity!

panda10 · October 2011

Whoo hoo! I just called my Dr. and she said that she would bill out out as medically necessary. Okay, I feel great about that. It's not that I need to know the gender, but I just feel that it is important to know if the baby is healthy. Okay, I'm feeling better about this.

Thank you so much for everyone's input and help. I really really appreciate it.

baltimorebride7 · October 2011

LilyPotter218:

I have heard a LOT of INS providers only paying for medically necessary u/s, but your OB determines what is necessary. Most OB's will say that the A/S IS a medical necessity!

Yup, it's all about those little diagnosis codes they put on their charts. I had an issue with my old GYN after getting a $1,000 bill for a standard panel of STD tests. According to my insurance company, that wasn't part of 'preventive care'

Oh how I love the health care system in this country! Thanks for the heads up though, I've been assuming everything is covered based on the "Pay Nothing" I read in the column next to maternity care in my benefits chart. I should probably call to verify that they actually cover my NT since I just scheduled it for next month.

Good luck! I almost feel like I need a special training class to navigate and understand all this stuff sometimes.

LilyPotter218 · October 2011

panda10:
Whoo hoo! I just called my Dr. and she said that she would bill out out as medically necessary. Okay, I feel great about that. It's not that I need to know the gender, but I just feel that it is important to know if the baby is healthy. Okay, I'm feeling better about this.

Thank you so much for everyone's input and help. I really really appreciate it.

Yay! Good news

I have had 9 u/s and they have all actually been medically necessary... BUT my OB said he would bill them all that way even if we did just want a sneak peek early on.

gigismomma · October 2011

I have BCBS in NC and I pay NOTHING for maternity care. I have had two u/s, blood work, and am due for a third u/s on the 26th. I get my statements in the mail saying "you had this done on this date and we paid for it" That is insane they do not cover u/s. I would see if your doc will work with you to make a u/s medically necessary. I mean heck if there is something that could be wrong then you may NEED and u/s. I would be upset.

Check into what PP said about going to a third party u/s clinic for an u/s. They are cheaper.

Out of curiousity what is the ratio for the bill for your delivery? Mine is 80/20.

roxygulrjax · October 2011

That IS ridiculous! I have VA benefits for the pregnancy and they cover EVERYTHING! I would assume that if the doctor's do an ultra sound then it should be considered "medically necessary"...shame.

livinreality · October 2011

panda10:
Whoo hoo! I just called my Dr. and she said that she would bill out out as medically necessary. Okay, I feel great about that. It's not that I need to know the gender, but I just feel that it is important to know if the baby is healthy. Okay, I'm feeling better about this.

Thank you so much for everyone's input and help. I really really appreciate it.

That is good news. We had to pay $500 deductible for an ultrasound this year (with miscarriage). The actual ultrasound was closer to $1000. But now that we have met our deductible they are covered as long as they are medically necessary.

chloebeth930 · October 2011

The a/s scan is not an anatomy scan. It is an anomaly scan. The main purpose of that ultrasound isn't to determine the gender but to check that your baby is developing normally. Some doctors actually perform a separate anatomy scan, so that is what your insurance was probably talking about, because that would be elective.

mikalchristina · October 2011

If men were the ones who got pregnant, I wonder how the insurance and healthcare cost part of pregnancy might be different.

Katelobster · October 2011

How the heck can an ultrasound cost so much?

I've already had two done by my doctor during office visits, and the amount billed for the entire visit was only $100 - $150.

panda10 · October 2011

I have to pay up to my $3,000 deductable, and then after that, they are 80/20 until I hit $5,000 then they pay for everything. I am trying to be very conservitive in 2011 and rack it up in 2012! DH just got a new job so I'm staying on this one, putting the baby on his insurance and then joining him next Oct. on his insurance and then having our next baby (hopefully) on his new insurance. It's all a mess. I told him I think we might move to Canada. LOL

panda10 · October 2011

chloebeth930:
The a/s scan is not an anatomy scan. It is an anomaly scan. The main purpose of that ultrasound isn't to determine the gender but to check that your baby is developing normally. Some doctors actually perform a separate anatomy scan, so that is what your insurance was probably talking about, because that would be elective.

That is the one I was talking about. I just call it the 20 week scan, or anatamy scan. I was thinking about the one that does the head to toe scan. Didn't know there was a different word for it. Thanks

appylovee · October 2011

I personally feel that is ridiculous! I have BCBS Healthmate Coast to Coast. Maybe you need to switch your plan. Mine covers almost everything I can ask for or think of.

charmschool · October 2011

I find this very alarming! I also have BCBS and 100% of maternity care is covered, including as many ultrasounds as my doctor wants me to have. We literally only have to pay for "extras" like a 4D ultrasound. I have the federal employee program, so maybe it covers more than other BCBS plans do, but it's crazy that they vary that much.

jp0129 · October 2011

Wow I guess my Ins isn't that bad afterall. I have UHC and it covers everything. I just pay my dr copay of $25 and I can have all the U/S and tests I need or want. Plus I only have a $500 deductible. I just hate that my prescriptions are a tier plan and all of mine are tier 3 so that is $60 x 3 a month.

SoCoGirl · October 2011

roxygulrjax:
That IS ridiculous! I have VA benefits for the pregnancy and they cover EVERYTHING! I would assume that if the doctor's do an ultra sound then it should be considered "medically necessary"...shame.

This is what I have and they have been awesome!

Cercamom2011 · October 2011

I have a HDHP with BCBS and I paid nothing once we hit our deductible (cause it pays 100%). Hopefully the dr can recode some things and get this deemed medically necessary.

melissa721 · October 2011

panda10:
Whoo hoo! I just called my Dr. and she said that she would bill out out as medically necessary. Okay, I feel great about that. It's not that I need to know the gender, but I just feel that it is important to know if the baby is healthy. Okay, I'm feeling better about this.

Thank you so much for everyone's input and help. I really really appreciate it.

You have an awesome doctor. Glad you got that worked out!

JAP09-02 · October 2011

I have BCBS too, and was told the exact same thing. Sooooo frustrating. I actually just called to cancel our NT scan this morning.

I did talk with a case manager at the OBs office, and she has seen BCBS pay for 1 ultrasound "generally" speaking. So, I guess we will just do the 20 week anatomy scan, and hopefully they will pick it up. Otherwise we'll just pay out of pocket.

I had u/s upon u/s with my last pregnancy, including fetal echocardiograms, and all of them were covered. I believe it was also a BCBS plan. Just goes to show not all plans are created equal. The only upside is that we currently don't pay any premiums.

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