Ultrasound Refusal (Vent)

amberdanielle68845 · November 2012

So we had an ultrasound scheduled for today as a follow up to some blood work scares showing possible birth defects that cam back ok on a 2nd round of bloodwork. I get to the ultrasound office and my SO calls and says he's on his way which is awesome bc last I knew he couldn't get away from work, well he left early as a suprise. The radiology tech comes out and says, "It's been less than 30 days since your last ultrasound, it's only been 27 days, and most insurance won't cover another ultrasound if it's been less than a month. I called your Dr to confirm this and I'm not going to do your ultrasound bc of possible insurance coverage." So I asked how much an "elective ultrasound" was and she says "Idk $400-$500 but thats not my department." So let me get this straight, your refusing to do my ultrasound bc of possible lack of insurance coverage but you can't tell me what it'll cost exactly? Am I wrong to be so angry at this? Grrrrrr, thanks for the vent.

nycnola · November 2012

Aren't extra ultrasounds paid for if medically indicated? That's what they told us with DD1.

jvaeth2012 · November 2012

I would be frustrated. I would think that most insurance companies would cover it if it was a follow up due to concerns.

kewltif · November 2012

That's ridiculous! I had two in 4 days because they couldn't get all the shots they needed (uncooperative baby).

jkoulton · November 2012

I don't think it's any of the tech's business whether it is covered or not. It was nice of her to tell you but they can't refuse. You are the one able to refuse. That would be really frustrating. I would contact your insurance immediately, let them know what happened and see what they say.

RussianMommy · November 2012

it's not your tech's fault she did not know the price - c'mon now.

mrsmcdonald · November 2012

Your insurance should cover it, if it's medically indicated. I get weekly ultrasounds for medical reasons and my insurance covers 100% of it. She probably thought she was doing you a favor by saving you possible out of pocket expense.

Most people working in doctor's offices cannot tell you how much a procedure is going to cost - there are a million different variables that could affect it. She's right, it's not her department. She should have had you speak to someone in the billing office.

lkm2006 · November 2012

nycnola:
Aren't extra ultrasounds paid for if medically indicated? That's what they told us with DD1.

This! I had 2 a week from 28-36 weeks last. All covered..

Unknown · November 2012

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acesup · November 2012

wouldnt it be covered if medically necessary? i had U/S 3 days apart earlier in my pregnancy and they were both covered.

Unknown · November 2012

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mben1119 · November 2012

BlissBerry:
As the patient and the insured, its really your responsibility to educate yourself on what's covered and what isn't, which you should have done when the appointment was made. nbsp;Obviously an U/S tech isn't going to know all the different pricing. Furthermore, there's a possibility she could have gotten in trouble for continuing with the ultrasound knowing that it might not have been covered. nbsp;nbsp;

This. An u/s can't tell you procedure pricing. Contact your insurance company for clarification.

InkedMegs · November 2012

Insurance companies differ so much, there's just no telling. I just got a bill in the mail for my routine A/S ($450). I called and complained because I thought they were all 100% covered, but apparently it goes toward my deductible. They did cover about half of the $450, but I am responsible for the rest.

Wouldn't you have been more angry if they freely let you get the U/S without any kind of warning and then you had to pay $500?

Years ago, I didn't realize I made my yearly exam appointment less than one year apart. The office didn't say a word and I ended up getting a $300 bill in the mail. I was livid.

I think waiting a few days is worth not spending $500.

Ooglybear · November 2012

nola78:
Bliss+Berry:
piglet6609:
wouldnt it be covered if medically necessary? i had U/S 3 days apart earlier in my pregnancy and they were both covered.
I'm going to take a stab in the dark and say there's probably more to this than what's been presented.
Agreed. I get u/s all the time since I'm high risk and my insurance company never has a problem with it. I've never heard of insurance denying a medically indicated u/s, but I guess there could be more to this story.

I'm guessing it has something to do with the second round of bloodwork clearing up the potential problem...

Ceefome · November 2012

Someone in that office should be able to give you the OOP price for an ultrasound. It has nothing to do with the insurance company if the insurance company denies coverage. You would be paying the office, not the insurance company.

I signed a paper at my intake appointment telling me that the 20 week a/s would be $400 OOP if insurnace doesn't cover it.

Someone is leaving something out here.

lightgetsin · November 2012

RussianMommy:
it's not your tech's fault she did not know the price - c'mon now.

this

MelissaRae1525 · November 2012

How do you expect the tech to know how much it costs? She's right, that's not her department. Why didn't you ask the people that handle billing? And they could have checked with your insurance to see if it would be covered.

beckajw · November 2012

Bliss+Berry:

As the patient and the insured, its really your responsibility to educate yourself on what's covered and what isn't, which you should have done when the appointment was made. Obviously an U/S tech isn't going to know all the different pricing. Furthermore, there's a possibility she could have gotten in trouble for continuing with the ultrasound knowing that it might not have been covered.

NO.

Yes, we are all responsible to know what is and is not covered. If we get a procedure that is not covered, we cannot say "oops I didn't know." However, that is not the issue here. The issue is that the tech decided not to do something because it might not be covered. And the information the tech gave was totally wrong.

Techs are hired to do a specific job. Their job is NOT to tell people what is and is not covered. Their job is NOT to decide which procedures to do and which not to do.

drewiekc · November 2012

Call your insurance company, or the billing department at your OB's office, to find out if this is covered, and reschedule. Sure maybe it's annoying, but its not that big of a deal.

If the tech refused to do your u/s at that time for insurance coverage reasons, the order was probably NOT written up as a medically necessary u/s. So yes, it is probably their office policy to not perform "elective" sonos that close together and she was following protocol.

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