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3rd Trimester
Ivorytower2
member
Insurance Problems- Ultrasounds
Ivorytower2
member
Hi all,
Just wondering if anyoe encountered any problems with insurance and ultrasound. My first two intensive ones were done at a hospital (not dr office) and I only had to pay a $50 copay. I moved and switched doctors and when I had my anatomy scan (also at a hospital) I'm was charged the insurance rate (several hundred dollars less than standard rate, but still it's over $200). It's standard prenatal care, so I just assumed it would be covered like the other ones. Wondering it it was coded wrong or something. I called insurance and they just said that was the insured rate and when i explained about prior ultrasounds, they couldnt give me an answer as to why this was billed differently. Anyone have a similar experience or any advice?
Just wondering if anyoe encountered any problems with insurance and ultrasound. My first two intensive ones were done at a hospital (not dr office) and I only had to pay a $50 copay. I moved and switched doctors and when I had my anatomy scan (also at a hospital) I'm was charged the insurance rate (several hundred dollars less than standard rate, but still it's over $200). It's standard prenatal care, so I just assumed it would be covered like the other ones. Wondering it it was coded wrong or something. I called insurance and they just said that was the insured rate and when i explained about prior ultrasounds, they couldnt give me an answer as to why this was billed differently. Anyone have a similar experience or any advice?
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Re: Insurance Problems- Ultrasounds
I am allowed 1 per trimester and then they have to have pre-cert. My high risk does it for me but not all offices will and it's ultimately your responsibility so I would call and ask
I know my 8 week one was like 90.00 and my anatomy 170 and my echo was 240... After insurnace. I have so many now though I just pay about 30-60.00 depending which is 20%
I called the insurance prior to going for my first u/s to make sure it would be covered. I was assured it would be because of where I was going. When I got there I had an intern do the u/s and never saw a doctor. Received a bill later from insurance who told me the doctor who reviewed the u/s after I left didn't work in that department and therefore wasn't covered. How can a doctor work in a department if they don't work in the department? Makes your head hurt. Regardless insurance would budge and in the end the hospital charged me for what the difference would have been had the insurance actually covered it.
Long story short keep in mind insurance companies are just that, companies. They are interested in their profits so if they can get out of paying something they will. Best thing to do is call before hand if where you are getting anything done changes. I even spoke to them about L&D and told them I didn't think I would be clearly thinking to ask each nurse and doctor before they walked into my room if they were covered under my insurance. I was told this was considered emergency care which is 100% covered under my plan. But you can never be too careful!
I filed four grievances in my first couple of trimesters and tweeted several times (and FYI, the tweeting got me a lot further than filing the grievances). Good news is that it got sorted eventually, but I really had to get involved and stay on top of it.
OP, the situation sounds legit (i.e., not all u/s are the same), but if you can't let it go, you could see what procedure codes were billed for each u/s and compare them. If it makes you feel any better, last pregnancy, I paid totally OOP for my a/s, and I paid ~$600.
As PPs stated, I highly recommend keeping every statement and bill you receive very organized. Document every follow up phone call you make on them to offices/insurance co./hospital, etc. (date/time/contact name/status). If you choose to hold off on paying any bills or put a minimum payment plan in place, keep in touch with the offices/labs so they are aware of appeal/claim status' and don't hit you with collections/fees, also keep track of all payments made in case they can be reissued to you.
I also recommend getting in touch with advocates on your behalf. Many practices have financial directors who are willing to assist patients - the finance director for my OB directly dealt with the hospital billing director on my behalf (this is who finally resolved the coding errors, even after the doctor had resubmitted my entire case). Also, the insurance company may have a patient advocacy rep in your area that would be willing to assist you in processing an appeal as a single case (including a multitude of claims, rather than dealing with each claim individually). I have BCBS and they process each claim through whatever regional office the service falls under (ie. My plan is based in MD, but if a lab is in CA the claim for that service is processed through a BCBS CA office - it's very confusing, and time consuming to deal with). Utilizing the patient advocate and making the entire case one appeal greatly assisted me in staying on top of all the claims.
Best wishes, I certainly understand the aggravation, but you are certainly entitled to the coverage your policy provides and in many cases these issues can very well be worth fighting.