Insurance question - ultrasound

meg2704 · March 2017

I got a bill from my insurance company for my second trimester ultrasound. I sent them a message and they responded that it was not considered medically necessary. Has anyone else had this happen? Is it normal to have to pay out of pocket for an ultrasound required by the doctor? I have Aetna insurance.

mirdamae03 · March 2017

By second trimester ultrasound are you referring to the anatomy scan or another ultrasound? I'd think that was pretty darn medically necessary, and should be covered. I don't have Aetna though, so I couldn't say 100%. You're in OKC right? Where did you go for the scan, Lakeside?

meg2704 · March 2017

@mirdamae03 yes it was the anatomy scan. I definitely think it should be considered medically necessary since it's checking the total anatomy of the baby and uterus! I went to lakeside radiology.

mkrel · March 2017

I think it depends on your insurance, so I would call them. Mine covers one per trimester, and any additional as medically necessary would be an additional copay above and beyond my general prenatal visit copay. Each company and policy is different.

mirdamae03 · March 2017

Did you do the NT scan? I wonder if that would have been considered your 1 for second tri if you did.

danij0 · March 2017

I have Aetna and both my ultrasounds (NT and anatomy) weren't fully covered which I was shocked to find out. DH and I both called and got the same answer. I think our's is partially due to my OB recommending going to the high risk docs for ultrasounds (though I'm not high risk). We figured we're more than likely going to meet our out of pocket maximum anyway so didn't really fight it.

meg2704 · March 2017

I have only had two ultrasounds so far, the one to confirm pregnancy which was covered and then the anatomy scan. However, I have a low placenta and the doctor wants to do a third ultrasound to determine if it has moved away from the cervix. This is so frustrating. I have contacted the doctors office to see if there's anything they can do.

jesselayne8 · March 2017

I had to pay for my anatomy because I hadn't met my deductible.

n0soup4u · March 2017

I have had to pay full price for both of my scans because I need to meet my deductible before insurance will pick anything up. Could this be the case for you as well?

mrt · March 2017

Before you meet your deductible you would have to pay, but it would still be "covered", they wouldn't be telling you that it's not medically necessary. I would want to find out. Maybe your doctor's office coded the ultrasound incorrectly?

danij0 · March 2017

Oh now that everyone is mentioning it I believe mine was "covered" but I didn't meet my deductible yet. We were confused because our insurance packet said all prenatal visits were completely covered even before deductible and then they weren't because it really meant the basic prenatal visits.

ashleyl31 · March 2017

danijo said:

Oh now that everyone is mentioning it I believe mine was "covered" but I didn't meet my deductible yet. We were confused because our insurance packet said all prenatal visits were completely covered even before deductible and then they weren't because it really meant the basic prenatal visits.

That's how mine is. I pay for all prenatal visits and such after the birth, but I'm charged now for ultrasounds, other tests, and blood work.

meg2704 · March 2017

I guess I need to call and figure it out. Thank you all so much for your insight!

Insurance question - ultrasound

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