insurance coverage for ultrascreen/NT scan?

Anyone else have an issue w/ their insurance covering the ultrascreen/NT scan?

I received an explanation of benefits from my insurance carrier (Blue Cross Blue Shield) basically saying I'd be liable for the ultrasound bill ($400!! ) b/c the procedure wasn't medically necessary (something to that effect, I left the paper at work so I can't write it verbatim).

Anyone else have to deal w/ this? I called the doctor's office and they said they'd call my insurance and then see if my secondary will cover it (although they always seem to reject charges and say my primary should cover it! .....and if they don't cover it worst case scenario is they'd bill me the patient rate of $200!! I am so annoyed since I told my doctor's office I wasn't even interested in having testing done b/c no matter what the results DH and I knew we wouldn't do anything about it, other than worry unnecessarily), if it turns out I end up having to pay for testing I didn't feel the need to have done in the first place I am going to be so angry!!! PS insurance companies really suck!!!

Now I'm worried about my upcoming Level II sono, will they give me a problem covering that one too?? UGH!!

Message edited 5/15/2012 9:17:16 PM.

Re: insurance coverage for ultrascreen/NT scan?

It really depends on your insurance. We have a $500 deductible for the year so we got a bill after the NT scan as well and had to pay a few hundred dollars (which we paid with a health savings account). The bill came from LabCorp and we've gotten a couple smaller ones since that (for bloodwork) but now we hit the deductible so we don't have to pay anything else out of pocket through birth.

Re: insurance coverage for ultrascreen/NT scan?

I have NC BCBS and didn't have any issue with my NT scan either pregnancy. That's really strange. The office should've informed you in advance that it wasn't covered -- I thought they check those things so this doesn't happen.

Re: insurance coverage for ultrascreen/NT scan?

Posted by springsandra

I have NC BCBS and didn't have any issue with my NT scan either pregnancy. That's really strange. The office should've informed you in advance that it wasn't covered -- I thought they check those things so this doesn't happen.

Re: insurance coverage for ultrascreen/NT scan?

Yes, my office told me to call my insurance and ask, the insurance company then called the OB and asked for the "procedure code."

I was told it was covered after I satisfied the $350 deductible, so I'm sure I will have to pay something.

Some insurance companies do jot cover it at all

Re: insurance coverage for ultrascreen/NT scan?

Do you have a deductible? Because if you do, you'd have to pay that before it was covered anyway so there's a chance you would have had to pay some or all of it anyway

I have empire bcbs and mine was covered, but it really depends on your plan. Do you still work at the same job? Don't want to post it publicly but the three letters place? Bc if so, my bff's husband works there too and she says the coverage is really NOT woman/testing/contraceptive friendly :( So it very well could be that they just don't cover it.

Re: insurance coverage for ultrascreen/NT scan?

I have anthem blue cross and it was covered. That doesn't seem fair, I would put up a huge fight. My dh had major surgery 2 years ago and a few days before it was scheduled we got a letter in the mail from some 3rd party company his doctor requested to do monitoring during the surgery. I called blue cross to see if it would be covered and then months later we started getting bills for 10k as blue cross denied the claim. It took months of calling but I didn't pay a dime. I don't think it's fair to be billed for something if you weren't informed of the charge. Good luck!

Re: insurance coverage for ultrascreen/NT scan?

I have Empire BCBS shield and they covered my NT scan with no problems. I think all I paid was a $30 copay.

Re: insurance coverage for ultrascreen/NT scan?

It depends on whether or not you have a deductible. I have a pretty high deductible, so many bills went to me before I met it.

Re: insurance coverage for ultrascreen/NT scan?

Posted by HelenZ

Posted by springsandra

I have NC BCBS and didn't have any issue with my NT scan either pregnancy. That's really strange. The office should've informed you in advance that it wasn't covered -- I thought they check those things so this doesn't happen.

I said that to the girl in billing I spoke to and she got a little snippy and said "we have so many patients we can't call ahead for everyone beforehand"

Re: insurance coverage for ultrascreen/NT scan?

I would appeal it!

Re: insurance coverage for ultrascreen/NT scan?

my NT scan was covered (GHI) we just had to make sure the dr and ultrasound tech took the insurance. We just had to pay $15 for the copay