Insurance Halp!

[honda13]

So.....I just found out my anatomy scan is not covered as routine maternity care.    It's also not considered preventative.  So wtf?  I'm pretty sure it is routine and preventative.   I have a bill coming for this one and they weren't able to get all the images so I am going back next week.  Which I am also being told I will be billed for.  Does this sound right?  I swear my AS for DD1 was not subject to the deductible, but maybe I'm wrong.  This is a routine ultrasound, right?  I feel like I'm off my rocker and the lady at the insurance company was no help.  She just kept telling me I was wrong.  Anyone have any knowledge about this?

[bewise]

I don't have tons of knowledge on insurance....but that doesn't sound right! And in my experience, it has been covered. Has your insurance changed since DD?

Maybe it got coded/billed wrong? I'm sure there is some process with your insurance company to dispute it?

[honda13]

bewise, insurance has not changed. MH is still with the same company and they still have the same insurance. She kept saying "it's not coded as preventative or routine, it's subject to the deductible". I'm like ok, so they need to rebill it with a different code? She said that's between me and my doctor. I spoke to the nurse at my drs office earlier this week about the re-do and she said yes it's covered, we need those images. This wasn't an extra test because of some type of complication. It's my understanding this is routine. I hate dealing with insurance so much!

[bewise]

Hopefully, it's a simple fix and the doctors office can just change the way it was coded! Maybe it was just a clerical error.

So frustrating though!

[sabrinaml]

No clue. My dating ultrasound and my 1st round of blood work weren't covered. (Went towards my deductible)
I'll have to make sure to remind them to code it as preventative. I'm scared because I will be skipping a "regular" U/S and going directly to a level 2 and meeting with a specialist that same day.
I hate dealing with insurance companies. They are outrageously priced and half the time don't cover anything!

[agm04]

hmmm i am certainly not an expert, but i thought the only things that weren't subject to the deductible were things like annual exams, vaccinations, etc. full disclosure, i knew we'd be meeting our OOP max with DD and we will with this baby too, so i don't pay super close attention. i just know that i paid more than a copay for the majority of my visits with DD and for the first couple with this pregnancy, because i hadn't met my deductible.

[honda13]

Jan 25, 2017 17:01:07 GMT -5 agm04 said:

hmmm i am certainly not an expert, but i thought the only things that weren't subject to the deductible were things like annual exams, vaccinations, etc. full disclosure, i knew we'd be meeting our OOP max with DD and we will with this baby too, so i don't pay super close attention. i just know that i paid more than a copay for the majority of my visits with DD and for the first couple with this pregnancy, because i hadn't met my deductible.

I didn't have to pay copays for my last pregnancy. I could be wrong. I'm a hormonal mess and this is making me pissy.

[sabrinaml]

I had different insurance with my 1st, but I barely paid for anything.
I know I have to pay for almost all of my sons vaccinations. I don't pay for his actual well visit with his ped (no copay either) but when he is sick I pay for that visit as well as a copay. I don't remember how much our deductible is off the top of my head.
I know with my appointments so far- I've been billed for all lab work, a flu shot that I didn't even want, and an ultrasound. No copay, and I haven't been billed for an actual visit with my OB.

[sdlaura]

That sounds crazy to me. I would definitely call back and argue with the insurance company. I've never heard of an anatomy scan not being covered.

[marshian]

I only have to pay an office co-pay for every visit to my midwife. Ultrasound, bloodwork, whatever. It's all just the office visit co-pay. Because it's all prenatal and preventative and is covered.

I would call your insurance and get them to walk through it. It's possible the coverage structure changed. But I thought prenatal visits were required to be free as a result of the ACA?

[honda13]

Jan 25, 2017 17:41:34 GMT -5 marshian said:

I only have to pay an office co-pay for every visit to my midwife. Ultrasound, bloodwork, whatever. It's all just the office visit co-pay. Because it's all prenatal and preventative and is covered.

I would call your insurance and get them to walk through it. It's possible the coverage structure changed. But I thought prenatal visits were required to be free as a result of the ACA?

I think this may be where I run into the problem. My OBs office doesn't do ultrasounds. They are scheduled at a radiologist office (is that the right word). So I think if my OB office did them it would be part of my visit, but since she doesn't it goes towards the deductible. Does that make sense?

[marshian]

Jan 25, 2017 17:56:51 GMT -5 honda13 said:

Jan 25, 2017 17:41:34 GMT -5 marshian said:

I only have to pay an office co-pay for every visit to my midwife. Ultrasound, bloodwork, whatever. It's all just the office visit co-pay. Because it's all prenatal and preventative and is covered.

I would call your insurance and get them to walk through it. It's possible the coverage structure changed. But I thought prenatal visits were required to be free as a result of the ACA?

I think this may be where I run into the problem. My OBs office doesn't do ultrasounds. They are scheduled at a radiologist office (is that the right word). So I think if my OB office did them it would be part of my visit, but since she doesn't it goes towards the deductible. Does that make sense?

That sort-of makes sense, except that it's still prenatal care. You might need to talk to the radiologist and have them code it differently so it goes through as prenatal and is covered.

[honda13]

Jan 25, 2017 18:03:05 GMT -5 marshian said:

Jan 25, 2017 17:56:51 GMT -5 honda13 said:

I think this may be where I run into the problem. My OBs office doesn't do ultrasounds. They are scheduled at a radiologist office (is that the right word). So I think if my OB office did them it would be part of my visit, but since she doesn't it goes towards the deductible. Does that make sense?

That sort-of makes sense, except that it's still prenatal care. You might need to talk to the radiologist and have them code it differently so it goes through as prenatal and is covered.

Thanks! I'll check into that with the office tomorrow.

[marshian]

Jan 25, 2017 18:06:02 GMT -5 honda13 said:

Jan 25, 2017 18:03:05 GMT -5 marshian said:

That sort-of makes sense, except that it's still prenatal care. You might need to talk to the radiologist and have them code it differently so it goes through as prenatal and is covered.

Thanks! I'll check into that with the office tomorrow.

I know it's a pain for you, but by law they have to cover prenatal care. It might take a while to sort out, but you should not be on the hook. At least, that's how I understand it. Definitely talk to your insurance provider, though. They will help.

[honda13]

Jan 25, 2017 18:09:07 GMT -5 marshian said:

Jan 25, 2017 18:06:02 GMT -5 honda13 said:

Thanks! I'll check into that with the office tomorrow.

I know it's a pain for you, but by law they have to cover prenatal care. It might take a while to sort out, but you should not be on the hook. At least, that's how I understand it. Definitely talk to your insurance provider, though. They will help.

I called insurance and they swear it's correct. They said, "nothing for maternity coverage is routine or preventative. It all is applied to your deductible.". I'm going to call the nurse at my OBs office tomorrow. She deals with a lot of the insurance stuff so she should be able to help me.

[applemuffins]

Insurance is soo confusing. Every plan is different. I have to pay a copay for my ultrasounds, but not my prenatal appointments. I have global billing they said, which means all costs will be billed to me at the end. But I have still received bills for lab work and stuff, so I'm not sure how this all works. It was way less confusing when I was pregnant with DD under a different plan. Definitely call you office tomorrow and have them speak with your insurance company. They will have a lot more experience with this.

[marshian]

Jan 25, 2017 18:13:59 GMT -5 honda13 said:

Jan 25, 2017 18:09:07 GMT -5 marshian said:

I know it's a pain for you, but by law they have to cover prenatal care. It might take a while to sort out, but you should not be on the hook. At least, that's how I understand it. Definitely talk to your insurance provider, though. They will help.

I called insurance and they swear it's correct. They said, "nothing for maternity coverage is routine or preventative. It all is applied to your deductible.". I'm going to call the nurse at my OBs office tomorrow. She deals with a lot of the insurance stuff so she should be able to help me.

Yes, use the staff at the office. They employ experts in coding and definitely know insurance well!

I might be reading the law wrong, but it sounded like prenatal care is supposed to be essentially free. A nominal copay I understand. Anything more, I don't get.

[agm04]

This is all so interesting. I had a lot of ultrasounds with my first pregnancy, so maybe that's why I paid all the time?

[Run20K]

Let us know how it goes. I really don't remember paying anything for my 1st. I've had a couple of hits with this pregnancy. We were billed almost $500 for the anatomy scan (maybe because they're twins?) We also took a hit for the N/T scan.

[animaldoctor]

My NT scan and anatomy scan were not covered either because they are technically elective. They count toward my deductible which I would meet anyway at delivery so in a way they don't cost extra... KWIM?

[animaldoctor]

Jan 25, 2017 18:09:07 GMT -5 marshian said:

Jan 25, 2017 18:06:02 GMT -5 honda13 said:

Thanks! I'll check into that with the office tomorrow.

I know it's a pain for you, but by law they have to cover prenatal care. It might take a while to sort out, but you should not be on the hook. At least, that's how I understand it. Definitely talk to your insurance provider, though. They will help.

Yes to prenatal care, but ultrasounds aren't covered for everybody. Very insurance dependent because they are elective.

[marshian]

Jan 26, 2017 9:09:32 GMT -5 animaldoctor said:

Jan 25, 2017 18:09:07 GMT -5 marshian said:

I know it's a pain for you, but by law they have to cover prenatal care. It might take a while to sort out, but you should not be on the hook. At least, that's how I understand it. Definitely talk to your insurance provider, though. They will help.

Yes to prenatal care, but ultrasounds aren't covered for everybody. Very insurance dependent because they are elective.

Ugh, that's ridiculous! 

[honda13]

Jan 26, 2017 9:08:32 GMT -5 animaldoctor said:

My NT scan and anatomy scan were not covered either because they are technically elective. They count toward my deductible which I would meet anyway at delivery so in a way they don't cost extra... KWIM?

Thanks! That makes more sense. Sucks, but whatever. Luckily my deductible is manageable and we have a flex spending account. I have to go back because they couldn't get all the images. I'll be unhappy if I have to pay for that one too.

[cateyes]

Jan 26, 2017 8:40:21 GMT -5 Run20K said:

Let us know how it goes. I really don't remember paying anything for my 1st. I've had a couple of hits with this pregnancy. We were billed almost $500 for the anatomy scan (maybe because they're twins?) We also took a hit for the N/T scan.

I have friends who have had twins and they said that yes, you get hit for the second baby. So while a scan may be covered for one, it is not covered for both and you have to pay the extra charge. Just the beginning of double for everything.

[iris1264]

As PPs said, every insurance will be different. I find it strange that the AS would be considered elective though. In my case, the AS will go toward the deductible first then the rest will be covered at 80% (which is what the rest of my maternity care is covered at). But I have $0 co-pays for all my regular appointments.

[violetrose]

My insurance doesn't cover any ultrasound unless it's medically necessary. For example- they didn't cover my dating ultrasound and they aren't covering my autonomy scan but they did cover the ultrasound they gave me around 10-12 weeks because they couldn't find the baby's heartbeat on a doppler. It's really annoying but I will have to meet my deductible anyway with delivery so I'm trying not to let it bother me.

[honda13]

Thanks ladies. Insurance is such a pain in the butt! I'm sure I will be meeting my deductible soon. After some research I found I did have to pay for DD1 ultrasound. Cost was $33.10 which was what was left in meeting my deductible. That must be why I thought it was covered at 100%. A few hundred dollars I would remember paying, $33 not so much.