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NT Scan Not Covered?

posted 4 months ago in Pregnancy
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    PandasWifey    September 26, 2009   Denver, Colorado

    Did anyone elses doctor NOT order them an NT scan? Mine didn't so I called to find out why and they scheduled me for one last minute, but now they just called back to tell me my insurance might not cover it because the Dr. didn't order it herself for me. Apparently she found it "medically unneccessary for us" and didn't even discuss the option with us AT ALL. I'm wondering if this is standard at all, because everyone else on these boards seems to have had or have an NT scheduled by their doctor... I'm thinking I may need to find a new Dr...

     
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    kiddosc    September 5, 2010   Houston, TX

    My doctor didn't order one, and it's not standard at the practice I go to if you're under 35 and don't have other risk factors.  My insurance wouldn't have covered it either for the same reasons.  If you would consider terminating a pregnancy because of a genetic abnormality, then I would suggest you get this earlier test.  But if you just want to know to be prepared for a possibly disabled child, then you are ok with doing the quantitative screening blood test and the anatomy scan which happen a bit later. 

     
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    PandasWifey    September 26, 2009   Denver, Colorado

    @kiddosc:  Thanks for the feedback. I'm curious to hear more from others. The nurse did ask us about a test for Cystic Fibrosis that wasn't covered, but not about the NT scan. I'm mad we weren't given the option. Honestly, I dont think I would keep a baby with Down Syndrome - I'm pretty sure I am not the type of person who could handle the mental and financial strain of that :(

     
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    Mrs. Spring    May 10, 2009   California

    It seems like the real issue here is that your doctor didn't discuss the scan with you.  Maybe just communicate to your doctor that you'd like to be informed of all procedures, voluntary procedures included, in the future.  To be honest, I'm in the process of changing doctors right now, and it's such a hassle.  I'm not sure I'd switch doctors over this, since it seems more like a miscommunication than a deliberate omission.

     
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    orvis18    August 12, 2011   Boston, Ma

    @PandasWifey:  My first doctor said the same thing even though my insurance covered the screening.  She said it would be insurance fraud to have the test if there were no risk factors in our families. I switched because of this and had my NT Scan today. I can tell you for me at least, it was incredibly reassuring and I'm very happy I decided to change providers. 

     
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    MarryMeTiffany    November 30, 2011   Illinois

    @PandasWifey:  With my now 3 year old son my doctor didn't even offer the test and IRL I have never heard of anyone having a NT scan.

     
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    Moja Milosc    September 24, 2011  

    Many doctors don't offer NT scans for women who have no risk factors, I was never offered one and was never told what it was. You can't always opt to have medical procedures, there needs to be justification or insurance won't cover it. For example, you can't go to your doctor and say you want an xray if there's no medical need for it. I don't think wanting the scan because you would consider terminating if the test showed a high risk of DS is a valid enough reason for the insurance companies, but I'm not entirely sure? But that is something your doctor probably should have gone over with you.

    I wouldn't change doctors because he doesn't see a medical need for an NT scan, because whatever doctor you switch to will probably agree, unless you believe you have some risk factor for some reason? Did they offer you the blood test? The results from that test should be factored into whether or not you need the scan.

    I agree it's a good idea to let someone at the office know you're interested in maybe sitting down and going over the common pregnancy tests and understanding why they are or aren't recommended for you. If they won't go over this information with you then maybe switching is a good idea.

     
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    cascadecherub    December 2011  

    When we had our 8 week appointment, we were told that the nt scan isn't covered by insurance but the later ones are. We were made well aware of this when we went in.

     
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    plantains    July 17, 2011   Live in NY, wedding in CT

    maybe schedule a talk with them to go over everything as other posters have suggested? I have never heard of anyone not having an NT Scan, I thought it was standard procedure. Maybe it differs regionally.

     
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    regberadaisy    August 14, 2010  

    I have to double check but if I remember correctly it was covered like all my other u/s. Which my insurance only covers a portion because I have coinsurance on mine.

     
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    PandasWifey    September 26, 2009   Denver, Colorado

    @Moja Milosc:  I understand, but the "risk factors" are literally that you are:

    1.) Over 35

    and

    2.) Have a history of DS in your family.

    I find it hard to believe that the hoards of women on these boards who all had the NT scans ordered by their doctors ALL fall into one of those two categories.

    @Mrs. Spring:  You hit the nail on the head! I'm more upset about the fact I had to figure out my options via Weddingbee of all things, because it wasn't even brought up with me, especially with a test like this where there is only a short window to have it done. The fact that I would terminate a DS baby combined with the fact I am having a very difficult pregnancy due to not being able to take my regular prescriptions, I would be very upset if I had to wait for later tests only to find out I suffered needlessly for 6-10 extra weeks.

    @orvis18:  I'm so glad I'm not alone! How did the transition go? When you brought it up with your new potential Dr. did they agree to do one right away? And was it covered by your INS?

    @plantains:  Yeah, I know of like maybe a HANDFUL of bees that weren't ordered the scan, so that was my thinking. With the commonality of such at test, at the very least it should have been discussed with me :(

     
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    Vegas Pug    November 27, 2010   Suburban Chicago

    My doctor told me that she was federally mandated to discuss the test(s) with me, but that it was my decision to proceed if I chose to do so.  Since she was required to provide me with the option, the insurance company does not have the choice to not approve it.  BUT, they did require me to go to a specific place for the test.

     
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    PandasWifey    September 26, 2009   Denver, Colorado

    Update - so I decided to call a different doctor in the area and the first one I tried I told them my situation and they informed me that the NT scan was STANDARD PROCEDURE for them and they order it for every single patient. They said they'd be sure to get me in in time for the scan. Unfortunately, I don't think my husband will be able to make the new apt. time, since they had more limited availability, but I feel so much better already knowing I dont have to deal with this other irresponsible dr. anymore :)

     
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    krsmall    July 16, 2011   Ashburn, VA

    Actually having a downs baby is not based on family history, there is a small likelihood of downs being related to family history, but the majority of babies born with downs, there is no family history of Downs Syndrome.  Also, your risk of having downs is lower if you are under 35, but that does not mean that because you are under 35 you have no risk of having a downs baby.  The NT scan should be discussed by all doctors, but it is your election to have the scan or not. 

     
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    chastenet    June 19, 2010  

    @PandasWifey:  Props to you for choosing to change to a practice whose procedures you are more comfortable with!  Is an NT scan always medically necessary? No.  It is a useful test to do anyway to make sure the baby is developing properly?  Yes.  Should your other doctor have clearly laid out your options and explained things to you?  Most definitely!  Also, I would like to point out, that I have a friend whose mother was told she already 3 healthy children and was under 35 so there was no risk and no need for the test.  Her 4th child was born with Down's syndrome.  She sued since she was advised not to have a test that could have diagnosed her daughter's condition in utero.  I think it's better to have as much information as possible.  Also, to the PP whose doctor said it was "insurance fraud" if you didn't have any risk factors, I find that laughable!

     
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    chrispygal    September 4, 2011   MA & ME

    Glad you have found a doctor that will move ahead with the NT scan.   My hubby didn't make that appointment either.  My baby wouldn't get into the right position to do the measurement, but they did say they would move forward with the second blood test anyway and that my results would still be viable, with a slightly higher chance of a false positive.  I'm still glad we are doing the test though and I hope yours goes well.

     
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    mwitter80    December 11, 2010   Connecticut

    My insurance doesn't cover it either unless there is a medical reason for it. The medical reasons they site is age (they view advanced maternal age as 30), family medical history, and previous children with major defects.

    I technically fell into all 3 so I got a scan. The only other woman I know IRL that got one was my sister. No one else I know did. 

    ETA: It's great that you found another doctor who will do it. I would just make sure it's covered under your insurance or you can afford to pay out of pocket so it's not a surprise if you get a bill. (I looked it up on my insurance claims and the insurance paid $723 for it)

     
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    PandasWifey    September 26, 2009   Denver, Colorado

    @mwitter, for some offices (actually I believe most offices) it's standard procedure to order the scan regardless of maternal age. My insurance will cover it but only if it's ordered by the doctor. I shouldn't have to beg my dr to order one for me when it's standard procedure everywhere else so I went to a new dr. Also I'm 29, so I think im close enough to 30 where I'd definitely want the test and no dr. Office should be fighting me on that, let alone not even informing me of my option to have it.

     
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    PandasWifey    September 26, 2009   Denver, Colorado

    Ps thanks to everyone for all the valuable info! @chastnet that story is out of this world. I'm usually against suing in general but I can totally see why that mom would!

     

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