Post # 1
I’m about 10 weeks along and my doctor has given us the option of doing the nuchal translucency screening in a few weeks. We want to do it, but aren’t sure if it will be covered. I called my insurance company and the best they could tell me is that one ultrasound is covered and all others would have to be medically necessary. Does anyone know: is the anatomy scan considered medically necessary? In your experience, was/is your NT covered? I know all insurance plans are going to be different, but I’m just trying to get a guage of what to expect. My fear is that I will get it, and then for some reason they will deny the anatomy scan and I’ll get this huge bill. Help me ladies! We are in the US, so bees from other countries probably wouldn’t have this issue!
Post # 3
I think it depends on your insurance. My insurance covers everything through delivery. I just had to pay a copay when they confirmed my pregnancy.
Post # 4
@emelee: Your doctor shouldve given you a number/code to give to your insurance company so you could get a definitive answer.
Post # 5
@emelee: The NT scan is more than likely not medically necessary. It’s just early detection for any issues. A lot of those things can also be discovered at the anatomy scan. Some people get the NT scan because if they discovered an anamoly they may consider terminating the pregnancy. That is easier to do at 12 week than 20.
Post # 6
I got an NT scan done with bloodwork, and it got billed as two parts of the same test!
I would assume it’s covered, and my doctor considered an anatomy scan to be medically necessary!
I had BCBS for the first 2 trimesters, if that helps!
Post # 7
My DR gave me the codes to ask my insurance. They were covered after a copay for the visit.
Post # 8
- Wedding: November 2013 - St. Augustine Beach, FL
@emelee: Before getting the procedure done verify that a clearance confirmation number approving the procedure has been obtained by your doctor. The front desk should be able to give it to you if you ask. If they can’t then I would wait until they obtain it. Without a confirmation number, the insurance company will most likely deny the claim.
Post # 9
@emelee: I had (was supposed to anyway) a NT scan. They told me the ultrasound portion was covered but not the labwork (out of network).
I ended up being too far along for the test so they just kind of gave me the ultrasound and didn’t do the labwork. I had the penta-screen because I was far enough along for that one on the same day. They covered that in full and my ultrasound from what was supposed to be my NT screen. They also covered my anatomy scan. I believe anatomy scan’s would be medically necessary.
I think it just really depends no your insurance but I would assume the anatomy scan is medically necessary. After I requested the NT scan my hospital called back to tell me what my insurance covered and then scheduled my appointment.
Post # 10
Mine is covered but only between 11 and 13 weeks. Have to make sure to get my appointment then!
Post # 11
My insurance said the same thing. It should be covered if the doctor orders it. I think they are just not covering elective ultrasounds Also the doctors office can and will make sure things clear your insurance. Call them if you want and they will break it down for you. They do this everyday with the same dozen companies.
Post # 12
- Wedding: October 2013 - Rustic mill, historical site
We were told the exact same thing, that one scan is covered, the others have to be medically necessary. However, the N/T test was elective, we submitted the bill, they paid it. My second ultrasound, the anatomy scan was done at the hospital and covered by medicare (I’m Canadian) then my third, was a 3D scan, not scheduled by my OB and totally elective and just for fun, we submitted the bill and they still paid for it, lol.
All my other ultrasounds were at the hospital and paid for by medicare,( although they could have been done in a private lab and covered by my private insurance becasue they WERE medically necessary, they needed to montor my son’s growth) or in another doctor’s office who had an u/s machine there.
We were prepared to pay out of pocket for both scans, the first was 400 I think and the 3D one was 250? We were happy the insurance covered it but prepared for if they didn’t.
Post # 13
Thanks ladies! All of your comments were helpful. It’s annoying to me that when calling my insurance they couldn’t even tell me specifically if it would be covered or not. I’ll see what my doc says about it. I see him Tuesday when I am at 11w1d.
Post # 14
@emelee: The NT U/S is typically part of the sequential integrated testing for genetic issues. If this is covered then the NT U/S should be covered.
I have Kaiser and it is covered fully, the blood tests and the NT U/S.
Post # 15
@emelee: Ask your doctor for the billing codes for the procedures. You can call your insurance company and ask them if those codes are covered.
Granted, this may vary by hospital, geographic location and insurance company. But, since I have a high deductible, I had to pay for the NT and anatomy scan out of pocket (at the contracted rate). The NT scan + bloodwork was about $800 and the anatomy scan was about $600. Just in case you were curious about what it *MIGHT* cost…