Post # 1
My husband have decided to start TTC this month. I figured we had better get an idea of what our insurance coverage would be. I don’t know about you, but insurance plans can be so confusing to read through. I have copied this straight from our plan and I have some questions.
MATERNITY SERVICES Covered Services – After pregnancy is confirmed, Covered Services include prenatal examinations and tests, delivery, and one postpartum office visit. Coverage includes but is not limited to a minimum of 48 hours inpatient hospitalization following a vaginal delivery and a minimum of 96 hours inpatient hospitalization following a cesarean section. Coverage is provided for the newborn Member’s routine stay in the hospital nursery from the moment of birth. Covered Services also include but are not limited to elective circumcision for the newborn Member. Please refer to Article I – Eligibility and Enrollment for enrollment requirements for newborns.
Limitations or Exclusions – The following services are not covered: 1. Amniocentesis, ultrasound, CVS (Chorionic Villi Sampling) or any tests or procedures performed exclusively for gender determination or selection are not covered. 2. Home birth.
My first question is that it includes ultrasounds in the services that are not covered, but includes prenatal examinations and tests. For those who have been through this or are knowledgeable about it, what would be a prenatal examination or test that isn’t an ultrasound that I would have to do? Also, any ideas how much an ultrasound or CVS/amnio is without coverage?
Any other words of advice welcomed.
Post # 2
I’d recommend calling your insurance company to get an explanation of that and to clarify exactly what’s included.
Post # 3
liade : Give them call to clarify but my understanding is that ultrasounds done only for gender determination would not be covered but ultrasounds done for pregnancy care would be.
ultrasounds… performed exclusively for gender determination or selection are not covered.
Post # 4
liade : I’d suggest calling the member services number for your plan for clarification. There are so many variations in the way plans are structured, there’s a high likeliehood other people’s experiences may not apply to your situation.
Post # 5
I had planned on calling soon. I think I wanted to see what others opinions are on it was. Does anyone have coverage similar to this? I feel that our health insurance is crap compared to what I’ve heard others talk about.
Post # 6
liade : I’ll be 11 wks tomorrow and my coverage says something quite simial to yours. At my first appointment, we were given an insurance breakdown stating that as long as we don’t have any complications, we will pay $0 out of pocket except maybe some hospital fees-YAY! If we do have complications, there’s an 80/20 rule or something like that.
The limitations section… read the WHOLE statement for #1… tests (ultrasound CVS etc) done EXCLUSIVELY for determining gender are not covered.
Ultrasounds are not as common as you might think or hope. I had 1 at my confirmation appointment that is used to make sure the baby is in there and for dating purposes. I will have another Friday at my 2nd appointment as part of the NT scan (checks for downs, etc), and then I’ll have one around 18-20 weeks for the anatomy scan (gender usually determined here, but not the sole purpose of the scan). Most people who get more have gone through fertility treatments to get pregnant or they are considered high risk.
Other prenatal tests include urine tests and blood work, glucose testing, pap smear, and probably a few others. As far as I can tell most tests use blood and urine samples. Group B Strep is tested with a swap late in the pregnancy.
As for the cost of tests outside of insurance… Probably not worth asking here. I’d imagine answers will vary. Talk to your doctor about optional testing, then see what insurance will cover as well as any costs you would be responsible for. I’m having the NT scan which includes an ultrasound but I could have opted for other testing at this stage that would have given us the gender also but it’s just done via bloodwork and since I’m not over 35 or high risk, I was told by my dr it was unlikely my insurance would cover it and could be anywhere from $300-500 depending on a few things.
Post # 7
labs and ultrasounds weren’t covered for my pregnancy. i think the ultrasound was a few hundred bucks. cant really remember.
Post # 8
TXbride2015 : Congratulations on your pregnancy!! Thank you! This was incredibly helpful. I feel like it’s hard to get a good understanding of what to expect until you’re in the middle of it! Thanks 🙂
Post # 9
knpswp : Thanks, good to know!
Post # 10
Ultrasound coverage varies greatly and I know mine are covered 100% under prenatal care because I’m designated as high risk (so it’s medically necessary testing), but other friends had to pay if they needed more than 2 sonograms without having any additional risk factors. If you look under the imaging/radiology portion of your policy it might further indicate if there is an additional copay for ultrasounds.