Post # 1
I am 11 weeks pregnant with my first baby. At my first OB appointment last week, he referred me to have some fairly standard perinatal testing done, including measuring the transnuchal fold (can be an indicator for Down’s Syndrome). I have horrible health insurance which does not cover “genetic testing,” which this is considered despite being just an ultrasound. The out of pocket cost could range anywhere from $400 to $1800 depending on how they bill it and if my insurance will cover any part of it – which no one, neither the hospital billing staff nor the insurance company – can tell me. We have already spent more than that in the last few months just to get pregnant, since infertility treatment is also not covered by my insurance. I am considered low risk at this point, with no known complications and no history of genetic abnormalities in my family. We also know that even if the baby turns out to have Down’s, we would not abort or do anything differently. I am wrestling with whether or not to do the test and risk another huge out of pocket expense, or skip it and just move on. Has anyone been offered this test and turned it down? Are there other benefits to the test that I’m not aware of?
Post # 2
My NT scan was covered by insurance and I still opted to not have it. The 12 week scan looks for early markers of genetic abnormalities, but quite often they will see things on the scan that turn out to be nothing and all that does is put stress and worry on the parents. Getting pregnant was a long road and everything had been going fine this time finally and the last thing I needed or wanted was additional stress from a false marker. Many women skip this ultrasound. The anatomy scan should hopefully be covered and your baby will be much better developed around 20 weeks and you’ll have a better idea of whether or not there are any issues.
Post # 3
It’s easy for an outsider who is not in your shoes to give an opinion, but here’s mine. Since you say that you’re low risk, and since you would not abort if an anomaly was found, I would save the money and skip the test. I hope all goes well for an uneventful pregnancy and delivery whatever you decide.
Post # 4
- Wedding: October 2015 - Ruby Princess
I agree with PP. If you are low risk, younger than 35, and wouldnt terminate anyway, I think it’s probably ok to skip it. There is another blood test done around 20 weeks (AFP/Quad screen) that screens for genetic anomalies, so you might have this come up again. Your insurance sounds dreadful. I am sorry it is forcing you to have to make these decisions. Speaking from a California USA standpoint, most of these genetic screens are covered by Medi-CAL.
Post # 5
Can you get the testing done anywhere other than the hospital? A lot of physicians and clinics will negotiate price with cash pay patients.
Post # 6
If you’re low risk and wouldn’t terminate then I’d probably skip it. Most likely everything is perfectly normal. And your 20 week scan would most likely reveal issues if there are any.
Post # 7
AmyintheTARDIS: I don’t mean this to be offensive in any way, but are you sure you are looking at your insurance plan correctly? Mine is a high deductible plan where I pay list price for everything (FU $80 a month birth control pill), but once you reach the deductible the majority gets paid for…… Just wanted to make sure yours wasn’t the same…
Post # 8
You may have already done this – if so, ignore me 🙂 – but I had that same run-around trying to get costs beforehand as you did. What ended up working for me was to get the exact billing codes from the dr’s office that they would submit and then calling the insurance company and asking what my coverage would be for those codes. That was the only way I got an answer as opposed to some wishy-washy we-might-we-might-not thousands of dollars range.
If I wouldn’t have been able to get that, I would have skipped the scan. The amount billed to the insurance company for the scan and associated bloodwork ended up being well over a thousand dollars so I definitely wouldn’t have wanted to pay out of pocket. At that point, I think I would have looked into paying for a Harmony test myself since those are more definitive or skipping it altogether.
Post # 9
AmyintheTARDIS: I am very surprised that they turn down the first ultrasound– as it’s important for dating purposes as well.
If it makes you feel any better, I didn’t have an actual NT scan- because my first scan was done slightly earlier than when they can see the NT- but it did help pin point a due date.
So technically, I didn’t have that test.
The only reason why that the NT scan would be THAT important, is if you knew you were going to abort if the test indicated that *maybe* the baby might have Downs. And that test is NOT an actual diagnosis.
If you’re not going to abort, that particular ultrasound doesn’t matter anyway. And yes- your 20 week ultrasound will be more important than the first one.
Still very shocked your insurance doesn’t cover a first ultrasound.
Post # 10
Is this the NT scan? I thought that was pretty standard to be covered by insurance….
I personally wouldn’t skip it in case something was wrong that would need to be addressed immediately at birth. That way you’d already have the staff on hand etc.
Maybe you could do the Harmony test (or similar) instead?
Post # 11
Andthepupmakes3: MrsEME: Westwood: Thanks everyone! To clarify a few points: this is not the first US I’ve had, although most of them were through my RE and were out of pocket. I had a dating US and as far as I know, that was covered – this is a separate test. My insurance has a high deductible and if they consider a procedure to be “not medically necessary,” you pay OOP and that does NOT count toward your deductible. According to them, genetic testing is not medically necessary and therefore they don’t cover it. They also don’t pay for the anatomy scan because they don’t consider identifying sex to be medically necessary. I’ve spent a lot of time on the phone with them going over this. Since I’m not a high risk pregnancy, they see no reason to pay for a procedure they don’t deem necessary. I’m willing to pay for the 20 week scan because I want to know the sex, and because that should give a clearer indication of any problems or concerns. I’m sure the fact that I have individual insurance (employer doesn’t offer it) limits the quality of coverage I can afford. I’m a little jealous of all the bees who had these tests covered without a question!
GearBride: I do have the codes actually, I think I will call the insurance company with the codes and ask if they cover them. The hospital billing dept was pretty useless as far as giving me any real numbers….I don’t think the woman I spoke with had ever even heard of my company! Ugh.
Post # 12
My stupid insurance didn’t cover ANY pregnancy related ultrasounds. I know, how is thing even possible? I skipped the NT scan even though I really wanted it. We payed out of pocket for the anatomy scan. It turned up a little heart abnormality that is probably nothing, but if we had the NT scan we could be much more certain that it IS nothing. Now all we can do is wait for the birth and hope all is normal. Grrrrr. I’m 34 with no risk factors, btw.
Post # 13
AmyintheTARDIS: we opted not do to the NT scan. The only ultrasound I had was the anatomy scan at 20 weeks. I was relieved to see everything looked fine then and we did not find out the sex. We opted not do it simply because we were also low risk, I’m under 35, and I was concerned about false positive results/unnecessary stress. That being said, in the future I think we WILL have the NT scan since 20 weeks is a long time to wait and I’ll be much closer to 35 for my next potential pregnancy.
My husband and I also do not have insurance through our employers and hence have pretty crappy insurance, I think we paid around $400 for the anatomy scan. For the record the fact that your insurance seems to believe the only purpose of the 20 week scan is to determine sex is completely ridiculous.
Post # 14
AmyintheTARDIS: Good luck! Hopefully, you can get a real answer but sounds like they’re being really obnoxious. They should know finding out the sex is not the point of an anatomy scan, for goodness sake. It’s to make sure your kids has all their parts and their systems are developing properly. 100% necessary? No, but pretty much considered standard of care at this point…so sorry they’re being jerks.