(Closed) Perinatal testing not covered by insurance – WWYD?

posted 4 years ago in Pregnancy
Post # 2
3755 posts
Honey bee
  • Wedding: April 2014

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
1777 posts
Buzzing bee

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
2319 posts
Buzzing bee
  • 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
2713 posts
Sugar bee
  • Wedding: September 2014

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
9675 posts
Buzzing Beekeeper
  • Wedding: September 2013

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
1938 posts
Buzzing bee
  • Wedding: March 2014

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
381 posts
Helper bee
  • Wedding: September 2012

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
2837 posts
Sugar bee
  • Wedding: November 2013

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
8601 posts
Bumble Beekeeper
  • Wedding: August 2012

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 # 12
188 posts
Blushing bee

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
3017 posts
Sugar bee
  • Wedding: October 2011

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
381 posts
Helper bee
  • Wedding: September 2012

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.

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