I just got a bill from the radiology department of our hospital for my ultrasound I had done at 20 weeks. My insurance has denied coverage on it stating that a routine ulrasound is NOT medically necessary!?!? I've always had them with my other children! Are they not medically necessary? I always thought that they were seeings how there were things they needed to check for!
2006-12-15 06:59:59 · 14 answers · asked by Trisha 3 in Pregnancy & Parenting ➔ Pregnancy
OKay apparently the first person on here didn't READ this. I already got my ultrasound done. I don't put a price on my children, I'm trying to get it figures out as far as my INSURANCE is concerned.
2006-12-15 07:05:15 · update #1
If I were you, II would challenge this decision by filing a written appeal. Don't just call them and complain, because this won't preserve your rights. Plus its good to have a paper trail.
They are required to mail you an "explanation of benefits" whenever they process a claim , which I assume you received. On this document, perhaps on the back of the form in fine print, you will find instructions for appealing a claims decision.
A comprehensive ultrasound is considered routine at 20 weeks, and your insurance company should certainly pay.
You must have Aetna! They don't pay ANYTHING if they can help it. LOL!
2006-12-15 07:10:38 · answer #1 · answered by EmLa 5 · 1⤊ 0⤋
They aren't medically necessary, unless there are some risk factors with you. Age, weight, medical conditions, previous high risk pregnancies. Also, much of it depends on how the Doctor billed the ultrasound, they need to bill it with a diagnoses. My doc used the excuse that I didn't know how far along I was, so they needed the ultrasound to determine the due date, and for what pre-natal care I needed. I think you should appeal, and find a reason like this to use. Doc can call the insurance company and try to get a retroactive prio authorization.
2006-12-15 07:16:38 · answer #2 · answered by camandkellysmom 2 · 0⤊ 0⤋
If your insurance only covers one, you'll probably only get one, considering everything is healthy. In theory none are vital to the health of a baby, unless an abnormality is picked up via ultrasound and the child is able to be operated on in-utero...but thats pretty rare! The amount of doctors that automatically assume pelvis' are too small to deliver naturally is unreal and almost concerning. Doctors are losing too much faith in the human body and nature, and relying on medical intervention way too much.
2016-05-22 21:35:00 · answer #3 · answered by Anonymous · 0⤊ 0⤋
You should have it done. They are very useful in identifying possible unfavorable fetus conditions. Depending upon if you are in the high risk area, they normally request that you have at least 1 ultrasound. If High risk, then possibly as much as once per week as my wife had to do.
With the Insurance Cos - the health group can normally win a case to have at least one completed as recommended + if they feel additional ones are necessary, they can normally fix it with the insurance co that is is covered. The Health group will just need to make sure they can prove it is required.
2006-12-15 07:09:11 · answer #4 · answered by Bob 5 · 0⤊ 1⤋
Ultrasounds are not medically necessary. There was no such thing a little over 20 years ago. Now, most doctors suggest, and some demand, that you get at least one, but if you have no history of problem births and aren't diabectic, ultrasounds are not necessary.
2006-12-15 07:14:29 · answer #5 · answered by B K 2 · 0⤊ 1⤋
Thats crazy. Most companies pay for at least one ultrasound. Up to 3 if they are needed. So I dont get why they would say that. I would call them up and ask about it. They help to make sure the baby isdeveloping properly , etc...
2006-12-15 07:04:44 · answer #6 · answered by Blondi 6 · 2⤊ 0⤋
Of course its necessary, unless its against your beliefs to get one. I can't believe your insurance company denied it! It's a standard part of the pre-natal doctor work, possibly even the most important! Hopefully it wasn't too expensive for you to pay on your own.
2006-12-15 07:09:42 · answer #7 · answered by Anonymous · 0⤊ 0⤋
Ultra sounds are medically neccessary. I think you should fighthtis with your Medical Group. The ultra sound purpose is to determine the baby is still alive and growing at the appropriate spedd, size, weight, ect. and to make sure there are no physical defects, there is enough fluid in the placenta. There are alot of things they check for. You should fight this with your medical group.
2006-12-15 07:06:51 · answer #8 · answered by Tasha 3 · 1⤊ 0⤋
Insurance!!!!!! they just piss me off!!!! you pay out the @ss for them for years and when you need the coverage they're not there for you!
If your doctor prescribed it then its medically necessary, not to mention all doctors do it as part of the routine check up during pregnancy. I'd fight w/ them tooth n nail. Also talk to your doctor to see how they catagorized it and maybe they can change it to get the ins. co. to pay for it.
2006-12-15 07:07:39 · answer #9 · answered by gypsy g 7 · 1⤊ 1⤋
They are medically necessary so they will know if anything is wrong with the baby and to make sure it is developing right. i dont understand why they said that, thats stupid.
2006-12-15 07:05:36 · answer #10 · answered by Anonymous · 1⤊ 0⤋