Is the 20 Week Ultrasound Considered a "medical necessity"?

[Anonymous]

Hi there...
I have my 20 week ultrasound coming up and my question is this:
I have Carefirst BC/BS PPO Insurance and when I contacted them about coverage, they indicated they only cover one ultrasound during the course of the pregnancy, unless subsequent ones are required due to medical necessity. Technically, my 20 week ultrasound would be my 2nd given that I had a transvaginal one done at 9 weeks to confirm the pregnancy, etc. Does anyone have experience with getting the 20 week ultrasound covered under their insurance as a medical necessity? Can it be considered a medical necessity given that I did not have any other testing done (i.e. nuchal transluceny, cvs, amnio, etc.)? Any input would be greatly appreciated!
Thank you!!

[Anonymous]

I would think it is a medical necessity since your doc recommends it, but I would double check with them - tell them that I have a doc referral to it (and make sure I have one - but usually everyone does).

[Anonymous]

I had Carefirst PPO and my 20 week u/s was covered. So was another one at around 35 weeks, when my doc thought I was measuring behind.

[Anonymous]

I have BCBS and my 20 week u/s was covered when I was preg. with DC #1 in 2007 and I had u/s at 7 and 9 weeks and NT testing. Essentially, if you are going to an in-network physician, I think all your OB appts are part of your pregnancy care and are covered. The OB does not even get paid until you deliver.

[Anonymous]

Thank you all for sharing your experiences and for that helpful information! I just want to ensure I won't have to pay out of pocket for it!
Thanks again!

[Anonymous]

I have Aetna and they allow up to two "regular" ultrasounds -- any additional ones have to be considered a medical necessity to be covered.