Insurance coverage of NT scan?

[jindc]

I can't find this on my insurance web site, and I'd like to call them as a last resort (since they're generally unaware of anything there!).

I have MD IPA - the web site says "one ultrasound" is covered - I had one yesterday. Does this really mean they don't cover more, or I just pay the contracted amount?

More importantly, is the NT scan covered at all? We'll do it regardless, but I want to make sure we don't get bill shock coming in the mail.

thanks!

[Anonymous]

My insurance (Carefirst) also covers a single ultrasound during a "low-risk" pregnancy, but I think they covered the first one I had for dating purposes, and then the 20-week one later on. Never had the NT scan so I'm not sure if it's covered...if you're AMA or otherwise high-risk, I would think it is. But it's always good to check with your insurer ahead of time!

[jindc]

MD IPA doesn't know what an NT scan is. On hold with them now while they figure it out even though I told them.

[Anonymous]

Yes, this is true for some insurance. My plan only covers one, but since I am over 40 they covered an NT scan as well. It all depends on how it is billed. It can get confusing.

[Anonymous]

It should be if the doctor checked off an appropriate indication box to show the medical necessity. (i.e. AMA, diabetes, whatever). While the NT scan is an ultrasound, it's also not an ultrasound, in terms of insurance.

[Anonymous]

NT scan should be part of the triple screen, so maybe not counted as an u/s per Se.

[jindc]

So heads up in case anyone wants to know, MD IPA told me that it "should" be covered as a diagnostic/lab test, I pay the copay ($50) and that should be it. There could be a lab fee because GW farms something out (the blood work, maybe?) but they said it shouldn't be outrageous.

I think the insurance company SHOULD know more than just to tell me that I shouldn't be charged a lot, but....that's all they knew <shrug>

[Anonymous]

It will be covered if you did IVF, which I believe you did jindc. Because there is a higher risk of birth defects/heart defects in IVF babies (a very statistically small change, but a change nonetheless) my doctor told me that extra screening tests were always covered for babies conceived with IVF. Many insurance companies will now automatically cover a fetal echo for IVF babies as well. I had two NT tests (long story, but there were abnormalities and the first one was done early, so we did another one closer to the average date). I never had to submit anything extra and everything was covered (by Cigna). I was not AMA, just a fertility patient.

[jindc]

thanks, PP - yep, IVF....but she didn't even mentioned that when I called. I'm not worried, per se, I just didn't want to received a $1000 bill because insurance didn't cover it (I'd still get it if it were OOP, but I'd want to know ahead of time, ya know?)

I have no reason to believe anything will be wrong, though the news stories about 1 in 50 children having autism was pretty terrifying....sigh...