Ultrasound at 20 weeks - not covered by insurer

[Anonymous]

Has anyone run into a situation where the 19-20 week ultrasound is not covered by their insurer? We have the Aetna Federal Open Access HMO. I called the ultrasound place in Alexandria to make an appoinment, and thankfully, they told me if the insurer refuses to pay it is $480. This seems really pricey. I then called Aetna, who informed me that it will not be covered. Does anyone know any other places to have this ultrasound done (known as a fetal anatomy scan)? Do you know if you have to use the place your doctor recommends if you are paying out-of-pocket?

[Anonymous]

Wow, really? I mean beyond finding out the sex that is a pretty important check to ensure major organs are developing properly. Was your doctors office able to provide any insight? I might call and ask to speak with the office manager and ask if they've encountered this before. Perhaps they just need to code it differently so it will be covered?

[Anonymous]

Wow -- I'm surprised. If you can't get coverage, try to negotiate a lower price (like what insurance would typically pay) with the provider. I have done this with success in the past. Good luck.

[Anonymous]

I have Aetna Federal Open Access HMO and my 20 week ultrasound WAS covered. I would get the insurance billing code and call the insurer back to confirm. I had a total of 3 ultrasounds and 1 sonogram, all of which were covered. The 20 week anatomy scan is standard of care, I'd be shocked it's not covered.

[Anonymous]

I agree with PPs, it's a basic procedure part of standard pregnancy care, it really should be covered. Maybe there is a misunderstanding based on the terminology used: maybe instead of saying "ultrasound", the insurance knows the procedure as "anatomy scan" or "level 2 ultrasound"...

[Anonymous]

Anonymous wrote:Has anyone run into a situation where the 19-20 week ultrasound is not covered by their insurer? We have the Aetna Federal Open Access HMO. I called the ultrasound place in Alexandria to make an appoinment, and thankfully, they told me if the insurer refuses to pay it is $480. This seems really pricey. I then called Aetna, who informed me that it will not be covered. Does anyone know any other places to have this ultrasound done (known as a fetal anatomy scan)? Do you know if you have to use the place your doctor recommends if you are paying out-of-pocket?

Did Aetna say they wouldn't cover AT ALL? or just with the u/s place in Alexandria?

It's good that you called to double check, but sometimes you have to take it one step further and see which places/labs/hospitals are "acceptable" (in the eyes of the insurance company). I wish I could give you a recommendation, but my doc. does it in the office.

[Anonymous]

I hate Aetna Open Access HMO and I've had two pregnancies with them, and both times I've had the twenty week ultrasound. You'll need your doctor's order, and you shouldn't have to pay anything for it - it's covered under your basic maternity care. I had mine done at Washington Radiology - I didn't pay a thing.

[Anonymous]

I have Aetna Open Access too and have already had 5 ultrasounds - all of which they have covered so I can't imagine they wouldn't cover the 20 wk one...

[Anonymous]

Same as above: I too have Aetna Fed Open Access and my 20 week sono / u/s was covered. I like all these suggestions; another is to call your doctor's office and make sure they've properly coded what's going on. I did have to schedule the u/s at the doc-specific place and it said on the doctor's orders (which I had to bring with) that this was 20 week. My doc office also enrolled me in Aetna's maternity program, which I've not had good results with, but they're supposed to provide a 24-hour on-call nurse for us. Free and convenient, that too may be worth a call just to get this straightened out. Just to be clear: Aetna should cover this, not you. Good luck and don't give up.

[Anonymous]

I'm surprised at the non-coverage, so follow the other poster's suggestions - this may just be a misunderstanding. Washington Radiology charged me $450 for a complete 20-week ultrasound and some very nice pics last summer. (I was un-insured at the time.)

[Anonymous]

My 20 week ultrasound was initially denied by United Healthcare. I was irrate, beyond furiuos so I really feel for you and encourage you to fight them on this.

In the end, my OB had to write a note about why it was "medically necessary" (ridiculous, I know since it is a standard procedure) and my HR dept had to get involved. I think the radiology office (also located in Alexandria, maybe it's the same one?) had to change the billing code to get it covered.