Anonymous wrote:I just got a bill for a routine 20-week anatomy scan for almost $1000. I have insurance (United Healthcare Choice Plus, high deductible) and this was done at an in-network hospital (Washington Hospital) and I'm kind of just aghast that there is no "plan discount" — I am left to pay the full amount.

Has anyone 1) Had this experience 2) Felt similarly swollen with rage 3) Done anything about it? Like, chosen a different radiology clinic for a future ultrasound? Disputed claim? Negotiated a discount (supposedly Medstar doesn't do this)

I feel extremely frustrated to be paying about $700/month for insurance that doesn't cover routine prenatal care. Just another thing to be angry about as a new parent in America.

Hospitals are the greediest of all. Frequently, they bill patient before insurance pays. Call your insurance company and find out what is going on. I had an outpatient minor procedure done and Dr's scheduler put down that I needed 24 hours observation which meant that I would be staying overnight in hospital. The billing office sent me an invoice within 24 hours of procedure. I spoke to billing office and was told Dr. needed to confirm that I had not been an inpatient but, in the meantime, "patient should pay and if insurance pays, hospital will reimburse me within 30-90 days"! I told them to pound sand.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That doesn't seem right. Routine pre-natal care should be covered under Obamacare, even with a high deductible. Do you have an explanation of benefits for this bill? Don't pay it until you do. And call you insurance and ask them.

+1. It should be free, OP. Call your insurance company.

I had a baby in 2019 and paid nothing for all of my prenatal visits (thanks, Obama!) but am pregnant now and every time I check in at my OB they try to say I owe a $40 copay. Every time I decline because I know that's illegal and I never hear about it again. But I see that they're trying to get money they aren't entitled to out of patients, and I wonder how many are falling for it.

I don’t think it’s the case for high deductible plans though.

can you explain this law? i definitley pay copays and thought that was standard (and have normal, low deductible plan)

Anonymous wrote:Welcome to the US... the land of they can charge you ANYTHING after the service without notifying you of the cost.

Not true, Trump signed the No Surprises Act which covers most private health insurances and bans this. OP you can definitely submit a dispute. Regardless of the amount, not providing you notice is very likely illegal in your case. https://www.cms.gov/NOSURPRISES

I had to pay 850 dollars for a transvganial ultrasound to investigate abnormal uterine bleeding because I had not met my deductible. This was at Georgetown.

Anonymous wrote:High deductible? That needs to be met prior to being covered. Learned that the hard way. Changed plans immediately after giving birth.

Unfortunately, this.

Yes, medical care is super expensive here.

That same ultrasound paid private in the UK would be around $150. My IL works for the NHS doing radiography.

Years ago, I had an ultrasound that I had to pay oop for. It was almost $1000. My IL was floored when I told them how much it costs. They said it usually costs like $150 paid privately.

Cost of medical care here is insane.

Anonymous wrote:Definitely call your insurance company and maybe call your OB as well. Routine prenatal care is supposed to be 100% covered.

ultrasounds are considered "extra" I have always had to pay the contracted rates until the deducible is met and usually that is not until birth

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That doesn't seem right. Routine pre-natal care should be covered under Obamacare, even with a high deductible. Do you have an explanation of benefits for this bill? Don't pay it until you do. And call you insurance and ask them.

+1. It should be free, OP. Call your insurance company.

I had a baby in 2019 and paid nothing for all of my prenatal visits (thanks, Obama!) but am pregnant now and every time I check in at my OB they try to say I owe a $40 copay. Every time I decline because I know that's illegal and I never hear about it again. But I see that they're trying to get money they aren't entitled to out of patients, and I wonder how many are falling for it.

I don’t think it’s the case for high deductible plans though.

It's not. The deductible must be met first before services are covered.

+1

Routine care like an annual physical are 100% covered even before deductible is met, but pre-natal care does not fall under that.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That doesn't seem right. Routine pre-natal care should be covered under Obamacare, even with a high deductible. Do you have an explanation of benefits for this bill? Don't pay it until you do. And call you insurance and ask them.

+1. It should be free, OP. Call your insurance company.

I had a baby in 2019 and paid nothing for all of my prenatal visits (thanks, Obama!) but am pregnant now and every time I check in at my OB they try to say I owe a $40 copay. Every time I decline because I know that's illegal and I never hear about it again. But I see that they're trying to get money they aren't entitled to out of patients, and I wonder how many are falling for it.

I don’t think it’s the case for high deductible plans though.

It's not. The deductible must be met first before services are covered.

Anonymous wrote:Welcome to the US... the land of they can charge you ANYTHING after the service without notifying you of the cost.

+1

Also strangely the land of occasional price discounting if you negotiate after the service.

My insurance provider is usually pretty good, but my OB required all patients to bring their own pharmacy-obtained prescription injection for avoiding fetal RH factor incompatibility because of trouble billing it.

That injection is completely standard maternity care. But it falls into a gray space between prescription drug plan and health insurer.

My self-filed claim was rejected the first time, then rejected on form letter appeal.

A year later, the payment showed up. I guess somebody, somehow managed to force a systematic correction of the error. I thank whoever put a stop to that particular piece of clownery.

I have a HDHP. The prenatal visits with the OB are covered for me but not the ultrasounds, I paid something similar. I needed a few extra visits as a check and I was on the hook for those too.

Definitely call your insurance company and maybe call your OB as well. Routine prenatal care is supposed to be 100% covered.

Welcome to the US... the land of they can charge you ANYTHING after the service without notifying you of the cost.

I looked up the standard charges list at WHC, which is available online (thank you, Hospital Price Transparency Act). An outpatient fetal anatomy scan for a single baby has the following possible charges:

Standard charge, gross: 1046.46
Standard charge, discounted cash: 680.2
Standard charge, min: 293.01
Standard charge, max: 941.814

That is for a:
US OB W/FETAL ANATOMY,SINGLE 40000762 CDM 402 RC 76811 CPT Outpatient

I would call the billing department and try to negotiate down the bill using the billing code for your ultrasound which you can get from your insurance Explanation of Benefits and/or the bill from the hospital. You can also consult the price transparency list going forward.

FWIW a lot of pregnancy care is billed as a global fee, meaning all OB visits and the delivery are covered under one deductible, but scans and additional testing may not be. Which means ultrasounds are often excluded from the standard fee (even though it's part of standard OB care, grrrr.)

Good luck OP!

Anonymous wrote:

Anonymous wrote:That doesn't seem right. Routine pre-natal care should be covered under Obamacare, even with a high deductible. Do you have an explanation of benefits for this bill? Don't pay it until you do. And call you insurance and ask them.

+1. It should be free, OP. Call your insurance company.

I had a baby in 2019 and paid nothing for all of my prenatal visits (thanks, Obama!) but am pregnant now and every time I check in at my OB they try to say I owe a $40 copay. Every time I decline because I know that's illegal and I never hear about it again. But I see that they're trying to get money they aren't entitled to out of patients, and I wonder how many are falling for it.

My doc will also collect copays that aren’t due, but then I am reimbursed. I think it’s just poor customer service and/or billing thing (collect in case it’s due rather than figuring it out every time and perhaps getting it wrong), but not an attempt to defraud patients. It’s annoying enough without calling it purposeful fraud.