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nferrandi
too excited for words
Member since 10/05 18538 total posts
Name:
Nicole
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health insurance question/issue- UPDATE
OK, so I had a growth sono last week. I just got a letter in the mail from our insurance company (Health Net) and they said that there was no medical reason for me to have the sono and that they wouldn't conver it. Did anyone else come across this?
I can understand them not covering a 3-D sono, but a growth sono? My Dr.'s office had better straighten it out, because it was never mentioned to me that insurance may not cover it. And to be honest, if I knew I may have to pay for it out of pocket I would have skipped it altogether. I had my 3-D sono the week before, so I already knew roughly how big the baby was measuring.
Update- so I brought the note into my Dr.'s office today and they sent me over to the billing dept. The lady there said not to worry about it and they would take care of it. She said that many insurance companies don't like to pay for a growth sono, but in the end they will. So hopefully the billing dept. will get it settled for me.
Message edited 9/8/2006 2:19:56 PM.
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Posted 9/7/06 9:50 PM  |
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ddunne2
LIF Adult
Member since 7/05 4189 total posts
Name:
Doreen
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Re: health insurance question/issue
I think it is pretty common for many insurance companies to only cover one sonogram unless others are medically necessary. I know that is the policy of my insurance company, so I had one at 20 weeks and that is the only one I get unless I want to pay for it.
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| Posted 9/7/06 9:53 PM |
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PrincessP
Big sister!!!!!!!!!!
Member since 12/05 17450 total posts
Name:
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Re: health insurance question/issue
I am sure the drs office will have to resubmit or something. I just had a cervix sono and bet your bottoms dollar I am not paying for that ESPECIALLY since I didnt even see the baby 
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| Posted 9/7/06 9:55 PM |
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michele31
LIF Adult
Member since 5/05 3372 total posts
Name:
Michele
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Re: health insurance question/issue
If they covered the 3-D the week prior they will most likely not cover another one. If your doctor ordered both sonos the office should be able to straighten it out.
You usually are covered for a 1st early sono and a 2nd sono to confirm things are growing properly. But if your doctor is ordering more, then the insurance should cover them I would think.
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| Posted 9/7/06 11:16 PM |
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monkeybride
My Everything
Member since 5/05 20541 total posts
Name:
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Re: health insurance question/issue
I had about 4-5 sono's during my pregnancy and never had a problem.  I had them in my doctor's office but I'm sure they billed the insurance for them. Hopefully they can say it was midically necessary so it can be covered.
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| Posted 9/8/06 1:03 AM |
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KateDevine
*
Member since 6/06 24950 total posts
Name:
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Re: health insurance question/issue
It really depends on your insurance. That being said, your doctor's office should be familiar with what your insurance covers and doesn't cover, so I would let them resubmit it and see where it goes from there.
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| Posted 9/8/06 6:55 AM |
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Stacey1403
Where it all began....
Member since 5/05 24065 total posts
Name:
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Re: health insurance question/issue
I get a sono at every visit. I haven't had a problem. I do however have diabetes so I think it is considered medically necessary
I'm sure if your OBGYN ordered it they could straighten it out.
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| Posted 9/8/06 7:12 AM |
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Charly
LOVE!
Member since 5/05 12578 total posts
Name:
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Re: health insurance question/issue
I had a ton of sono's in the beginning b/c of bleeding, plus my ultrascreen, level II and a couple to check my cervix for placenta previa. I've never had a problem. I did get a few notices that they weren't covered but I called my drs office and they recoded the "reason" to make it medical and I never heard from the insurance company agian. I would just call your drs billing dept they know what to do.
Good luck Nicole
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| Posted 9/8/06 7:42 AM |
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Re: health insurance question/issue
While PG I had Oxford and they only allow 3 sono's and I had to go to Radiology place for them. The PA did do a "secret" sono at 12 weeks because she couldnt find the heart beat and she found the baby with the sono but I dont think ever put it on my chart. So it might be that they limit how many you. If that is the case then I dont think the doctor's office should have done one or should have informed you and you should have made the decision.
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| Posted 9/8/06 8:50 AM |
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nferrandi
too excited for words
Member since 10/05 18538 total posts
Name:
Nicole
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Re: health insurance question/issue
Posted by michele31
If they covered the 3-D the week prior they will most likely not cover another one. If your doctor ordered both sonos the office should be able to straighten it out.
You usually are covered for a 1st early sono and a 2nd sono to confirm things are growing properly. But if your doctor is ordering more, then the insurance should cover them I would think.
My insurance didn't cover the 3-D sono. My friend is a lab tech and did it for free- I didn't deal with insurance at all. That's why I'm so annoyed that they want to charge me for the growth sono. As far as I'm concerned, I would never have done it because I'd just had the 3-D one a week before.
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| Posted 9/8/06 10:08 AM |
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wowcoulditbe
wow, pic is already 1 yr old!!
Member since 1/06 6689 total posts
Name:
D
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Re: health insurance question/issue
Posted by monkeybride
I had about 4-5 sono's during my pregnancy and never had a problem. I had them in my doctor's office but I'm sure they billed the insurance for them. Hopefully they can say it was midically necessary so it can be covered.
We were lucky to never have a problem either! good luck!
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| Posted 9/8/06 10:50 AM |
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babymakes3
Almost there!
Member since 7/06 7376 total posts
Name:
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Re: health insurance question/issue
I hope the Dr. office straightens it out for you. If your Dr. ordered it, obviously there must be a medical reason for it. If he/she ordered just for fun, without consulting you, then they should eat the cost.
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| Posted 9/8/06 11:20 AM |
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Marybeth222
My Girls!
Member since 5/05 2688 total posts
Name:
Marybeth
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Re: health insurance question/issue
Ask your doctor to write a letter and hopefully they'll accept it and pay it.
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| Posted 9/8/06 11:54 AM |
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nferrandi
too excited for words
Member since 10/05 18538 total posts
Name:
Nicole
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Re: health insurance question/issue- UPDATE
bump with update on top
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| Posted 9/8/06 2:20 PM |
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Charly
LOVE!
Member since 5/05 12578 total posts
Name:
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Re: health insurance question/issue- UPDATE
Posted by nferrandi
Update- so I brought the note into my Dr.'s office today and they sent me over to the billing dept. The lady there said not to worry about it and they would take care of it. She said that many insurance companies don't like to pay for a growth sono, but in the end they will. So hopefully the billing dept. will get it settled for me.
Glad to here it worked out! The billing depts generally know how to get their bills paid
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| Posted 9/8/06 2:39 PM |
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spooks
So in love!
Member since 6/06 4378 total posts
Name:
Sarah
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Re: health insurance question/issue- UPDATE
Glad it will be worked out. I have Healthnet and although I'm not PG - my colleagues who were this past year had all sorts of problems with them -mostly with the sonos. Personally I hate Healthnet. I hope the rest goes smoothly!
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| Posted 9/8/06 3:48 PM |
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pmpkn087
Life is good...
Member since 9/05 18504 total posts
Name:
Stephanie
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Re: health insurance question/issue- UPDATE
I'm glad it's worked out (or at least ALMOST worked out).
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| Posted 9/8/06 3:50 PM |
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Janice
Sweet Jessie Quinn
Member since 5/05 27567 total posts
Name:
Janice
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Re: health insurance question/issue- UPDATE
great news!
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| Posted 9/8/06 4:34 PM |
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