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Dulcinea
Weekend Warrior
Member since 3/08 2530 total posts
Name:
Dulcinea
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Only One Sono Per Pregnancy?
Ok, I mentioned previously that my insurance company (United Health) is not covering the 20th week sono...
Well the story gets even better. I called them today and was informed that they only allow 1, yes 1, sono per pregnancy. The others can only be done if the doctor deems it medically necessary. :P
This means my doctor has to write me a prescription if I want to find out the baby's gender! How absurd is that?
Has anyone heard of this?
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Posted 7/14/08 11:12 PM  |
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Jen2999
Baby girls & beagles rock!
Member since 8/06 10356 total posts
Name:
Jen
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Re: Only One Sono Per Pregnancy?
I have empire NYSHIP which United Healthcare and I have never had a problem.
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| Posted 7/14/08 11:19 PM |
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mommy-of-2-angels
It's all about Sophia
Member since 9/07 1731 total posts
Name:
Laurie
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Re: Only One Sono Per Pregnancy?
I have the same health ins and I get sono's every 2 weeks and never had a problem
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| Posted 7/14/08 11:24 PM |
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Jen2999
Baby girls & beagles rock!
Member since 8/06 10356 total posts
Name:
Jen
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Re: Only One Sono Per Pregnancy?
Its probably just the code that your dr is using to submit the claim...
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| Posted 7/14/08 11:28 PM |
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DRMom
Two in Blue
Member since 5/05 20223 total posts
Name:
Melissa
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Re: Only One Sono Per Pregnancy?
You should speak to the insurance person at your Dr's office. It is no problem for them to deem any sono medically necessary for cramping or any other reason
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| Posted 7/14/08 11:42 PM |
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Re: Only One Sono Per Pregnancy?
Many insurance plans need referrals and such for sonos. I know anything outside of my doctor's office I need a referral.........and I am sure her staff have to write up the claim a certain way everytime I go in there and have a sono. It's really just how many insurance companies are nowadays. I wouldn't worry about it too much.
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| Posted 7/15/08 5:17 AM |
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headoverheels
s'il vous plaît
Member since 6/07 42079 total posts
Name:
LB
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Re: Only One Sono Per Pregnancy?
if you are still talking about 3D sonos then i can understand.
i have the same insurance you do and i have had five sonos so far, all 2D, so no problems.
you do NOT need a 3D sono to determine gender.
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| Posted 7/15/08 7:30 AM |
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Re: Only One Sono Per Pregnancy?
I have NYSHIP (Empire) as well which uses United Healthcare for doctors and I was told at the beginning of the pregnancy that we are only allowed 3 sonos, and the rest needed to be pre-approved. I spoke with the insurance person at the doctors office and they said they take care of it.
Unfortunately I have been diagnosed with GD so I need growth sonos all the time now, but I had still gotten more than 3 sonos before the diagnosis with no problems.
Definitely speak to the insurance person at your doctors office...they should know exactly how to get you preapproved. (not for 3/4d though)
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| Posted 7/15/08 7:35 AM |
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NinaLemon
It's a boy!!!
Member since 10/07 6453 total posts
Name:
Jeannine
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Re: Only One Sono Per Pregnancy?
Just an FYI about insurance, having the same insurance company does not mean you'll have the same policy as others. The insurance companies sell many policies at various prices; your employer chooses which one best fits their budget/needs.
I agree that you should speak with your Dr., it is not difficult for him/her to come up with 'medical reasons' why you would need another sono.
Good Luck! 
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| Posted 7/15/08 8:01 AM |
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asecretposter
LIF Adolescent
Member since 4/08 574 total posts
Name:
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Re: Only One Sono Per Pregnancy?
I had my Dr pre-write all the sonos she wanted me to have and gave them to the sono place. The insurance person in the Drs office kmew how to get them all paid.
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| Posted 7/15/08 8:21 AM |
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sometimesmommy
Always in my heart.....
Member since 11/06 6686 total posts
Name:
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Re: Only One Sono Per Pregnancy?
As someone who had a 952K pregnancy bill with UHC (sonos every other week for some parts of the pregnancy etc--its not hard for your doc to get approval.
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| Posted 7/15/08 10:14 AM |
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Pooka
Oh Happy Day!!
Member since 11/06 5689 total posts
Name:
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Re: Only One Sono Per Pregnancy?
I have the same insurance and I have had a lot of sonograms throughot my pregnancy. I had a 5 week to confrim the pregnancy, the 12 week, the 20, multiple sonos when I was in the hospital with my asthma for a week, and then a growth sono at 31 weeks. I go back for another sono at 34 weeks to see if he is still breech and then I start weekly sonos once I am 36 weeks until the baby is born.
Something dosent sound right. Speak to the insurance person at your dr's office. It dosent sound like they are submitting the claim correctly.
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| Posted 7/15/08 10:22 AM |
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Blissful
Ultimate Expression of LOVE
Member since 6/08 4985 total posts
Name:
Maria
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Re: Only One Sono Per Pregnancy?
Yes, It is actually very common. A lot of people get sonos more often because the MD will deam them medicallly necessary and bill the insurance company without you knowing all of this.
The medical standard is that a normal healthy pregnancy should not need more than 1 sonogram to confirm everythign is ok unless there are symptoms present determining that something sould be off (ie. bleeding, excessive cramping etc).
US physicians greatly overuse ultrasounds during pregnancy as compared to other industrialized nations with lower mother and infant mortality rates.
If you really want another one, speak to your physician and see what they say, you would have to give a medical reason why you want the ultrasound though. Determining the babies gender is not considered to be a medical reason and the MD won't write a prescript just for that!
good luck
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| Posted 7/15/08 10:29 AM |
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Dulcinea
Weekend Warrior
Member since 3/08 2530 total posts
Name:
Dulcinea
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Re: Only One Sono Per Pregnancy?
Thanks for responding everyone.
My doctor has no problem writing up the prescription for me to get another 2D sono but it just irritates me that UHC restricts the # of sonos you have.
There are a whole slew of UHC patients at my doctor's office who have the same problem as me and I'm sure they don't all the same UHC plan.
Getting a 20 week sono to check for any anatomical anamolies is pretty valid. It should not required a medical reason. We're not just doing this to check the gender.
I envy those who get sonos at every office visit w/o having to jump through hoops.
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| Posted 7/15/08 11:26 AM |
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hunnybunnyxoxo
this is what it's all about
Member since 11/07 3321 total posts
Name:
Lisa
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Re: Only One Sono Per Pregnancy?
omg!!! that is insane! never heard of that!
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| Posted 7/15/08 11:27 AM |
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Blissful
Ultimate Expression of LOVE
Member since 6/08 4985 total posts
Name:
Maria
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Re: Only One Sono Per Pregnancy?
Posted by Dulcinea
Thanks for responding everyone.
My doctor has no problem writing up the prescription for me to get another 2D sono but it just irritates me that UHC restricts the # of sonos you have.
There are a whole slew of UHC patients at my doctor's office who have the same problem as me and I'm sure they don't all the same UHC plan.
Getting a 20 week sono to check for any anatomical anamolies is pretty valid. It should not required a medical reason. We're not just doing this to check the gender.
I envy those who get sonos at every office visit w/o having to jump through hoops.
I know it is very frustrating. I had the same argument withmy midwife and she said the insurancec companies are getting stricter these days. She said because I was under 35 that the statistics show that a sono at 20 weeks to check for anatomical abnormalities is not needed.
Its all paperwork asn insurance crap.....like we need the extra stress when pregnant.
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| Posted 7/15/08 11:33 AM |
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DRMom
Two in Blue
Member since 5/05 20223 total posts
Name:
Melissa
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Re: Only One Sono Per Pregnancy?
I have some of the crappiest insurance out there and have not had any problems. BTW it shouldn't be you jumping through the hoops it should be your office. Have your Dr write a list of all the sonos he wants you to get and have the insurance person call UHC and get them approved.
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| Posted 7/15/08 12:46 PM |
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SweetTooth
I'm a tired mommy!
Member since 12/05 20105 total posts
Name:
Lauren
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Re: Only One Sono Per Pregnancy?
I don't think its UHC - its your employer that sets theses policies. I have UHC and I have no limit on the number of sonos I can have..
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| Posted 7/15/08 12:47 PM |
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Blissful
Ultimate Expression of LOVE
Member since 6/08 4985 total posts
Name:
Maria
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Re: Only One Sono Per Pregnancy?
Posted by SweetTooth
I don't think its UHC - its your employer that sets theses policies. I have UHC and I have no limit on the number of sonos I can have..
It can be this but also the individual MD office. I worked in a GYN office in college and the physicians all liked to do a certain amount of sonograms. So for insurances that only covered 1 or two we had a generic letter that was sent to the insurance company to cover all the sonos. This was all done without the patient even knowing about it.
It is probably a combination of teh MD office, and your individual plan.
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| Posted 7/15/08 12:56 PM |
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junebride06
love my boys!
Member since 2/08 3181 total posts
Name:
Robin
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Re: Only One Sono Per Pregnancy?
I have UHC and all my sonos are covered...how can they only allow one!
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| Posted 7/15/08 3:46 PM |
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NinaLemon
It's a boy!!!
Member since 10/07 6453 total posts
Name:
Jeannine
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Re: Only One Sono Per Pregnancy?
Posted by junebride06
I have UHC and all my sonos are covered...how can they only allow one!
because it isn't just set by the insurance company, it is also set by what policy your company purchases.
example: My company and my DHs company both offer insurance through CDPHP, we get insurance through DH because:
my company's policy has much more expensive co-pays, does not offer domestic partnership (we used this before we got married), does not offer eye or dental care and it costs $600/mo vs. $15/mo (my DH works for a much larger company) - these are just the big things there are tons of specific things that are different as well.
Message edited 7/15/2008 4:01:53 PM.
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| Posted 7/15/08 4:01 PM |
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Re: Only One Sono Per Pregnancy?
Posted by NinaLemon
Posted by junebride06
I have UHC and all my sonos are covered...how can they only allow one!
because it isn't just set by the insurance company, it is also set by what policy your company purchases.
example: My company and my DHs company both offer insurance through CDPHP, we get insurance through DH because:
my company's policy has much more expensive co-pays, does not offer domestic partnership (we used this before we got married), does not offer eye or dental care and it costs $600/mo vs. $15/mo (my DH works for a much larger company) - these are just the big things there are tons of specific things that are different as well.
This is very true. I have NYSHIP and so does my neighbor. I have higher copays than she does and am constantly getting lab bills that my copay didn't cover.
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| Posted 7/15/08 4:58 PM |
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sweetbabydreams
My Dream come true!
Member since 12/07 2205 total posts
Name:
Stephanie
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Re: Only One Sono Per Pregnancy?
Posted by Jen2999
I have empire NYSHIP which United Healthcare and I have never had a problem.
Yeah i have teh exact same one and it is great. NO ISSUES AT ALL. they are actually covering IUI and all 100%
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| Posted 7/15/08 10:00 PM |
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Dulcinea
Weekend Warrior
Member since 3/08 2530 total posts
Name:
Dulcinea
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Re: Only One Sono Per Pregnancy?
It's very odd, UHC's rep didn't specifically say that my plan only covers 1 sono. They said UHC only allows 1 unless it's medicallly necessary.
Perhaps those who get them often have doctors who are used to just processing all the sono requests as medically necessary? It's not like the ins. company would argue that.
I'm just trying to find rationale for this, I love my doctor so won't want to change just because they don't give sonos at every visit. :(
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| Posted 7/15/08 10:10 PM |
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KateDevine
*
Member since 6/06 24950 total posts
Name:
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Re: Only One Sono Per Pregnancy?
Why do you need more than 1 sono?
Our parents didn't have them. I had to explain how they worked to an attorney in my office whose kids are my age, and they are fine.
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| Posted 7/15/08 10:24 PM |
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