Insurance denied ultrasound?!

Question

I got a packet in the mail saying that coverage for my next ultrasound had been denied. Has anyone else had this problem? I don't care about finding out what the sex is I just want to know of my baby is going to be okay since with my first ultrasound they told us that our baby had too much fluid behind its neck. I just don't know what I'm going to do if they don't let me see my baby or make me pay some ridiculous amount...

Answer

Insurance companies only pay claims if your doctor has proven medical necessity for whatever action they have taken. I would go back to your doctor and have them resubmit their request to the insurance company if they have reason for concern. If you're not high risk your insurance company probably won't pay for an extra ultrasound. You should get an anatomy scan around 20 weeks and then a final ultrasound at the very end.

Answer

Have the doctors office deem it medically necessary. Fluid on the c-spine is more than enough reason, especially in cases of spina bifida. (Not saying that that's the cause.) They should give reason for the denial. What week are you? What was this ultrasound for? There are certain ultrasounds that a necessary for pregnancy. You can yourself to find out more information. Also I fired my medical assistant for entering wrong codes and error in referrals and pre-certs. The office could have made an error. First call insurance speak with someone find out the reason then call back the doctors office and ask to speak with the manager of the practice or doc. Good luck.

Answer

Don't stress too much! Your doctor's office will make sure everything is taken care of. It's part of the standard of care especially if it's an anatomy scan and your insurance is required cover it. I've had a few problems with the insurance during this pregnancy and every time the balk at covering something my doctor has called and left not so nice messages for the insurance. They always cover whatever it is I need after that (after complaining to her staff about how mean she was 😂😂😂). So definitely talk to your office if they haven't brought it up yet.

Answer

I work in a dr office. They will get the same notice more than likely and will call to get the prior authorization completed. We have to do this everyday with medications and procedures. I work in a specialty office

Answer

If you Doctor puts in that it's not just to find out the sex, that it's a medically necessary ultrasound to check for fluid complications, then the insurance should pay for it. With mine they pay for 3 ultrasounds ultrasounds ( dating scan, anatomy scan, and one around 36 weeks for measurements for birth ) well at my 20 week scan my little boy was stubborn and wouldn't move so they could see his heart and face. My ob just told insurance it was medically necessary for them to see his heart and do more measurements, and my insurance paid for another at 24 weeks. I would talk to your OB about it ! Good luck !

Insurance denied ultrasound?!

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