I’ve had a very frustrating week and need to vent. I’m so stressed about this and so encouragement would be appreciated!

I’m a person who tends to run high on anxiety naturally, and so I’m a double checker at heart. I’m especially nervous about health insurance matters, because getting something wrong can cost you greatly. I’m in my 2nd pregnancy, low risk. I have Aetna, but had Independence for my 1st pregnancy. I always always call insurance with CPT codes and NPI numbers before going to any appointments just to make sure I’m covered.

All has gone smoothly until I get a big stack of test order forms from my doctor in May for upcoming blood tests, genetic tests, and ultrasounds. So in May I called insurance, giving test procedure codes and where I would have them done. Everything was good to go except for one blood test I opted out of because I’d have to pay out of pocket. My anatomy scan order page, with procedure code 76805 said “anatomy evaluation of the fetus, >= 14 weeks.” Seemed straight forward enough and it was covered. My doctor had called it my “anatomy scan” and told me to schedule it ASAP, so I did. I called the ultrasound place he referred me to (same building and care network, but different office) and scheduled my anatomy scan.

Then July comes, I get the anatomy scan done at 19.5 weeks. All seems similar to my 1st pregnancy. Now a few weeks later I get a notice from insurance saying they’re denying coverage for the anatomy scan, procedure code 76811. I call them to tell them I didn’t get procedure 76811 done, I got 76805. They tell me that it was billed wrong and to contact the place where I got the ultrasound done. I rifle through my files and pull out the original test order form with code 76805, call the ultrasound place, and hear from a very snippy lady in billing that 76811 is an anatomy scan and 76805 is a dating scan. She tells me that the OBGYN gave me the wrong code from the get go and to talk to them about it. I call the OBGYN’s office and am waiting to hear back.

I looked it up since, and online it says 76805 is a standard 2nd trimester ultrasound including an anatomical survey of the fetus, and 76811 is a detailed anatomic ultrasound usually performed in high risk patients.

As far as I’m concerned, either: the ultrasound place schedule me for a high risk ultrasound while knowing I’m not high risk, or the OBGYN gave me a code for a dating scan and told me it’s an anatomy scan.

Either way I’m currently on the hook for $520.