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Ultrasound and insurance question

So my doctor has already done about 4 ultrasounds, and then I had one done at the ER because I was having abdominal pain....None of which I requested myself (well I opted to go into the ER of course..). Everythign has been healthy so far. The insurnace company is now telling me that they only cover 1 u/s per pregnancy unless the doctor shows records that it was "medically necessary." Do you think my doctor can do this even if there technically weren't any problems? Has anybody encountered this problem?

Answer Question

Asked by LittleMonster22 at 9:43 PM on May. 17, 2009 in Pregnancy

Level 3 (15 Credits)
Answers (10)
  • Awwwwwwww the medical business! Well, you'll be in debt but if you pay them every month it can't show up on your credit. Just pay them 5 bucks a month and you'll be fine. When you get out of college and get an amazing career then you can pay it off! Good luck!

    Answer by Anonymous at 9:44 PM on May. 17, 2009

  • I had to have three ultrasounds done, my insurance only covers one, and my dr's were able to prove they was needed even though no problems showed up in them. Call your dr and tell them what is going on.

    Answer by Anonymous at 9:47 PM on May. 17, 2009

  • Yea just talk to your dr. My insurance is the same but I've had to have two and they covered them because of how my dr filed it. Good Luck

    Answer by jazzysmommy1004 at 9:55 PM on May. 17, 2009

  • I'd talk honestly with you doctor and ask them to resubmit with medical need proof. Tell him paying for them yourself will really impact your money once baby's born. I had my tubes tied during the csec birth of my third baby. Insurance told me they wouldn't cover two operations at one time. My doctor didn't charge me or my insurance company for my tubal. Great doc!!!

    Answer by Anonymous at 10:06 PM on May. 17, 2009

  • If it wasn't medically necessary, you should have declined the ultrasound to avoid this problem. If your doctor thought it was medically necessary than have him send your records to your insurance company.

    Answer by mnt_2_b_mommy at 10:07 PM on May. 17, 2009

  • I am not a doctor - how would I know what is medically necessary or not? This is my first baby. I figured that if he was performing these ultrasounds, that it was routine and that it wasn't just for shits and giggles

    Answer by LittleMonster22 at 10:08 PM on May. 17, 2009

  • if you didnt request it and the doctors did them they would have to have some reason to want to do them for you so in my opinion i would see what was going on and explain to your doctor and insurance company.. ive had like 6 as well so i know where youre coming from but if you didnt request them ask the doctor whats up! good luck!

    Answer by USMC_Elisa at 10:31 PM on May. 17, 2009

  • find out if it was medically neccesary...the one at the ER sounds like it might have been but the other ones probably werent...

    Answer by hug4akiss at 10:31 PM on May. 17, 2009

  • My dr files all of mine as medically necessary.
    I don't know how she does it, but the insurance company can't do anything about it.
    I'd just ask your dr to file it differently. They don't do them for no reason.

    Answer by emmetsmom09 at 11:11 PM on May. 17, 2009

  • You know what is medically necessary by being proactive about your own body and pregnancy. It's not rocket science here. Unless there is a suspected problem with the baby, the only ultrasound needed is the one to check fetal developement, and even that is debatable. So, basically, unless your doctor tells you "I HAVE to do an ultrasound because..." then it isn't medically necessary. Doctors make money off ultrasounds you know.

    Answer by mnt_2_b_mommy at 1:33 AM on May. 19, 2009

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