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Aetna says...
My wife is pregnant and the doctor we refer to had ordered an ultrasound check up as I understand is normal practice to find out the fetal growth and check for abnormalities. So we got it done and then came back happy after seeing our baby. However suddenly last week we got a bill for $1537 for the lab expenses!! When I questioned Aetna Health Insurance and the doctor's office, the answer I got was very shocking to say the least.
Aetna said that they code that the hospital used was for routine check and they don't cover routine ultrasound unless it is a medical necessity. Fair enough. We thought the hospital billing department had made a mistake and talked to our doctor's office regarding this. They promised to check and get back to us. It seems that the hospital is doing everything right but it is Aetna who is behaving strangely. They are denying all claims of ultrasound checks done as per normal pregnancy procedures. It seems that (the all mighty) Aetna has decided that ultrasound tests as a part of normal medical tests is not a medical necessity and should not be done regardless of whether the doctors think otherwise or not.
Well excuse me for being so naive, but I thought that doing ultrasound test is required during pregnancy to determine expected delivery date and fetal growth and identify problems if any. If what Aetna says holds good, then it is like going back in primitive times when there were no medical tests and every situation was handled as it presented itself. If that is going to happen, then why in the world are we paying such a high premium for health insurance?
And if the insurance companies are not going to cover these costs, then I think nobody will be able to afford a baby in America. I am now at a loss at what to do. The doctor's office has assured me that they will resubmit the claim with some accepted code. I will be escalating this to my employer to see if we can do something about it. At the same time, I would like to escalate this in Aetna to their CEO or someone and see if it makes any difference. If anyone knows any contact information, please let me know. I mean this is totally ridiculous reasoning on Aetna's part. And it is now up to us consumers to make sure that these big insurance companies don't get away with it. If you agree with me lend your support to me and pass the word around.
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I just received a $700.00 bill for my 20 week ultrasound. I got the same exact run around that you did. At one point the person at Aetna asked why we had a 20 week ultrasound done and why we went to the hospital to do it. Well, every other ultrasound was covered and the doctor ordered it and told me where to go so I did what he said. Since when is a 20 week ultrasound not needed! I guess they think it is ok not to find out about major medical issues until the baby is born? It's not like the utlrasound was done just to see what the baby was doing at that time! They were checking major items like organ growth, fluid levels, size of the baby, heart beat/growth, etc.
If I had known it would not be covered I would not have gone to the most expensive place to have it done!
I cannot believe they are saying this was not needed and wont pay!
Did you guys get this covered from Aetna finally ?
I am facing the same problem with Aetna and at my clinic OBGYN Eden Prairie MN .
This inspite of Aetna rep. informing that the Ultrasound is covered when i had called. Now after the ultrasound is over they say its experimental.
Thanks
Samant
612 392 9739
Hi Samant,
Yes, we finally got it covered. I guess you have to tell the doctor's office to change the codes they use for billing the ultrasound. That's what my doctor's office did and they finally got it covered. It seems that Aetna is trying to save money by any means and not pay up. If the Doctor's office can somehow show that they Ulrasound they did was very much required, then they will cover it.
Let me know if this helps.
Hi Mukund,
I had posted a big para here about Aetna not covering my wife's 'USG' not sure why it got lost.
Anyways, did u finally manage to convince aetna that the USG for 20th Week was 'required' and is not 'experimental
' ?
Thanks
Samant
612 392 9739
Eden Prairie
MN 55344.
Hi Mukund,
I had posted a big para here about Aetna not covering my wife's 'USG' not sure why it got lost.
Anyways, did u finally manage to convince aetna that the USG for 20th Week was 'required' and is not 'experimental
' ?
Thanks
Samant
612 392 9739
Eden Prairie
MN 55344.
Same issue here. Aetna is very unhelpful if you call--and rude and demeaning, too. I luckily called the day before my 16 week (guess I'm going to go ahead and cancel my 20-week, too!) and learned it wasn't covered since I got the 13 week (as the initial Down's test).
I DID learn that if your doctor is willing to "fudge," say you have certain risks, and submit a preapproval 30 days before you ultrasound, there is a higher chance it will be covered. Then again, my experience with Aetna is I wouldnt trust that, either. I am beginning to think that birthing in a hut sounds better than working with Aetna!
aetna is the worst! i hate them.searching for better