Hi All! Hoping to get some insight of if I can fight this. I was charged approximately $1000 for my first prenatal visit (ultrasound, labs, office visit). After calling insurance they state that this is considered a “Well Visit” but that any subsequent appointments will be covered (other than birth). Below are two different sections of my insurance plan. This is just really frustrating due to calling initially and asking plan details and they stated that prenatal is covered. Well apparently the first visit isn’t considered prenatal. Is there anything I can do?
Maternity: Expenses Incurred by all Covered Persons for: (a) Pregnancy. (b) Preventive prenatal and breastfeeding support as identified under the preventive services section below. (c) Services provided by a Birthing Center. (d) Amniocentesis testing when Medically Necessary. (e) Up to 2 ultrasounds per pregnancy (more than 2 only when it is determined to be Medically Necessary).
Preventative Care: With respect to women, such additional preventive care and screenings, not otherwise addressed by the Task Force, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration and published on August 1, 2011 (or any applicable subsequent guidelines or guidance requiring any additional women’s preventive services). Those guidelines generally include the following: (A) Well-woman visits. Well-woman preventive care visits annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. The inclusion of a well-woman visit is not meant to limit the coverage for any other preventive service described elsewhere in this Plan document that might be administered as part of the well-woman visit. Coverage for prenatal care is limited to pregnancy-related Physician office visits including the initial and subsequent history and physical exams of the pregnant woman. In the event a provider bills a “maternity global rate”, the portion of the claim that will be considered for prenatal visits and therefore, preventive care, is 40% of the “maternity global rate”. As a result, 60% of the “maternity global rate” will be considered for delivery and postnatal care and the normal cost-sharing provisions would apply. Items not considered preventive (and therefore subject to normal cost-sharing provisions) include Inpatient admissions, high risk specialist units, ultrasounds, amniocentesis, fetal stress tests, delivery including anesthesia and certain pregnancy diagnostic lab tests.
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[link] [comments]Hi All! Hoping to get some insight of if I can fight this. I was charged approximately $1000 for my first prenatal visit (ultrasound, labs, office visit). After calling insurance they state that this is considered a “Well Visit” but that any subsequent appointments will be covered (other than birth). Below are two different sections of my insurance plan. This is just really frustrating due to calling initially and asking plan details and they stated that prenatal is covered. Well apparently the first visit isn’t considered prenatal. Is there anything I can do? Maternity: Expenses Incurred by all Covered Persons for: (a) Pregnancy. (b) Preventive prenatal and breastfeeding support as identified under the preventive services section below. (c) Services provided by a Birthing Center. (d) Amniocentesis testing when Medically Necessary. (e) Up to 2 ultrasounds per pregnancy (more than 2 only when it is determined to be Medically Necessary). Preventative Care: With respect to women, such additional preventive care and screenings, not otherwise addressed by the Task Force, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration and published on August 1, 2011 (or any applicable subsequent guidelines or guidance requiring any additional women’s preventive services). Those guidelines generally include the following: (A) Well-woman visits. Well-woman preventive care visits annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. The inclusion of a well-woman visit is not meant to limit the coverage for any other preventive service described elsewhere in this Plan document that might be administered as part of the well-woman visit. Coverage for prenatal care is limited to pregnancy-related Physician office visits including the initial and subsequent history and physical exams of the pregnant woman. In the event a provider bills a “maternity global rate”, the portion of the claim that will be considered for prenatal visits and therefore, preventive care, is 40% of the “maternity global rate”. As a result, 60% of the “maternity global rate” will be considered for delivery and postnatal care and the normal cost-sharing provisions would apply. Items not considered preventive (and therefore subject to normal cost-sharing provisions) include Inpatient admissions, high risk specialist units, ultrasounds, amniocentesis, fetal stress tests, delivery including anesthesia and certain pregnancy diagnostic lab tests. submitted by /u/iliketoclimbthings [link] [comments]Read Morer/HealthInsurance