I also have BCBSNC and experience a similar problem (several times) during my pregnancy and then after the baby was born. The first problem I encountered, I felt I need to be tested to for chickenpox antibodies. One of my students attended class while infected with the chickenpox and just because you’ve had the virus once doesn’t mean you are always immune. I called the doctors and then the insurance; I was scared and frustrated with the lack of results. Finally, I asked the billing clerk at the doctors office for the billing code that would be used for the claim and spoke o a claim specialist and got my answer. Now, be sure to speak to someone in claims because account reps can tell you if you are covered but they might not be able to tell you if you are responsible for the co-pay or 20% or if there is a contracted rate. That’s another long story…

Just to pile on BCBS ... four years ago, after I had my daughter, they actually billed my daughter for her time in the hospital because ... and I still crack up when I think of this ... my daughter had not notified them that she was going to be in the hospital. Apparently, at the time (I have a different insurance now, so not sure what the policy is), if you know you're going to be in the hospital, you must notify insurance. Of course, my daughter was a newborn, so not exactly sure how she was supposed to do that, you know, pre-birth. It was ironed out pretty quickly thankfully.

Something similar happened to me with my son. We were discharged from the hospital on the second day but day three we had to rush him back to the hospital. His bilirubin count was so high we rushed him to the ER and he was admitted into the NICU. The claim took months to resolve since we did not have a pre-authorization.

Thank you for your comments.

In your experiences, did BCBS cover the first trimester screening??

I would re-think getting the screening done if you're referring to the amniocentesis. I declined it because when I was pregnant I talked with my doctor about the false positive results, plus the chance that you could miscarry during the screening. Also, unless you're over 35 and have a history of genetic disorders in your family, you're not likely to be at risk.

Hi barb, this screening is just the ultrasound to check the nuchal fold, space behind the neck, and blood test.
I'm not going to do the amniocentesis unless really necessary, think it's too invasive.

In my BCBS policy, only one ultrasound was covered. I had my ultrasound at 17 weeks. I did not get the screening. When I set out on this journey, my mind was set to have the least medical intervention possible. I wanted this baby regardless of any possible complications and put my faith in God and my body’s ability. This was very out of character for me and I wouldn’t expect it others. In other words, I think every mother needs to trust her own instincts. Despite all this, I was so nervous when I did have the ultrasound. I was particularly scared of spinal bifida even though I’d plenty folic acid before and during the first trimester. Then, like I mentioned before, I had the chicken pox scare even though I had already had the chicken pox. This process of bring a child into the world can be scary. It having the screening will make you feel better, I suggest you t ask for the billing code and call BCBS and see if it’s covered. It’s important for your concerns to be addressed so that you have a happy and stress free pregnancy.

Congratulations on your pregnancy! It's been my experience that BCBS only covers one ultrasound during the pregnancy and that's usually your second trimester diagnostic scan. Most scans that your doctor deems as necessary, are usually covered, (sometimes requiring much preserverance on your part). In this instance, you would probably need to be a mother with risk factors that would prompt him to order the NT screening as necessary, such as advanced maternal age or a family history of chromosomal abnormalities. If none of these risk factors are present, you will probably find the test is not covered. Not every clinic performs this test, those clinics who do should be able to give you the answer as to if they are covered to perform the screening for your particular situation. Wishing you a worry free and healthy pregnancy! Kim@triangle4dbaby.com

Triangle Imaging Center

www.triangle4Dbaby.com

Yes, BCBSNC will cover your First trimester screening. I have BCBS coverage at the lowest end of the totem pole and they paid for the First screening at about 12 weeks and again for an anatomical screening at about 18 weeks. These ultrasounds are considered diagnostic, or some such, and not elective per se. We tried the same gambit: calling here, calling there, etc., and got the same non-answers. It all worked out fine. Don't worry. And be prepared to be surprised because the images in the First screening are really quite clear and kind of startling in that it looks....like a baby!

If you really are concerned, ask to speak to the "maternity" caseworker at BCBS. She/he should be able to answer that question and any others that may arise.

Yes, this screening will be covered. BCBS's maternity policy is pretty comprehensive and you should be able to proceed with this test and have it covered under your maternity benefits. Be sure to sign up for the BCBS Maternity program which sends you free books and other info. about pre and post natal subjects. Congratsulations on your pregnancy!

Thank you to all of you for your help and advice.

I am so happy to have joined this forum. 

First trimester screening can detect up to 85% of babies with Down syndrome and trisomy 18. I got this information when i was doing one of mywork at home jobs. In order to go for screening, high fees and charges are required and BCBS helps the pregnant women to get their screening.

Hi sehrish...

I did the work at home jobs also. I was actually doing affiliate mrketting for Halo Electronic Cigarette Company. It worked out pretty good while I was pregnant. I got to work off my computer and make my own hours. Pay was decent at best, but I couldnt beat the schedule. Which work at home job did you have?

Janet

My experience with Health Insurance is that you must always be referred to a specialist by a doctor!

My name is Dan Manson On July 10, 2009 I was driving down i75 in Naples, FL in my friend’s black explorer with two of my other friends, one in the front passanger nd one in the back. we met with an accident and i know Im young and I should suck it up and take it like a man. but I really dont see this situation getting any better. I haven’t been able to crack my health insurance since the day prior to the accident. Sitting here right now typing all this hurts my back. I cant stand or sit for too long, time spand of give or take 30 to 45 mins. It takes me 15 to 30 mins just to sit up on my bed in the morning.

if you are covered but they might not be able to tell you if you are responsible for the co-pay or 20% or if there is a contracted rate. That’s another long story.
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I need your help. We recently redecorated our house (last summer) and without knowing the consequences we used Toxic Chinese Drywall for our interior decoration. Sounds silly, but we honestly didn't know it is toxic... and the seller we bought it from... assured us everything is OK with it. My little bot has asthma... so he started having big breathing problems. Now we have to buy some expensive pills to help him recover... pills that our medical insurance doesn't cover. Do you think it's worth get a lawyer and sue the seller... and try to get money for my baby's medication?

Health Insurance must be covered.Xtracum

It should be covered by your health insurance.

Collagen

Hello :-) I would say that the tests will almost certainly not be covered. Anytime an insurance company says that they require something to be medically necessary to be covered by insurance, they take this in the strictest sense of the term. Sessions with a laser hair removal machine aren’t medically necessary, even if the resulting alleviation of social stress prevents you from having to seek treatment for depression. Unfortunately! Something must be necessary, not just for your peace of mind, but to actually prevent further inevitable harm, to be covered by insurance. If your risk factors for Down Syndrome are high (age, heredity, etc), then insurance should cover it even if the test comes out clear. If they aren’t high, even if the test shows a high risk factor, then you likely won’t be covered.

Presently have health insurance through my employer for which I pay $225/month for myself. There is a $1000 deductible. Fortunately, I'm healthy, take care of myself and go to the doctor for routine exams/physicals. Don't take routine medications or abuse going to the emergency room, doctors office or hospital. So far this yr, I've paid $1800 out-of-pocket expenses for having health insurance.
Been working in the health care system for 30 yrs now and have seen a dramatic decline in pt's with health insurance. For the most part, it seems, either people have medicaid or are classified as "self pay" meaning no insurance. How can the state, or we as tax payers, afford so many medicaid points ? How can the it be that the working class have no health insurance either ?How can medicaid points receive better health care coverage/cost than a working person who has insurance or doesn't ?The abuse in the health care system only increases and many Americans go without essential health care.
Another point to wonder. Why is it so many come to the hospital in this country on medicaid that don't speak English and I for one as a tax payer, pay for a translator to communicate with these points who receive "free" health care.Why do our criminals in prison get better health care than the homeless ?

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