First prenatal visit charged as diagnostic/regular office visit (weeks, early, months)

[audreyywq]

Hi,

I'm pregnant the first time and just went to my first prenatal visit. They did the urine test to confirm my pregnancy, an ultrasound to hear the heartbeat and some blood tests as well. Just realized I owe them hundreds $$ for that visit. My insurance cover prenatal care at 100% so I never thought I would be billed for almost every test I did on that day including the office visit itself. Except the ultrasound was billed as prenatal so it was covered by the insurance without problem. The insurance company told me the doctor office billed this visit as a diagnostic visit so everything would go to my deductible first and I will have to pay out-of-pocket. The doctor's office told me they are counting this visit as a diagnostic visit because the purpose was to figure out why I missed my period instead of a prenatal visit.

It was a surprise to me and I wonder is it a common practice to bill the initial prenatal visit as a non-prenatal? I went to this OB practice for my routine well women exam and I'm an existing patient. And I told them when making the appointment that I tested positive at home!

Thanks!!

[TabulaRasa]

Not standard. It should be coded as prenatal.

[Sollaces]

Call your insurance company. They do mess up. I don't know if blood work is separate billing or not. When I have blood work done at the OB office, it's done by a diagnostic company so of course it's separate.


That's odd an ultrasound is done when determining a pregnancy. Is that usual? Isn't that done at 5 months or have things changed?

[newtovenice]

The OBs office HAS to submit the forms to the insurance company using proper codes for billing. Insurer is only going by what was submitted to them by the doctor's office. They only care about the codes on the form.

You need to talk to billing at OBs office to get this sorted out.

Billing is all about the billing codes.

[ReblTeen84]

Originally Posted by Sollaces

That's odd an ultrasound is done when determining a pregnancy. Is that usual? Isn't that done at 5 months or have things changed?

Our OB did the first at 8 weeks I believe. I used the images to tell my grandparents she was pregnant.

OP, from my limited experience, all of that should be prenatal. Our OB office coded everything correct, which included everything you had on the first visit. Our insurance also covered the genetic testing we had done.

[jc718]

I went to see my dr at 5 weeks to get a sonogram (to confirm)and to get my yearly pap smear. The doctor's office told me that my insurance would only cover the pap smear. They don't start covering what they consider prenatal visits till 8 weeks. I paid out of pocket for that tiny picture. I didn't care. I wasn't going to wait two more weeks to get a tiny glimpse of my little one.