Strictly speaking, that’s not what she’s being billed for. She’s being billed for a 1st trimester ultrasound (one procedure), and a Nuchal translucency scan (a second procedure). They may be performed in the same actual ultrasound session, but they’re not the same thing.
It’s like if you go into the ER with a compound fracture and need surgery to repair it, you’ll only go into surgery once, but you’ll be charged for a procedure to set the bone, and a procedure to stitch you back together as the parts of that surgery.
The NT scan and the 1st trimester scans are similar- the NT scan is a specific procedure to look for something specific, while the 1st trimester scan is a more general scan to check fetal health. Our experience (2 boys, had to go to a perinatologist for both) was that this is how it works- I think ours were $1200, not $800.
I’d call the doctor’s office and make sure that’s indeed how this worked, and how you got charged.
I’ve worked for several insurance companies and you can scream all you want, but no insurance company is going tell a member or a provider exactly what diagnosis and procedure codes to use to get a claim paid. At most you may given technical information about how to actually file the claim (like a claim address, electronica payor ID, what forms to use, etc) and referred to a medical policy document written in an unholy combination of legalese and medical jargon (or just told to follow Medicare guidelines).
Yes, this is exactly what happened. They did two (medically indicated) things with a single ultrasound. But my insurance is interpreting it as them doing one ultrasound, and then another ultrasound for no reason.
