I was sent to a Perinatolgist (sp) high risk pregnancy Dr. due to preterm labor when I was four months pregnant. The Dr. sent me to another facility to have an ultrasound. This ultrasound was very detailed and apparently included measurements of the fetal brain, placenta, etc. that are usually only measured if there is a question of fetal development or genetic anomaly. Not for preterm labor. My insurance denied the claim. The ultrasound facility submitted it again and again denied. The Dr. office submitted pretty much all of my records and again the claim was denied. I have now received a notice from a collection agency and if I don't pay by January 15th they are going to report it to the three major credit agencies. I don't know what to do! I don't know where to turn! I'm not certain if I really needed the very detailed ultra sound that the Dr. ordered or if maybe he made a mistake and I should have gotten a less expensive ultrasound.

My insurance, Aetna says it won't pay the bill. The person in the billing department at the facility said they performed the test the dr. ordered and want their money. The Dr. office says as a standard practice this is the test that is ordered for preterm labor. What should I do?

Hi Siglin. I hope all is going well with your pregnancy. It is a shame that you should have to worry about a bill with everything that is going on!

Check your explanation of benefits from Aetna, or call them to see if they say that this bill should be your responsibility. If they say no, tell them that you are being billed and have been sent to collections.

Also, when the test was performed, did you sign anything saying something to the effect that if your insurance refused to pay that you would be billed? Some places do this when they know that it will be denied by the insurance co.

I know you said that your dr sent your medical records. Did he also send a letter of medical necessity? These are time consuming for the dr to write, but they can make all the difference.

One last idea, ask the ultrasound facility abut the diagnosis that they used. If an incorrect diagnosis was used, it will cause the denial.

As a final resort, you can always appeal with Aetna, but there are usually time limits for appeals. Check with Aetna about your rights.

Good luck to you!