Insurance Hassles (Episode 2)

At the last appointment with Dr. G, he: (1) declared I shall be seen by a maternal-fetal medicine specialist (or MFM – which is a fancy name for a high-risk OB) for the rest of my prenatal care; and (2) suggested that we have a nuchal translucency (NT) scan to non-invasively test for Down Syndrome and a few other abnormalities. Since I have insurance through Tricare Prime, both of these things require authorizations.

A couple days after the appointment, Dr. G’s nurse called and said she’d gotten my NT scan set up for 3/9 at 9:30. I don’t think that Dr. G’s office actually sees that many Tricare patients, or at least they must not make a lot of referrals for us. Since the nurse couldn’t confirm for sure that Tricare would cover the scan, I began a marathon of phone calls.

Initially, Dr. G’s office hadn’t even submitted an authorization request at all, despite my repeated voicing of insurance concerns. By Thursday, I got the nurse to fax in the requests – but she put both services on the same request form. Even through yesterday, the nurse tried to convince me that everything would be just fine that way. Today, Tricare finally finished processing the request. They approved the authorization for the MFM care, but the NT scan couldn’t be approved on the same authorization because, though both are through the same Providence hospital, they are different providers. I had to put in a rush call to have the nurse phone in, rather than fax, the request information to Tricare if there’s any hope of getting it processed before tomorrow morning’s appointment.

Why don’t I quit stressing about it and just reschedule tomorrow’s appointment? Besides the fact that Brendon and I both already arranged to get the day off work? Apparently, either 13 weeks 4 days (according to Dr. G) or 13 weeks 6 days (according to BabyCenter) is the last possible day that you can have an NT scan done. Tomorrow is 13 weeks 3 days. In other words, there’s not a lot of wiggle room with the appointment time.

I’ll be putting in another call to Tricare at the end of the day to make sure we’re good to go. Fingers crossed.

***Side note – there’s a chance, with the higher-quality ultrasound equipment they’ll use for the scan, we’ll be able to find out the genders tomorrow! If you haven’t voted in the poll at right yet, this may be your last opportunity!

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