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The images produced from an ultrasound, a milestone procedure in many pregnancies, are called sonograms. Ultrasounds are part of routine pregnancy care, but they do cost money. If you have insurance, you may find yourself paying some-out-pocket costs for them. Expectant mothers without insurance will have to pay for all charges relating to them. Ultrasounds performed in some settings, like many hospitals, can result in both a procedure charge and a physician fee, with the patient responsible for a copay or coinsurance for each.
Ultrasounds for pregnancy
Ultrasounds use high-frequency sound waves to produce images of the body’s internal structures. Pregnancy ultrasounds are often done transvaginally or over the abdomen to visualize the fetus, the placenta, and the amniotic fluid.
Ultrasounds estimate the age of the fetus and thus, the mother’s due date. In addition, ultrasounds usually pick up problems like ectopic pregnancies or birth defects, as well as monitor fetal size and position as the due date approaches. Most pregnant women in the U.S. will get at least one or two sonograms before they give birth and some, who have suspected problems or high-risk pregnancies, will get many more.
The American Academy of Family Physicians says, "It is the standard of care in most U.S. communities to offer a single ultrasound examination at 18 to 20 weeks' gestation, even if dating confirmation is not needed."
How much does a pregnancy ultrasound cost?
The "sticker price" of having an ultrasound can vary dramatically, depending on where you live, and who’s providing the service.
Healthcare Bluebook, which estimates fair prices of medical procedures in various parts of the country, suggests that a reasonable cost for a fetal ultrasound is $202. This amount may vary, depending on the city or state of the mother. According to Healthcare Bluebook, a fetal ultrasound in New Jersey could cost around $350 but in Oklahoma, it drops to $175.
The amount you’re charged can also vary dramatically depending on your provider. Large hospitals with higher administrative costs may charge more for a sonogram than a doctor’s office or stand-alone clinic would. If you want to know how much your first ultrasound will cost, call your provider to find out the cost. Make sure to stay in-network to minimize your costs.
If you are uninsured, you will need to ask your medical provider upfront. You could ask them if you can negotiate the cost or set-up a payment plan, as well. The FDA and several medical groups like the American Medical Association and The American College of Obstetricians and Gynecologists warn women against "keepsake sonograms," which may be offered by private companies.
How much does a sonogram cost?
To comply with the Affordable Care Act, health insurers must cover preventive care including "many services necessary for prenatal care" with no cost-sharing, according to the U.S. Department of Health and Human Services.
That means, no deductible, no copay, no-coinsurance, literally no out-of-pocket cost to the insured beyond the premium. Certain tests are mentioned in the legislation and subsequent guidance, including screening for gestational diabetes, however, no specific mention is made of radiology, which is the category that includes ultrasounds.
Most insurance companies have interpreted the Affordable Care Act’s requirements on prenatal coverage with no cost-sharing to exclude ultrasounds. For example, UnitedHealthcare Community Plan "considers ultrasounds not medically necessary if done solely to determine the fetal sex, or to provide parents with a view and photograph of the fetus." Ultrasounds are not listed as a service for pregnant women on its website.
Doctor-prescribed sonograms (but not keepsake ones) will still be covered by your insurance, meaning they’re considered medically necessary and part of acceptable care. However, depending on your plan’s specifics, you may have to pay for some portion, or all, of them yourself.
What to expect, when you’re expecting to pay some part of your sonograms
Exactly how much you’ll have to chip in for your pregnancy ultrasounds depends on both the cost of the procedure at your provider and the payment structure of your health insurance plan.
Again, if you don’t have health insurance, or are opting for a totally elective sonogram (perhaps to find out the gender of your baby), you’ll have to pay the entire cost out of pocket with no help from insurance. In these cases, it is possible to negotiate directly with ultrasound providers, so ask them for their best deal.
If your ultrasound was prescribed by your doctor, you may have to pay for it as part of your deductible before the insurance plan steps in. Otherwise, you will pay your plan’s predetermined copay or coinsurance percentage. You’re only home-free after you’ve reached your plan’s out-of-pocket limits for the year. After that, insurance should pay for all of your health care in its entirety. Ultrasounds conducted at a larger hospital can also incur a physician or radiologist fee.
Copays and coinsurance costs
Because of such variations from plan to plan, it’s important to check the details of your own, so you understand what costs you will ultimately pay. If you want to minimize your expenditures, it’s also essential to get all of your care from in-network providers, since out-of-network options can leave you with even higher out-of-pocket costs.
And keep in mind, if your pregnancy spans two calendar years (like if you become pregnant in September, and deliver the following June), you will be subject to your deductible, copays and coinsurance for both calendar years.
To calculate your worst-case scenario, (which is not uncommon if you need many tests throughout your pregnancy) multiply your out-of-pocket max by two for a ballpark estimate.
Also consider what you’re paying annually in premiums, which are not included in the out-of-pocket max. It may make sense to switch to a plan with a lower cap on out-of-pocket costs, when you know you’ll be getting a lot of medical care.