$275 For An Anatomy Scan: Worth It?

I’ve been blogging for a few months now about the costs of my oh-so-American pregnancy, which is “covered” by a bronze-level, high-deductible Obamacare insurance plan. You can read the previous installment here.

After a frank conversation with my midwife, I found I had a choice to make. The anatomy scan, which takes place at about twenty weeks, loomed. Did I want it, knowing roughly what — or at least that — I would have to pay?

Based on the bills I had received thus far, I had learned that the lab charged my insurance $500 per sonogram and had tried to give me three. I bowed out of the third, once I was told by the midwives that, with no ill effects, I could. As I’ve pointed out elsewhere:

According to the American Pregnancy Association, “many healthy pregnancies will not require ultrasound” at all. “For women with an uncomplicated pregnancy, an ultrasound is not a necessary part of prenatal care.”

My insurance absorbed some of the cost of both ultrasounds, thank goodness, but still passed a chunk of it on to me. Indeed, it may have already passed the cost on to you too. Because this is how it works in our crazy capitalist health care system:

1) Labs and doctors schedule lots of work-ups and charge per procedure.

2) Patients, thinking it must all be necessary, acquiesce. Especially during pregnancy, it feels dangerous to say No to anything. Think of the baby, you selfish monster. Are you really going to pinch pennies or contradict a doctor when there’s a helpless child’s potential well-being at state? Besides, nothing is pitched to patients as a choice; they are simply told, “OK, now it’s time for another blood test,” and off they go.

3) Insurance companies negotiate rates and finally pay the lab.

4) Insurance companies raise rates on all of us.

All parties share responsibility for how dysfunctional this is, because we each have a part to play and because we could put pressure our representatives in government to make changes but we don’t.

Anyhoo, like I said, after conversations with the midwives, I started politely rejecting any blood work and ultrasounds that I was told weren’t mandatory. The anatomy scan was the biggie, though. I remembered it from my last pregnancy: that was the ultrasound to which I brought Ben, and the two of us marveled together at the guided tour of our child-to-be. Look, there are the kidneys! The brain has two hemispheres! The heart has four chambers! That’s some first-class body building right there.

We got to know our future kid inside and out. In some ways, we understood that was a peak experience, that we would never be allowed such intimacy again. Also, we were told we were having a girl.

It seemed so sad to forego the experience this time. Besides, the midwives said they really did appreciate getting the in-depth information offered by the anatomy scan; they found it useful. Ben and I discussed the matter and agreed. If the lab told me the price wasn’t exorbitant, we would go forward.

“$275,” said the woman from the lab, when I called to ask. “That’s what we’ll charge your insurance.”

I asked her several times if she was sure and if she could repeat the number, because it seemed strangely low in comparison to what they have charged for other services, but she told me she was certain. Ben and I shrugged at each other. For $275, we decided, we would proceed.

This week, that is what we did. Yet again, my belly got glopped up and a tech took us into night-vision land to show us the inner workings of our developing child: heart, brain, kidneys, limbs. Everything was fine, thank goodness. Because that’s the other thing an anatomy scan can do: alert you that there’s a serious or potentially fatal problem, which occurs in about 1% of cases but can mean you may elect to terminate for medical reasons. (That’s why the vast majority of people have late-term abortions, in case you were wondering.) In England, they call it an “anomaly scan.”

“Oh, it’s a boy,” said the tech suddenly, apropos of nothing, and just like that, everything became that much more real.

The doctor came in later to repeat what had been done, underline that things looked great, and then to tell me I shouldn’t forget to get my blood drawn before I left.

“Uh,” I said, “is that a new test?”

“It’s a continuation of the chromosomal screenings from before,” she said.

“Yeah, I talked about it with my midwife,” I said. “I think I’ll pass, thank you.” My midwife had told me that all that test would indicate was whether there was an increased likelihood of abnormality, rather than a guarantee of anything. And then, once I had that information, all I’d be able to do about it anyway was a) pull the plug, or b) spend four months worrying. No thanks.

The doctor’s eyebrows went up.

“But you began this process with us,” she said, in the manner of a man surprised that I wasn’t interested in a second date. “Are you sure you don’t want to proceed?”

“I am,” I said. “Thank you.”

She recovered her composure and said farewell, adding a congratulations as she went out the door. I looked at Ben to gauge if he felt like I’d handled things right. He nodded vigorously at me.

“It’s a boy,” I said to him.

“It’s a boy,” he said back to me, grinning.

That smile was definitely worth $275. If only we could be sure that $275 will indeed be the price on the bill.

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