Prenatal Care

  • prenatal carePrenatal visits and how they're billed

    If you notice signs of pregnancy or have a positive home test, schedule an appointment with your healthcare provider to confirm the pregnancy. It's recommended that pregnant women supplement folic acid daily to prevent serious birth defects of the spinal cord and brain. To use your pharmacy benefits to help pay for this, get a prescription from your doctor.

    Pregnancy care, after your first visit, is usually billed as a “global bill,” that includes most routine pre-natal visits, delivery of your baby, and one postpartum visit (six weeks after your baby is born). You will receive one bill after the baby is born. Certain labs, ultrasounds, and hospital care are billed separately.

    The common schedule is to see your doctor or midwife every 4 weeks until you are 28 weeks pregnant, then every 2-3 weeks until week 36. After that, expect to see your doctor every week until the baby is born.

    At these visits, your doctor will check the baby's growth, test your urine to detect any problems, and answer questions.

    Common tests

    You can also expect to be offered several tests:

    • An ultrasound to check your placenta, the fluid around your baby, how your baby is growing, and how your baby's organs are developing.
    • Diabetes test, which involves drinking a sugar drink and then having your blood drawn.
    • Blood tests to check for certain conditions or infections, such as anemia, rubella, HIV, hepatitis B, and sexually transmitted diseases.
    • Checks for Rh Incompatibility, urinary tract infection, and chlamydia
    • PAP smear
    • Your health plan covers standard professionally endorsed genetic testing for cystic fibrosis and spinal muscular atrophy (SMA). Other genetics tests might be covered based on family history. Your plan does not cover genetic testing for sex or frequently advertised broad DNA tests.
    • Some women also choose to have a genetic test in early pregnancy that has higher sensitivity for certain trisomy disorders (such as Down's). Your provider can help you decide if this test makes sense for you.

    Find your doctor

    Sign in to your account and use Find a Doctor to make sure your doctor is in your health plan's network. Confirm with your doctor that the labs they use are in-network. The services listed are recommended under the Affordable Care Act, and for most plans the services will be covered without any additional cost to you. Your doctor may also need to bill for other tests not listed, which may require additional costs because they are covered under your health plan rather than Affordable Care.

    Some pregnancy-related services are not included in the global bill, including ultrasound, amniocentesis, special screening tests for genetic conditions, visits for unrelated conditions (that might be incidental to pregnancy) or additional visits due to high-risk conditions.

    If you switch healthcare professionals before or for delivery, your physician has the option of billing each visit or service separately rather than global billing.

    Back to pregnancy overview

  • Benefits under your health plan may differ, so sign in and refer to your benefit booklet for information on what your specific health plan covers.

    Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on