Yes we do submit your claim to the medical aid! Most medical aids will cover TWO 2D ultrasound scans – those are the two BIG scans (Downs syndrome screening/Anomaly scan).

We submit the account for these scans LIVE to the medical aid to get real time feedback on what will be paid by the medical aid and what the shortfall is. Patients can then make the shortfall payment after the scan.

We charge the relevant medical aid tariff for most schemes. We do not have a payment arrangement with any specific scheme. We don’t charge more than the Discovery rate.

Unfortunately the viability, early scans, Growth and Doppler as well as 3D/4D scans are not paid for by the medical aid. These scans are paid in cash on the day of your scan.

Medical aid and ICD Codes:

For the Downs screening (11 – 14-week scan)  the codes 3615 and 3637 are used.

ICD10 code is  Z36.0

Practice number: 039 004 044 5088

CODE DESCRIPTION:

Code 3615 is the description for normal ultrasound performed between 11 and 14 weeks.  This is usually covered by most Maternity programs.  Should your obstetrician use this code before we do the scan, then you would be liable for the payment of this code.  Each medical aid has a different benefit amount for this code.  That is why the patient portion for each scan, might vary from patient to patient. 

Code 3637  is a Doppler code.  This is specific software we use to assess the blood flow in the various arteries – in the uterine arteries to check the function of the placenta, enabling us to predict the risk of pre-eclampsia and high blood pressure developing at a later stage in the pregnancy.  If you are found to be at high risk for PE, preventative medication can be given.  The Tricuspid valve and ductus venosus are also evaluated with the use of Doppler ultrasound.    The NT scan/risk calculation is incomplete without the use of the Doppler ultrasound and the evaluation of these structures.

IMPORTANT!!!

Several schemes do not cover code 3637 from the Maternity Program, but from the day to day benefit, should there be benefits available at the time of the service date. Some schemes do not cover this service code at all.  The rate for this code varies between R800 and R1200, depending on the benefit amount for each fund and plan.  PLEASE NOTE that the amount that you would probably have to pay in out of your own pocket is approximately 1300.00 if your day to day benefits are depleted.  

The private rate is R2000.00

For your own peace of mind, you need to confirm your benefits available and benefits for your specific option and plan, prior to each consultation. If you would like to know what the shortfall might be, please do not hesitate to contact us at accounts@fetalultrasound.co.za.  or Whatsapp us on 061 540 5657.

PRICE LIST FOR 2024:

Viability / Early pregnancy scan (6-10 weeks)	R840.00
Downs screening (11 – 13 weeks 6 days)	R2000.00
Gender Scans	R840.00
Anomaly Scan (18-22 weeks)	R2000.00
Growth and Doppler	R1100.00
3D / 4D Scan (26-30 weeks)	R1100.00

WITH WHICH MEDICAL AIDS ARE WE AFFILIATED?

We are affiliated with most medical aids. We submit all claims ON THE DAY of the scan. Any PORTION which the medical aid does not cover patients are liable for. This may be paid after the completion of the scan.

Medical aids and scheme plans which do not provide full payment:

Medical aid	ESTIMATED patient portion:
Bestmed	R1 439.80
Bonitas	R642.00
Camaf	Cash only
Fedhealth	R570.80
Medshield Custom	R1 266.60
Medshield Mediphila	R1 266.50
Momentum Ingwe	Cash only
Momentum Health 4 me	Cash only
Motohealth	Cash only
Medimed Standard	R1 266.50
Medimed Alpha	R1 266.60
Medihelp	R179.90
Discovery Keycare	R1 266.60
GEMS Emerald	R478.70
GEMS Emeral Value	R478.70
GEMS Ruby	R1 266.60
GEMS Beryl	Cash only
Sizwe	Cash only
Profmed	Cash only
Polmed	R980.00
Old Mutual	R600.00
Discovery Retail	R1 266.60
Malcor	Cash only
Bankmed	Cash only
Remedy	Cash only

THESE AMOUNTS ARE ALL ESTIMATES. PLEASE CHECK WITH OUR RECEPTIONIST ON THE DAY OF YOUR SCAN WHAT THE FINAL AMOUNT WILL BE.