Pregnancy: What tests does the health insurer cover?

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Written By Kampretz Bianca

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What are the benefits of health insurance for pregnant women?

At the Maternity policy regulates which services are paid for by statutory health insurance companies. All services are voluntary. That includes:

  • Regular examinations of mother and child (assessment of health status, detection of high-risk pregnancies)
  • Monitoring the mother’s blood pressure and weight
  • Urine test for protein and sugar
  • 3 basic ultrasound exams
  • Tactile exams to assess the position of the uterus and the position of the child
  • Control of the child’s cardiac activity
  • Blood tests: determination of blood group and Rhesus factor, antibody screening tests (AK), determination of hemoglobin and tests for infections such as chlamydia, rubella, syphilis and hepatitis B
  • Toxoplasmosis test (if there is reasonable suspicion of infection)
  • Gestational Diabetes Test
  • HIV Test
  • Seasonal flu vaccination
  • Vaccination against pertussis (whooping cough)
  • Oral health education and nutritional recommendations (e.g., increasing iodine intake and information about the link between diet and cavity risk).

Blood test to determine fetal Rhesus factor

Previously, all Rhesus-negative pregnant women were treated with anti-D immunoglobulins. This is clinically unnecessary because the risk of maternal sensitization only exists in a Rhesus-positive child. Context: If women with negative Rhesus factor are expecting a Rhesus positive child, the mother’s blood may produce antibodies against the child’s Rhesus factor.

A blood test has been available for pregnant women since July 2021. This determines whether you need preventive treatment with anti-D prophylaxis. The test is used to analyze the child’s DNA in the mother’s blood in the laboratory and, thus, determine the Rhesus factor of the unborn child. The goal is to find pregnant women who will really benefit from the treatment. If the child is Rhesus positive, the mother receives anti-D immunoglobulins. The test can only be performed from the 12th week of pregnancy. This avoids unnecessary medication administration.

Trisomy Testing for High-Risk Pregnancies

From the 10th week onwards, pregnant women can have a special blood test to check whether their child has trisomy. Until now, so-called prenatal testing (NIPT) had to be paid for privately. Is about no a standard or routine exam during pregnancy.

Since July 2022, prenatal examinations have been covered by health plans in certain situations within the scope of prenatal examinations. The costs will be covered if other tests indicate trisomy or if a woman decides together with her doctor that this test is necessary in her personal situation.

During the exam, the child’s genetic components from the pregnant woman’s blood are examined for genetic defects or trisomies 13, 18 or 21. Unlike amniocentesis, the blood test for trisomy does not pose a risk of miscarriage.

Trisomy 21 is a condition known as Down syndrome, in which people have one more chromosome than others in every cell of the body. There are three copies of chromosome 21. In addition to Down syndrome, the test can also detect trisomies 13 and 18, which are rarer and more serious.

The consequences of trisomy are mental and physical disabilities and developmental delay. However, the characteristics are very different.

Trisomy cannot be treated. Therefore, if possible, psychosocial and medical counseling should be considered before and after the examination. After an abnormal diagnosis, expectant parents can contact pregnancy counseling centers, self-help groups or associations for the disabled.

You can find more information and contact details on the Federal Joint Committee website.

What ultrasound exams does the health insurance company cover?

The three basic legally required ultrasound exams, also known as sonography, occur around the 10th, 20th and 30th week of pregnancy. They serve to regularly check whether the pregnancy is occurring normally and whether the child is developing according to its age, without malformations or functional disorders.

Since 2013, pregnant women can choose between a normal or extended ultrasound for the second basic ultrasound. Important parts of the child’s body (head, neck, back, chest and trunk) are also examined in more detail. The guidelines stipulate that doctors must have special qualifications and equipment for this purpose. Otherwise, you should refer someone to trained colleagues.

What additional services do doctors offer?

Since January 1, 2021, ultrasound examinations during pregnancy that are not medically necessary are prohibited. Three ultrasound exams are planned as part of prenatal care.

O IGeL Monitor already concluded in 2016 that additional ultrasound examinations do not bring medical benefits.

Scientific studies have not provided evidence that additional ultrasound examinations reduce the risk of infant mortality, whether malformations, growth disorders or birth risks can be better identified, or whether the parental bond with the child becomes stronger.

As part of the new radiation protection regulation, so-called “baby television” has been banned since January 1, 2021.

With “Baby TV”, gynecologists perform 3D and 4D ultrasound examinations, the sole purpose of which is to take photos or film the unborn child. To protect the fetus, these medically unnecessary ultrasound examinations can no longer be performed, as significantly more sound energy is absorbed by the bone when bone formation begins. 2D exams carried out as part of normal prenatal care and paid for by health insurers will continue.

If doctors notice any abnormalities in the child’s development, they may continue to perform a 3D or 4D ultrasound. This can, for example, be granted as a health insurance benefit if a specific developmental disorder, an unclear diagnosis or a high-risk pregnancy is suspected. Pregnant women generally need to look for a specialized office for this.

Tips for patients

  • Patients should always think critically about additional paid offers during pregnancy and seek detailed advice from their doctor.
  • If you want more than legally required, ask your health insurer what additional services it covers before using it.
  • Depending on the statutes of the health insurers, extra services are possible, such as additional on-call obstetrics, alternative medicines, measuring neck wrinkles, dental care during pregnancy or birth preparation courses for parents.

more on the subject

G-BA (Federal Joint Committee) Maternity Guidelines

IQWiG health information about pregnancy and birth

You can also find one at gesundheitsinformation.de Downloadable overview of preventive exams during pregnancy

Advice from the NRW consumer advice center: Pregnancy and birth are self-determined

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