insurance question (and vent!)

  1. You have chosen to ignore posts from stefani2. Show stefani2's posts

    insurance question (and vent!)

    hi ladies, i just got an $850 bill for my infertility workup - hsg test, sperm test, bloodwork.  i was floored!  figured it must be a mistake, but when i called my insurance they said it wasn't covered.  then i looked at the benefits booklet and for 'infertility' it says "not covered," with a footnote: "Coverage will be provided for the treatment of an underlying
    medical condition up to the point an infertility condition is diagnosed.
    Services will be covered as any other illness."  what does that mean?  do i have any argument or do i need to just s*ck it up and pay it? 

    ANNOYING!  i feel like nothing i ever need is covered by my insurance - it's like why do i pay into it!  ;)
     
  2. You have chosen to ignore posts from ALF72. Show ALF72's posts

    Re: insurance question (and vent!)

    Talk to your doctor's office or billing person. It's possible there is a code they can go back and change so that the procedure is covered.  Sometimes there are multiple codes for things and if you input the wrong one it's not covered, but if you use another one, it is.  Good luck. 
     
  3. You have chosen to ignore posts from luckinlife. Show luckinlife's posts

    Re: insurance question (and vent!)

    Stefani - are you living in MA?   I thought the private insurances were required to cover infertility - not sure though.

    Increasingly, it is getting more difficult to change the insurance coding.  In the past, what Alf suggested was fairly easy.
     
  4. You have chosen to ignore posts from GC1016. Show GC1016's posts

    Re: insurance question (and vent!)

    I agree with Alf -- start with the billing rep at your doctor's office.  Then I would carve out some time and call your insurance provider and see if they have a client advocate or some other sort of coordinator that you can talk to about benefits, coverage, etc ...

    Also, we're coming into open enrollment season ... not sure if changing plans is an option, but it might be worth it to comparison shop (if your employer or DH's employer offers more than one plan).  It may be worth it to pay a higher monthly premium if certain pricey treatments are covered.  Just a thought. 
     
  5. You have chosen to ignore posts from ALF72. Show ALF72's posts

    Re: insurance question (and vent!)

    I always call my insurance provider ahead of time [before the scheduled procedure] to make sure it's covered. They always ask about which billing code the doctor's office is using, so I get to scramble around in advance looking for this stuff. My ins doesn't cover infertility, so I always check ahead of time to make sure something is covered before I attend the appt. It's possible that the dr's office can 'fix' something one time around by claiming they made a typo on the code.  In the future, I'd check ahead of time to make sure it's covered.  Good luck!
     
  6. You have chosen to ignore posts from Mary1800. Show Mary1800's posts

    Re: insurance question (and vent!)

    Hi Stefani -

    Even with good insurance coverage, the infertility work-up has been adding up for me. My insurance only covered 80% until we hit a certain deductible, which was around $1500 I believe. I think for all of the testing that was done with me and DH thus far, I have paid about $2500 out of pocket. Before I went through any of the work, I had to call the "infertility hotline" at my insurance carrier. The finance office at my DE was really helpful letting me know who I had to call and they have to pre-clear everything in advance. Check in with the financial people at your DE and see how they can pre-clear things in the future. Your insurance company should send you a specific packet that talks about your infertility coverage.
     
Sections
Shortcuts

Share