OOP $ WW3T do? Billing and our finances - Long

sundowner85 · October 2012

First, I am glad that H's SA came back normal. Sigh of relief. The actual urologist (specializes in MFI) was out of town so they didn't give specific numbers over the phone, just said "normal range." Should I try to get H to get them to give the exact numbers?

Next issue- I am already feeling defeated. I have mentioned before that we're OOP for testing. We are struggling with deciding if and when to go forward with more tests. Could someone please help me decide what to do if I give you the following info.....?

I went in for my annual exam w/ OB and asked for recommendation for an RE. We talked for 10 minutes about my history (opks/ temps show ovulation) and she recommended an HSG (quoted $1800). The ENTIRE exam was coded through insurance under "infertility" --- so what was supposed to be my FREE annual exam is now a $275 visit. I've been calling the office and leaving messages but no calls returned. The office is 5 minutes from my house and I want to storm down there and ask (demand?) them to recode it. Why was my freaking pap smear denied coverage because of "infertility" code when I have no diagnosis? WW3T do?

Similarly, the urologist's office said the SA would cost $175 with $75 for a follow up consult if results weren't normal. I tried to get DH to get it in writing and he was a chicken and didn't ask. Instead the EOB shows $426 with nothing covered for a quick consult and the lab test. DH just wants to pay and move on, but I want him to call and fight for the $175 quote. WW3T do?

I normally wouldn't share this next personal info, but I think our income is very relevant to my "WW3T do?" questions and I posted alot of this on Money Matters on the Nest a year ago anyway:

We both have bachelor's degrees in education and we were working in our field making combined 75k gross income the year before we got married. Then DH got laid off, and took a lesser paying job out of necessity. Soon after that, I switched to teaching private school for my sanity. We now make 62k combined gross income. We pay 500/month in premiums for insurance through H's work. We don't have any student loans, car payments (for now) or credit card debt, thank goodness. We have 25k in a "catch-all" savings account (emergency, baby fund, house repairs, vacations, no maternity leave at work- only FMLA unpaid leave). We only put 5% into retirement.

I do not get any paid sick time or paid time off, and my work frowns on taking time off during the school year since our summer break is supposed to be our "time off." DH gets 11 paid vacation days per year, but no sick time, personal leave, etc and can really only miss work if there is a real emergency since he is the manager at his location. So that has to be taken into consideration when we think about how much money/time it would cost us to pursue more tests and the like.

DH wants to try 2-6 more months before I go in for testing since there are no apparent issues. Part of me wants more answers NOW after so long, but part of me just agrees with H-- but only because of how freaking expensive it is for us. WW3T do in our financial situation?

Thanks to those that read my novel. Don't you want to make these life decisions for me? :-)

jschwind22 · October 2012

I would definitely demand that your yearly pap be re-coded. That definitely should be covered. My OB actually coded some of my initial testing as painful periods until we figured out if we had IF coverage or not. She did some bloodwork and a saline ultrasound. She also would have done the HSG with that code, but I went to the RE before we got to that point. I would also certainly ask for an explanation of the charges for the SA, as that seems excessive and is very different from what you were quoted. Good luck!

larhun3 · October 2012

I would recommend getting the appt recoded and before doing any drug therapy I would have that hsg. No point in making more eggs to release if you have blocked tubes? Do you have irregular periods or painful periods or spotting? My OB coded my first appt as irregular menstraul bleeding when I first went bc I had spotting 4 days before AF and she tested p4, estrogen, etc.

sundowner85 · October 2012

Okay, thanks. I will definitely try to get it recoded then. I knew I wasn't crazy about that. If I still can't get through on the phone next week I will go down there and try not to be a total bi*** about it unless I have to.

pantsarella · October 2012

Well, first off I would definitely fight with the OB and the Urologist. If they fight you back, explain the situation (no IF coverage, not high salaries, etc). They may be willing to write off part of it. I had emergency surgery and one of the doctors was out of network, so the insurance didn't cover anything and I got a bill for $1K. I was in grad school and was making barely above the poverty line. I explained that it would take me years to pay off that bill and they wrote off everything above the amount that insurance would have paid them anyway.

As for how to move forward, I think the HSG is critical before you consider any meds. What are the costs of bloodwork? Could you do CD3 bloodwork and 7dpo bloodwork with your OB? That would probably be my first step and then move to an HSG.

This is obviously an extreme measure, but do you have any ability to relocate? I don't know where you live, but some states mandate some IF coverage. I wouldn't normally recommend going to that extreme, but I work for a public school system and MD mandates IF coverage. And our premiums are a lot lower than you're paying now. Like I said, obviously an extreme measure, but something to possibly consider.

sundowner85 · October 2012

larhun3:
I would recommend getting the appt recoded and before doing any drug therapy I would have that hsg. No point in making more eggs to release if you have blocked tubes? Do you have irregular periods or painful periods or spotting? My OB coded my first appt as irregular menstraul bleeding when I first went bc I had spotting 4 days before AF and she tested p4, estrogen, etc.

Oh no, I don't plan on any meds at all before the HSG. I have learned that much from 3T. We will just try on our own without any medical intervention until we do.

My periods are regular. 1-2 days of heavy but not too painful bleeding (nothing regular pain relievers and a heating pad can't handle), then 3-4 days of medium and light bleeding. This current cycle I spotted for one day the day before ovulation. Last cycle I spotted for 2 days after my period was a few days late, then my regular period came.

I will have to find out exactly what was coded because I will be so pi**ed if my 10 minute conversation that was everything I already knew thanks to Dr. Google and the Bump costs me that much. I feel sick just thinking about how much testing will cost in relation to how much we already pay for insurance and our income.

sundowner85 · October 2012

pantsarella:

Well, first off I would definitely fight with the OB and the Urologist. If they fight you back, explain the situation (no IF coverage, not high salaries, etc). They may be willing to write off part of it. I had emergency surgery and one of the doctors was out of network, so the insurance didn't cover anything and I got a bill for $1K. I was in grad school and was making barely above the poverty line. I explained that it would take me years to pay off that bill and they wrote off everything above the amount that insurance would have paid them anyway.

As for how to move forward, I think the HSG is critical before you consider any meds. What are the costs of bloodwork? Could you do CD3 bloodwork and 7dpo bloodwork with your OB? That would probably be my first step and then move to an HSG.

This is obviously an extreme measure, but do you have any ability to relocate? I don't know where you live, but some states mandate some IF coverage. I wouldn't normally recommend going to that extreme, but I work for a public school system and MD mandates IF coverage. And our premiums are a lot lower than you're paying now. Like I said, obviously an extreme measure, but something to possibly consider.

Thank you so much for your response. I will definitely try what you said. I realize that 62k is still a decent income considering this economy, but for two college grads I feel like dirt and like I would never be able to afford treatment anyway.

I will look into the cost of bloodwork. My OB recommended the HSG first and gave me a recommendation for an RE. Now that I feel like I'm getting screwed over already though, I am so nervous about ANY kind of Dr appt or test because I am afraid they will quote one thing and then charge another.

I feel guilty because I know we have a pretty good chunk of savings considering our income (I am frugal as hell and we live below our modest means). Part of me thinks I should just suck it up and use part of our 25k savings, but I had a *purpose* for those savings and I can't afford to spend it all away.

As far as relocating, that is not on our radar at all. Despite our lower incomes and crappy benefits, DH and I both feel SANE and surprisingly happy at our jobs, which is worth more than the cost of IF tests/treatment to me. We were both in a really dark mental place after the layoff and what made me switch jobs, and we are happy now. Almost all of our families live near us, too. We would be much, much more likely to consider domestic adoption before we would consider relocating. But thanks for your thoughtful answer, I really appreciate it.

larhun3 · October 2012

FYI: domestic adoption is about as expensive as IVF. I like to plan ahead bc I only have IUI coverage and I am planning on 3 IUI cycles at the most and I am unsure if I want to do IVF. I looked at adoption and agency fees plus all the other fees can add up to be 10, 15, 20 plus thousand dollars! I was shocked. If you are willing to adopt an older child or siblings or children with special needs it's ALOT less. But to adopt a baby it can be comparable to fertility treatments. I am no expert though so I would encourage you to research options and decide what you are comfortable with.

sundowner85 · October 2012

Thank you for sharing this. I have a very close friend who has adopted 6 African American infants from New York over the past 10 years so I have a support system with that. My whole family has talked long before we even started TTC about adoption. The agency I am slightly familiar with would end up costing 8-10k to bring home a healthy AA infant, and alot of that is legal fees. Since we're already looking at over $2k for testing, then if you consider actual treatment, a few thousand for an IUI, or $15k for IVF only to have no guarantees at all for a baby, whereas with this agency you know your family is growing by 1 at the end of it. So I think that is where we're really starting to think about even though we know it's expensive too.

DH wants to keep trying on our own until the summer and then pursue adoption. My experience here on 3T makes me want to pursue the HSG and bloodwork sooner. I would also want to start thinking about adoption in the Spring. We will have to figure it out. DH is being very supportive so I am glad about that. We are on the same page.

Lexilynn345 · October 2012

I wanted to chime in and say kudos to you for being proactive about your charges and having such a great safety net of savings!

Your persistence will pay off, I bet the Dr's will recode/rebill both bills so far. If you can find any abnormality in your cycle, insurance might cover some diagnostic tests and appointments with an RE. Good luck!

sundowner85 · October 2012

Lexilynn345:

I wanted to chime in and say kudos to you for being proactive about your charges and having such a great safety net of savings!

Your persistence will pay off, I bet the Dr's will recode/rebill both bills so far. If you can find any abnormality in your cycle, insurance might cover some diagnostic tests and appointments with an RE. Good luck!

Thank you so much. People in my real life would probably say my persistence is just my craziness showing. But I was crazy long before having trouble TTC. :-)

I appreciate your well wishes. I won't give up!

demofea01 · October 2012

I would definitely talk with your OB and the Urologist about the charges. I'd be beyond angry if my MW coded an annual appointment as "infertility" simply because I asked her a couple questions and got a recommendation for an RE.

Your financial situation is actually very similar to mine, but SO and I are lucky that we have some infertility coverage. I would go ahead with the testing and then make a plan on where to go from there. If the RE can't find anything wrong and you aren't comfortable with paying for IUI's ect. OOP then keep trying for as long as you and your H want. If there is something going on that's preventing you from getting pregnant then at least you'll know it and can make plans to save up for treatment or just go straight to adoption if that's what you choose to do.

sundowner85 · October 2012

demofea01:

I would definitely talk with your OB and the Urologist about the charges. I'd be beyond angry if my MW coded an annual appointment as "infertility" simply because I asked her a couple questions and got a recommendation for an RE.

Your financial situation is actually very similar to mine, but SO and I are lucky that we have some infertility coverage. I would go ahead with the testing and then make a plan on where to go from there. If the RE can't find anything wrong and you aren't comfortable with paying for IUI's ect. OOP then keep trying for as long as you and your H want. If there is something going on that's preventing you from getting pregnant then at least you'll know it and can make plans to save up for treatment or just go straight to adoption if that's what you choose to do.

Thank you. I really think this is where I am mentally right now. Get the testing done soon even if it costs $2k or so just for peace of mind, then go from there. I really don't think we are mentally prepared for anything else beyond just trying to get some simple answers as to why it's taking 16+ months. Thankfully DH's mood has improved SO much since getting the good SA results. I feel like we can at least get on the same page together.

Thanks again to all of you for your advice. I feel like I am not going insane now!

katib77 · October 2012

Sorry, since it's late I did read your entire post but not all the responses so if this is repeating forgive me...

Yes, fight for the recoding on your pap. And if your husband is too chicken - you call about the Uro's office on the pricing. trust me, as I have dealt with the Uro for my husband enough that they have to be used to the women being the ones that wear the pants in the family LOL. Also ask for the specific numbers. If they require DH to call for that fine, but give him a list of questions so he gets it all in the first phone call (or better yet, have him sign the release for a copy of it all...you will need it eventually for the RE so why not get it in your hot little hands?)

Finally, testing costs. treatment costs. Ouch. As an OOP I understand it. But you have something we don't...great saving skills. Yes, those are set aside for baby and repairs, etc....but if you go years without using it for trying you might not have that baby. So I say pay for the tests. But that's just my opinion. We don't have savings (except for 401K which we've even borrowed out of). And even if I come out of this being CFNBC, I will still think it was all worth every penny to know that we've done/did all that we could to fulfill our dreams. Will you look back in a few years with "I wish we had...."? Only you can answer that. Admittedly, we took some "extra" time (nine months) after our Dx before moving to treatment because we were not mentally and financially prepared when we got the Dx. But we both agreed to a *short* time frame. So if you hold off, both of you should agree on a set time frame. And honestly, with the work situation you mentioned. I try to get testing out of the way before summer hits so that if you want to do treatment right away you can "save" that for the summer time.

OK, now I'm just rambling from lack of sleep. That's just my "two cents".

sundowner85 · October 2012

Katib, thank you so much for reading and replying.

Yes, I am used to wearing the pants in the family! Ha. I have always been the agressive one, and H the passive one. I am actually a patient at the same uro because of my kidney stones. I wanted to give H the opportunity to be the one to handle it (he did all the scheduling) but I guess it's time for me to take over again.

Thanks for the advice about the savings. I think you are right, even though those savings were for other things before, now a little bit can be for testing. That is a good point about doing testing soon so that if we need to do anything over the summer while I'm off, then we can. We do need to come to a consensus on the time frame. I think we will end up compromising and waiting 2-3 more months, but then test and go from there. DH's SA results made him feel like everything's fine and that we don't need to do anything else, and I don't think he gets that there are still 100 other things it could be.

I think part of the reason we hesitate to use our savings is because we were SO scared when he got laid off a few years ago. He was unemployed for 2 months while he job searched and it really broke his spirits to be let go from his dream job. 10k of that 25k savings is something we *never* plan on touching unless we absolutely had to, such as if one of us was laid off again and we couldn't pay the bills. That experience really changed us and turned us into big savers.

shannonm97 · October 2012

If you have a local Planned Parenthood, you could possibly get the bloodwork and HSG done there. I know people only think of them as BCP and abortions, but they do a lot for women's health as well. I'm not sure how extensive they are, but my friend had a pap, bloodwork, and an outpatient procedure (lap- I think) at one.

I know you've heard this a ton, but get your bill recoded. If you go to a large clinic, call the billing dept. not the Dr's. office to have this done. I ran into a ton of problems getting a pap covered 2 years ago and the billing dept. was super helpful in getting it covered.

Good luck. Hope it works out quickly and smoothly with the recoding.

deelopi9 · October 2012

I explained to my OB prior to making the appt that my ins didn't cover infertility. Luckily I had a cyst in March and they were able to do the HSG to check against that in May before seeing a RE. I would definitely ask them to re-code that. Is there anyway since you are paying OOP to negotiate some of the costs for the SA and follow up. They discount it for the insurance companies, why not help out someone who is paying OOP.

You and DH need to be on the same page regarding TTC/treatments. If not, it will place an additional strain on the relationship. I wouldn't worry about your job! You can't predict that you'll get pregnant and have the baby around summer. It happens when it happens.

Twinkie0612 · October 2012

Definitely talk to them about recoding your annual, you should not have to pay OOP for your yearly pap. I would also ask about the SA quote, but be prepared to pay the full amount. The person giving the quote my have only given a quote for the doc's portion and not all of the other related costs.

As far as being OOP for testing, I completely understand your pain. We have no coverage for IF testing or treatment and are paying OOP. I had prepared myself for the cost of IF treatment, but hadn't prepared for the cost of the testing. I haven't received any bills yet, but I have been tracking the totals on my insurance site. So far we owe $320 for DH's SA (including both the hospital and Pathologist charges which were separate), $500 in bloodwork (CD 3 and 7 DPO), and $1200 for my HSG (hospital and radiologist charges). I haven't seen my bill from my doc yet for my HSG, but I was told that it should be $275. It's all really frustrating when you know that if the insurance paid for it, they would pay only a fraction of the cost. For my annual pap, the lab charged my insurance $95 and after discounts, my insurance only paid $19.

I can't tell you wether or not to proceed with testing, but can only recommend talking with your husband and go over your finances and decide how much you are comfortable in spending. Personally we have a decent amount savings and are just taking it one step at a time. We should be able to comfortably afford to pay for our testing and 4 or 5 cycles of IUI (based on estimates I found online). If we were to move onto IVF, we would have to look at taking out a loan.

GL, IF is stressful enough without the added stress of the financial aspect. I still have moments where I get pissed that we have to spend so much money/time/heart ache to TTC, while others just throw out BC and have sex to get pregnant. But life isn't fair.

GettinCrafty · October 2012

Some REs offer special pricing on basic testing. I've seen 99 for fertility checkups in Chicago. Look around locally. That could be a good start, at least.

10-4LilBuddy · October 2012

You've gotten a lot of great advice fro PP's. Doctors' offices miscode stuff all the time. Most won't think twice about correcting their coding. You just have to ask.

If you are OOP for testing and decide to do testing, you can call ahead and ask what the price is being OOP and if you pay in full at time of treatment. I saved 40 just by asking.

Good luck.

sundowner85 · October 2012

Thanks to everyone else who left replies and advice. I was out of town since Friday afternoon so I am just now reading these replies. I appreciate all the advice.

I will definitely be looking into recoding and negotiating. I do have a Planned Parenthood near me as well so I may look into that.

sundowner85 · October 2012

deelopi9:

You and DH need to be on the same page regarding TTC/treatments. If not, it will place an additional strain on the relationship. I wouldn't worry about your job! You can't predict that you'll get pregnant and have the baby around summer. It happens when it happens.

Oh, trust me, I am no longer worried about "predicting" when to have a baby. I am not a naive newbie anymore. When we first started trying we were aiming for a summer baby since my work does not pay for maternity leave and my H does not make a high income. (My boss is also notorious for being nosy and dumb, and she has actually told me more than once to "try and have a summer baby"). We are bitter and jaded now, ha! I am just hoping for a baby at some point, period, and if it's during the school year, then that's perfectly fine.

I was only adding that information because DH and I both cannot really afford to take off alot of time from work for these tests and especially not for various treatments since we do not have sick time or personal time to take. But there are a couple thousand dollars of our savings that we cannot touch until then because I have to be prepared for the 8-10 weeks I wouldn't be getting paid at all if I ever get lucky enough to find a way to get pregnant.

OOP $ WW3T do? Billing and our finances - Long

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