Can't even describe my feels right now

BananaPancakes02

I was so happy I got a referral authorization last week, I e-mailed the referral to the RE.  I figured all would be ok, but that would be false.  I got a call from the RE that they can't use the referral because the diagnosis that is on there is Metrorrhagia.  Which when I look that up, it doesn't apply to me at all.  And I asked if they could see me if it said PCOS (which is more accurate, obviously), she said that it was a gynecological issue, and they could only see me if it said "global infertility".  I want to get pregnant, yes, but it is probably more important to me at this point to know I have gotten a true diagnosis, and I thought an RE would/could do that.

I'm mad/ready to cry/confused, all at the same time.  I don't even know how to argue this.

ttuprincess

Ugh.  Sorry.  That is so frustrating.

So the RE will not see you unless it says "infertility" or he will see you but your insurance won't cover it?  Is there another RE who might take your referral as is? 

Sorry you are dealing with this.  ((hugs))

BananaPancakes02

He can only see me if the diagnosis is infertility, per his HMO contract.  He could still see me, but insurance wouldn't pick any of it up.  I just spoke with his insurance person, and she said the referral coordinator at my OB gave me wrong information that I'd have to wait a year to get "global infertility" regardless of not ovulating or having periods without medication.  So I may be able to get this fixed, but its probably going to require a ton of frustration/bitching on my part.

BananaPancakes02

I actually normally love my HMO.  And once I get all of this approved, its going to be absolutely amazeballs when it comes to coverage.  It's just getting the approval that is a bitch right now.  

I do understand why this is difficult, they don't want to pay for people who are simply impatient and wanting to do IVF right off the bat.  But, it wouldn't be so awful if RCs were using the correct codes!

athlete010688

I'm sorry you're dealing with that!  I didn't have to get a referral...is it because your insurance covers procedures?  All my insurance covers is the testing and diagnostic.

theholmanherd

Find a doctor willing to work with you as far as getting coverage. I'm sure you can find an RE that wants to get paid enough to help you on the paperwork. I'm sorry you have to deal with all of this. I'm in the same boat. If I want anything covered for IF, I have to pay OOP. It's disheartening, I know. Good luck (((hugs)))

BananaPancakes02

athlete010688 said:

I'm sorry you're dealing with that!  I didn't have to get a referral...is it because your insurance covers procedures?  All my insurance covers is the testing and diagnostic.

Yes, they cover procedures. Any outpatient procedures, I will have zero copay. Inpatient will be $500 copay. It's amazing coverage, and luckily, I do have the time to wait for it to be covered if I end up needing it.

I think I can get this straightened out, I just need to get to the right people to change the bullshit diagnosis they plugged in. I am lucky in that my MD agreed to at least test me for insulin resistance (I go in tomorrow for the bloodwork), so I am hoping if that comes back abnormal, it won't be a problem to get put on Metformin in the meantime.

pcrumley

Good news is--there are plenty of drs out there, you don't necessarily have to se an RE at this point, many OBGYNs and nurse practitioners can start the process for you, testing, bloodwork, procedures like HSGs. Also a new doctor could give you a diff referral. . Good Luck! O:-)

BananaPancakes02

@pcrumley‌

I have an HMO, and they require an RE to go any further. I did find out that the problem is just with the particular RE I was given the referral to. He can only see for fertility (Solely trying to get pregnant. They are going to refer me to another RE who will be able to see me for PCOS/amenorrhea. I'm finally getting somewhere!

pcrumley

Good luck then. )