Those with insurance coverage for DE

chicagobride_07

Do you have any insight on how this was submitted or coded to get processed by insurance? My policy definitely has coverage for this under our state mandate, and I have this in writing in our specific plan's insurance certificate. However, dealing with our insurance customer service has been more than frustrating. So far, they have covered all my costs but denied anything submitted for the donor. In calling customer service, I get the feeling that they don't see these types of claims often. They just don't understand the process. Even after I read the exact language in my insurance certificate to them, I've been told that the donor needs to put the costs through her insurance (what?, this is all anonymous). I asked to have everything reviewed by a senior specialist, they came back 2 days later and stated (quite proudly) that they reviewed the mandate extensively and my claims were denied because surrogacy was an exclusion! I tried to explain that I am using a donor, not a surrogate to carry, but this was completely lost on them. After days of dealing with this, I finally found someone in customer service, a supervisor, who was willing to help. She mentioned all donor claims should just be submitted as they were mine as anything else would be denied. This just doesn't sound right. I see a solo practitioner RE and his billing person is out for an extended period, so no help on that end, either. I hate to gripe, but dealing with this all on top of a failed cycle is taking its toll.

daydreamer34254

I'm sorry you're dealing with this BS, but it's wonderful that your insurance covers DE! I'm in a mandated state as well which will cover up to four ERs (either my eggs or a donor's qualify for coverage). We are still responsible for the donor's compensation and program fees, but the medical side of things should be covered for us and the donor. I am not too far into the process yet though, so I don't know how smoothly this will go in reality. I'm sorry I'm not much help answering your questions! But I hope you get it figured out without too much aggravation! 

Km672

So sorry you're dealing with this... I've had lots of experiences with insurance issues, but this seems ridiculous. I would get the info to have a formal appeal done. With the claim, I would write them a letter specifically explaining that it is not surrogacy ; ect. I always, (for all 4 cycles we have used donor sperm) have called and literally filled out the claim with a rep, submitted it, gotten a letter I was denied about 8 weeks later and have had to call and argue. It's incredibly frustrating and I wish I had a better way to get it done right the 1st time. Ps, ygpm-

cc+mm

Sorry you are going through this on top of everything else. We are in a mandate state and everything except donor compensation and the donor admin fee were covered under my insurance. I am not completely familiar with the billing as our clinic took care of it all, and we were only charged co-pays. I do know that on my insurance website and our fertility website, my donor's claims were listed as donor (my last name).

lincoln79

Are you in IL? Our gestational surrogate is covered by the IL mandate, but we have to submit everything for her (medical for infertility) through our plan. That is correct. It is weird, but we have an awesome billing person who re routes everything and my husband called her periodically to get the bills paid. 

Once she became pregnant, her plan took over but the bills still get re routed so we can pay them. It just cuts down on the receipts.

I hope this helps!

chicagobride_07

Thanks, ladies. Yes, I am in illinois. I spoke to my REs billing person today so hopefully this will get sorted out soon.