RE tomorrow~need advice...

panda246

Tomorrow is yet another date with my RE.  Too bad he's not buying like if we were on a proper date..LOL.

Unfortunately, payment is one of the things we will probably be discussing.  I'm hoping some of you ladies can share your insight or advice on this.  I'll know for certain tomorrow, but it appears that I will have to have a lap. to remove both of my tubes.  The last time we met I asked him about how this would be coded since I've been complaining about abdominal pain ever since I started TTC with my OB/GYN (who has it in my records).  This pain is certainly from the hydrosalpinx.  He said that because I came to him for IF, all my procedures performed by him have to be coded IF.  That means my ins. will only pay 50%.  I met with my PCP today just to get some advice on how to handle this.  (Hopefully I didn't a cold from all the sick people in the waiting room.)  She wants me to ask him one more time about the coding and if he won't budge (which I don't think he will) she thinks I should see if he will recommend an OB/GYN who can remove my tubes.  I don't want to jeopardize my relationship with the RE, but I'm trying to save every $ for our IVF.  My RE is a very matter of fact man.  I'm certain he won't take it personally, but I keep thinking there's got to be a way to get the lap. covered.

Any similar experiences and/or advice?

I'll probably post over on TTTC, but have only lurked over there, never posted. 

joyfulnature

Hey, Panda.

Your RE will understand whatever you have to do as an OOP person. he's still getting plenty of your money, anyway!

But FWIW, I was told by my ob/gyn that insurance companies go solely by the coding, not by who does the procedure. In other words, the procedure would have the same code - and they would pay or not - regardless of who performs it.

But do check this out with your folks. As we all know all too well, insurance varies so dang much!

 

GL!

hollymichael

If he won't code it differently than IF, I would find an obgyn to do the procedure, assuming they will code it differently.  I think they should be able to code it as pelvic pain so that you can get insurance coverage. Before my IF coverage kicked in, my obgyn coded as much as he could as pelvic pain, as did my pcp.  Good luck!

MrsKario

Ditto what others have said.  Im sure your RE will understand.  You need to go wherever you can to get this covered by your insurance.   You are going to need all your cash for the IVF. 
Good luck with your apt. 

FrannyS

I like your PCP's advice.  If he will only code as IF, you should have the procedure done by someone else.

I don't think the RE will have a problem with that if this is about the money.  They know how expensive all of the IF tx is. 

lilacfritz

Dr.'s like to try to help their patients out by coding things so they can get covered (w/legitimate cause of course, but "pelvic pain" is legit) I would pursue another dr. doing the procedure if he can't/won't code other than "IF"

shyntrue

no advice, but I wanted to wish you good luck!