Has anyone had an experience where your insurance said they were paying or appeared to pay and then they later took it back??
When I log in to my insurance website it appears as if they're paying for my ultrasounds. I was told by the RE billing at the beginning that I was covered for u/s without precertification. But this morning the RE billing told me that my insurance has not paid for any ultrasounds in 6 months. I've had a lot of issues with slow or non-response to meds and have therefore had about 9 bazillion u/s so I am freaking out. Can they really take it back??
I know I might be incredibly lucky and that many must pay for this oop, which majorly sucks. But to think it's covered and then be told after 6 months of treatment that it's not??!?
Re: insurance vent/question
I have not heard of an insurance saying they cover something then "taking it back" but there could have been confusion as to what types of ultrasounds they cover...like mine covers diagnositic only so my first cd3 U/S was covered not not any used in the process of IUIs. And if it's believed I have a cyst, that would be covered...but not if it was part of a cd3 baseline.
I encourage you to call your insurance company today and talk to them to find out what the hold up is for paying the bills (start off with that without asking if it's covered or not...play it as simply as it's supposed to be covered - why is it not paid yet?) And if worst case, there was confusion and you do owe for the past six months I would then talk to your REs billing department about discounting a lot of it since I'm sure they were the ones who said it was covered - so they are partially at fault for this.
IUI#4 1/23/13 on 75iu x9 Follistim = BFP then chem preg m/c (Feb 2013)
IUI#5 BFN (April 2013)
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Weve experienced many 'glitches', mostly due to the urologist not sending paperwork to the insurance. It's been a PITA to get things covered, but it's all been fine.
Another note is that my RE does bloodwork with a lab that's not covered under insurance. I got a letter from my insurance saying that they werent covering like $6k of diagnostic bloodwork. Turns out the RE has a special contract with the lab, so we were only billed $25.
We decided against having the varicocele surgery, because even if it's coded as varicocele and not infertility, the insurance can review the patient charts and deem that it was coded incorrectly and decide not to pay. We can't take that $4600 gamble.
My advice is not to worry until you get a bill. Once you get a bill, then get to the bottom of it. Until then, try not to freak.
I agree with Katib. You have to be really careful and clear when asking what they cover. My initial diagnostic u/s was covered, but nothing during treatment.
When we initially called our insurance company to ask about coverage, they simply said, nothing is covered. We have since been able to get some (very little) of our meds covered. So its just a matter of really digging in and talking to the insurance company and making sure you are clear in what you are asking.
Good luck, I hope you get this all sorted out soon.
Another thing to consider...
Try talking to the RE or the billing department about how they were coded. You may need to find out what codes are covered by the insurance co. and see if the RE can bill it using the code they cover. Some doctor's offices are willing to do this to help you get coverage. I've gone through that before and after the coding was changed and bills re-submitted, some more of my bill was covered.
Hope that helps some and good luck figuring this out.
TTC #2 since 6/2010
10/2012 DH diagnosed with Epilepsy
A few failed IUIs summer 2012 and 2013.
DH taking clomid and waiting to see if he needs another vericocele repair.
Hoping for a 2015 baby or babies.
Wishing, hoping, waiting.
O5/05 Lap #1 for diagnosis
12/08 Lap #2 for pain management
Married on October 3rd, 2009
Me:30 DH: 35
TTC since 05/10
Clomid 25mg since 08/10
06/11 IUI #1 ended with a m/c
08/11 IUI #2 BFN
09/11 IUI #3 BFN
12/11 Lap #3 for IF
04/12-06/12 Letrezole, Trigger shot, TI
07/12 IUI #4 BFN
"When you feel like you cannot walk another step, that's when you try to run another mile."