Trouble TTC

insurance vent/question

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??!? 

TTC with PCOS since July 2011.
IVF Oct/Nov 2012
Beta #1 = 77, Beta #2 = 190, Beta #3 = 1044
Cautiously optimistic.

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. 


    TTC since July 2009. Dx MFI & LPD. 
    IUI#1&2&3 (2011 & 2012) BFN
    IUI#4 1/23/13 on 75iu x9 Follistim = BFP then chem preg m/c (Feb 2013)
    IUI#5 BFN (April 2013)
    IVF w/ICSI Oct. 2, 2012 - 13R, 11M, 7F, 1 frozen blast 4BB grade - - - FET Nov 15, 2013
    BFP! Beta 1:104 @ 10dp6dt, Beta 2:178 @ 12dp6dt,  beta 3:366 @ 14dp6dt
    Saw heartbeat twice before missed M/C at 8w3d on 12/27/13, missing my little angel boy
    JUNE 2014 IVF#2;  5R, 2M, 1F Three day transfer 6/7.  Beta 6/18 - BFN
    Child Free Now?
    S/PAIFW , S/PALW

    My Blog

    image



  • Six months is a long time for them to "take it back". However, I did experience a bit of a glitch with my insurance in the past couple of months when they did not fully cover my last IUI and the RE billed me. I knew it should be covered and I gave my insurance co. a call and they assured me that yes, it would be covered, it was just bouncing back for some reason. It's all cleared up now. I'd give your insurance company a call and see what's going on. Hopefully it's just a glitch like mine was. Good luck!
    Warning No formatter is installed for the format bbhtml
  • Loading the player...
  • imageLightdrwr:
    Six months is a long time for them to "take it back". However, I did experience a bit of a glitch with my insurance in the past couple of months when they did not fully cover my last IUI and the RE billed me. I knew it should be covered and I gave my insurance co. a call and they assured me that yes, it would be covered, it was just bouncing back for some reason. It's all cleared up now. I'd give your insurance company a call and see what's going on. Hopefully it's just a glitch like mine was. Good luck!

    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. 

    Photobucket
  • 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.

    Warning No formatter is installed for the format bbhtml
  • 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.

    Image and video hosting by TinyPic 

    DD conceived after 3 years of ttc.
    MFI - DH had varicocele repair and took Clomid to get DD b. 02/2010

    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.


    Lilypie Fifth Birthday tickersLilypie - Personal pictureLilypie Trying to Conceive Event tickers

    Image and video hosting by TinyPicImage and video hosting by TinyPic
  • I sure did with my first IUI. They said they would pay for the ultrasound and shot. I got a bill for the shot so I called them and they denied saying any of that. Insurance companies piss me off.
    Diagnosed with Endometriosis 05/05
    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." Photobucket Photobucket Photobucket Photobucket Photobucket Photobucket Photobucket Photobucket
This discussion has been closed.
Choose Another Board
Search Boards
"
"