Anyone know about insurance? (longish)

kathrynlo

Yesterday, MH and I found out that the clinic and doctor we choose for our IVF is out of network for our insurance. We do have some out of network coverage in that we have to pay $1000 deductible first, and then insurance will cover 70% and we will be responsible for 30% until $5000 and then after we hit $5000 insurance will just cover the 70% and we will no longer be responsible for the 30%.

This does not matter for IVF since we will be completely OOP for that as insurance does not cover anything IVF related, however, all our tests leading up to our IVF will be under this out of network coverage.

My question is concerning bloodwork. How does insurance cover bloodwork? If an out of network doctor ordered it, but it is drawn and ran at an in network lab, will it still be covered? Does it matter who orders the b/w?

This is all so confusing for us! TIA for you help!

kmc84

You need to call and talk to a rep from your company. Every plan is different. Good luck!

kathrynlo

kmc84:

You need to call and talk to a rep from your company. Every plan is different. Good luck!

That's the thing, I was trying not to call my insurance because I didn't want to red flag it by asking. I guess I may have to call anyways.

lovekatespade

For my insurance, if the lab is in-network, you get charged in-network rates regardless of who ordered the work.  But every company is different, so I would suggest calling them directly.

Edwina.McDunnough

lovekatespade:

For my insurance, if the lab is in-network, you get charged in-network rates regardless of who ordered the work.  But every company is different, so I would suggest calling them directly.

this for me too. 

lovekatespade

kathrynlo:

kmc84:

You need to call and talk to a rep from your company. Every plan is different. Good luck!

That's the thing, I was trying not to call my insurance because I didn't want to red flag it by asking. I guess I may have to call anyways.

Hmmmm.  Maybe try asking the billing ppl at your clinic?  Our RE is great- they have several different labs they use, so they find out which one is in-network for you and order through that one.  Same with pharmacy, etc.  Anything they outsource, they do through an in-network provider for your ins. co.  Maybe yours will do the same?  Worth a shot.

Also, I have United (to clarify my previous post).

kathrynlo

Thank you all so much!

I did ask my clinic, and they said they were pretty sure that as long as the lab was in network, it didn't matter who ordered. I am just going to call today and ask if my lab is in network and if its covered, I am just going to leave out the part of the doctor who ordered it being out of network. Thanks again.

Edwina.McDunnough

kathrynlo:

Thank you all so much!

I did ask my clinic, and they said they were pretty sure that as long as the lab was in network, it didn't matter who ordered. I am just going to call today and ask if my lab is in network and if its covered, I am just going to leave out the part of the doctor who ordered it being out of network. Thanks again.

In-network labs are generally listed online under facility. GL 

kathrynlo

Edwina.McDunnough:

kathrynlo:

Thank you all so much!

I did ask my clinic, and they said they were pretty sure that as long as the lab was in network, it didn't matter who ordered. I am just going to call today and ask if my lab is in network and if its covered, I am just going to leave out the part of the doctor who ordered it being out of network. Thanks again.

In-network labs are generally listed online under facility. GL 

Thanks so much! This would be so much easier!