Fish and Microarray not covered by insurance?

CEOwife

" border=0 alt=">:(" src="https://images.****/new/angry.png">We knew that our regular doctor was covered at 100% but when we were sent to a specialist just 48 hours post A/S I spent the better part of the day following our A/S calling doctors and insurance to find out about the specialist. The insurance company and doctor confirmed that the specialist was also in network and it would be also be covered at 100%. I recently got the EOB (explanation of benefits) for the specialist. $2,000+ was covered at 100% for exactly what went down at the appointment following out A/S (doctor consult, ultrasound, surgery?...I can only guess that is the amnio procedure, injection...rhogam, medical supplies, ect.).

What they did not tell us was to check with our insurance for what were to happen with the amniotic fluid after the retrieval. The testing they did on the fluid for chromosomal work ups and syndromes was NOT covered by my insurance. I guess I was so caught up in the moment, I assumed when they said the amnio was covered that meant the testing too. NOPE! We just got a $5,300 bill in the mail for "investigational maternity testing."

I spent yesterday on the phone with my insurance four times! I was calling the specialist between each call. It seems as though we can appeal it but my doctor is saying that he has never seen the insurance change their mind on such testing. I am going to try to collect all "evidence" and medical opinions that pointed us in this direction and re-submit to the insurance! I just 1. hate having to re-tell the story over and over and over 2. getting blind sided by a $5,300 bill!!

Oh, AND, I think the frustration and the stress cause me a teenie cold sore and sniffles. I wonder if I need a mental health day?!

If you made it through this vent, you deserve a bowl of ice cream for breakfast!!

 

Was your FISH and microarray covered by your insurance? Did you have to appeal? Were you successful?

Williamandshawnna

I can not speak to any of the testing, but the insurance company frustration I am all too familiar with. I hope you get to the bottom of it and the appeal gets approved.

I think a mental health day is in order. I left work early b/c my body decided it wanted my husbands cold. Although I have done everything possible to not get it.

As far as the ice cream for breakfast, I opted for a frozen reeses cup for lunch

Good luck!

~Shawnna

careyalis

Keep fighting with them and don't take no for an answer!  I had to have the microarray and FGFR3 testing. There is only one lab in the country that does he second and its out of network, so I had to get it approved.  They do not make it easy at all!  I spent hours and hours bawling on the phone with my insurance company, an I finally got reimbursed for the procedures. Good luck lady!

LuckEinLuv

careyalis:

Keep fighting with them and don't take no for an answer!  There is only one lab in the country that does he second and its out of network

I was luckily told this before we had the microarray so we opted to wait on having it.  The FISH was covered.  When we discovered his heart defects, there was no need to keep testing the CVS sample.  Even before deciding whether to do the microarray, I went back and forth with insurance because "depending on how it is coded, they might pay, they might not."  There was no way to know if it would be $1270 OOP or a $20 copay.

Bayberry12

I am sorry you are dealing with this.  I don't have any experience with this kind of testing, but I do know how frustrating dealing with insurance companies can be, especially for something to so sensitive while the insurance company treats it like "just another case" 

CEOwife

Thanks ladies for the feedback. I am sorry we all walk in the same shoes.

 We are a school district with 18 schools and our own health center. It is essentially a doctors office and pharmacy. I only use them for basic things...colds, sinus infection, migraine meds. They house an insurance liaison in the building that works for the employees as a appeal-er and negotiator. I just found this out. She will do all the fighting and leg work.

She said not to pay a penny and that they WILL be covering the testing at 100%. She said it was clearly ordered from a doctor and needed from a specialist perspective. I wanted to kiss her. I did not need to tell my story or answer any questions. She knew exactly what was going on by the codes.