If you go to a Dr. who take NO insurance...

patchen30 · November 2009

I know you pay upfront, but if you submit it to your insurance company do they just consider it out of network like they would if the Dr. took an insurance you don't have, or do they not cover it at all?

I called my insurance company and they said it would be covered like it was out of network - but I thought I'd ask you girls b/c I don't trust them at all Big Smile

Thanks - sorry for all these annoying insurance questions - I have spent the past 3 hours looking into this stuff!

EastCoastGirl* · November 2009

I think this would depend on your specific infertility benefit and whether or not it allows for out of network coverage. My benefit has NO IF coverage for out of network providers, so if I chose to go that route, I would pay everything OOP.

JillAly · November 2009

Mine treats it as out of network. I pay up front and they give me back 80% but it's 80% of what they think it's worth - not 80% of my actual cost. That's the real problem- it's what is reasonable and customary. If you're in a big market like NY/LA/Chicago where things may be more expensive, it doesn't mean they cover more of the cost. I ended up getting around 50% of the cost when all was said and done.

patchen30 · November 2009

JillAly:
Mine treats it as out of network. I pay up front and they give me back 80% but it's 80% of what they think it's worth - not 80% of my actual cost. That's the real problem- it's what is reasonable and customary. If you're in a big market like NY/LA/Chicago where things may be more expensive, it doesn't mean they cover more of the cost. I ended up getting around 50% of the cost when all was said and done.

Do you have an annual out of pocket max? They told me that my annual out of pocket max was $2000 for out of network providers so once I hit that they pay 100% of the remainder. I'm skeptical though.

Villo24 · November 2009

Your dr could submit it and if you had IF benefits, it could be considered out of network. However, if you have a plan that does not cover out of network services, then it would still leave it 100% patient liability.

Ali212 · November 2009

Yes, my current RE does not take insurance so I pay it all upfront. I've maxed out on my lifetime fertility coverage with my insurance now but, before I had, I would submit to my insurance and they reimbursed me based on out-of-network coverage (70% for my plan) and my remaining payable benefit.

JillAly · November 2009

patchen30:
JillAly:
Mine treats it as out of network. I pay up front and they give me back 80% but it's 80% of what they think it's worth - not 80% of my actual cost. That's the real problem- it's what is reasonable and customary. If you're in a big market like NY/LA/Chicago where things may be more expensive, it doesn't mean they cover more of the cost. I ended up getting around 50% of the cost when all was said and done.
Do you have an annual out of pocket max? They told me that my annual out of pocket max was $2000 for out of network providers so once I hit that they pay 100% of the remainder. I'm skeptical though.

My primary insurance is 80% of what they think it's worth - period. I have supplemental insurance that has a $500 deductible and then pays 80% of out of pocket expenses. However, I'm not sure what is going on this time because both seem to be rejecting more this time around. I didn't think there was a lifetime cap. They cover 3 IVF's and 3 rounds of drugs. I've maxed out on the drugs a long time ago.

Honestly, I'd be shocked if anyone pays 100% after a $2000 deductible. That seems almost too good to be true. I'll take your insurance if that is the case!

AimeeL85 · November 2009

I am still getting used to all the insurance stuff and don't totally understand it, but we are with Cornell also working with Dr. Davis and the times we have been there so far, what we have submitted to our insurance afterward was covered like it was out-of-network.

I actually didn't understand until your previous post that the clinic and the doctor are two different entities when it comes to insurance acceptance, but that makes sense as to why we have to submit ourselves for consults, and the clinic submits for us when it's bloodwork, ultrasound etc...

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If you go to a Dr. who take NO insurance...

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