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Insurance companies SUCK

redstars93redstars93 member
in TTC After a Loss 6 Months+

I just called my insurance to get some answers RE: what is/isn't covered etc and to also find out if there is a time frame/limit for testing etc.

Good news: diagnosis & treatment is covered (i.e. labs/xray/meds/office visits)

Bad news: IUI/IVF etc not covered at all. And she couldn't give me a time frame/limit on when I could go to a RE. Her response was "medical necessity".

So basically I would have to go to my OB, have them deem me worthy of testing and then go to an RE, have them run tests and THEN the ins co will review my case to determine medical necessity. WTF. What if I go through all the tests and they say "um. nope. not necessary."?!

 But all this is a moot point because my OB won't even consider testing until it's been a year since our loss (not including the cycles we were TTA).

And I'm over 35. Suck it, body/OB/insurance company.

Momma to three boys: Henry - 4yo Alex - 18mo Jack - born 2/23/12 at 20w due to ruptured uterus (previa and accreta resulting in hysterectomy) He only lived here on Earth for an hour, but he will live in our hearts forever. m/c #1: sept '09, m/c #2: july '10
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Re: Insurance companies SUCK

  • rjl07rjl07
    That's really annoying.  My insurance also only covers the diagnostics and I'm OOP for IUI/IVF.  I didn't have to have anything approved as medical necessity though.  They have covered everything without question.  I would try to find out what testing would be done and see if the insurance company can approve it in advance so at least you know what the costs will be upfront if they don't cover it.
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  • Scout05Scout05 member

    Insurance companies are ass_holes, no two ways about it.

    I'm glad they will cover testing (ours doesn't), but not covering IUI is bullsh!t.

    I think you need to go to your OB and DEMAND to see an RE. I did, and honestly, as soon as I said "I want to see an RE" they were like "okay, no problem." I have a feeling that office would do what is needed to get you "qualified" to see an RE. Your case totally warrents it.

    eta: And if not, maybe it's time for a new doctor, with a more proactive attitude.

    And RE's offices are champs at forcing insurance companies to pay for stuff - despite some set backs for us (and again, we started with a policy that does not cover testing anyway) they have managed to get some major concessions from Cigna. Most RE offices have a financial person who just haggles with the insurance companies all day - they know the ropes and how to jump them.

    I think your first step is to get in to the OB and ask for the referral. Go from there. And if you end up paying oop - well, it blows goat balls, to be honest, but getting the answers is worth it. At least, that's what we keep telling ourselves.

    I'm sorry they are being such d!cks.

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  • dondraandluisdondraandluis member

    Mine was the same except I didn't have to get approval to go. Sorry your OB won't give you a referral. I'm still young and if I had not had 3 m/cs already I wouldn't be seeing my RE yet. I thought if you were over 35 it was 6 months? Sorry you have to deal with all of this.

    TTC Since Oct 08 BFP #1- 1/23/09, missed m/c 2/26/09 BFP #2- 9/8/09, natural m/c 9/16/09 BFP #3- 4/13/10, missed m/c 5/26/10 BFP #4- 4/6/11 beta#1 at 12dpo-133 prog-55.7, beta#2 at 16dpo- 861 DD born 12/8/2011 BFP#5- 11/23/12 EDD 7/25/13 Dx- Uterine septum (removed Aug 2010), endo, MTHFR C677t hetero, Factor II hetero, Low Protein S Baby Birthday Ticker Ticker
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  • redstars93redstars93 member

    I just called the OB's office for a RE recommendation... I think I'm going to do the "make an appointment and then call for my records kind of thing".

    I really do like my OB/GYN (she's been with me through a lot) so I'd hate to switch out of her practice over this.

    Momma to three boys: Henry - 4yo Alex - 18mo Jack - born 2/23/12 at 20w due to ruptured uterus (previa and accreta resulting in hysterectomy) He only lived here on Earth for an hour, but he will live in our hearts forever. m/c #1: sept '09, m/c #2: july '10
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  • redstars93redstars93 member

    I am now on hold with the hospital so that I can get a registration number so that the RE will make me an appt. I f'in hate jumping through hoops.

    There is a special spot in hell for insurance company CEOs.

    Momma to three boys: Henry - 4yo Alex - 18mo Jack - born 2/23/12 at 20w due to ruptured uterus (previa and accreta resulting in hysterectomy) He only lived here on Earth for an hour, but he will live in our hearts forever. m/c #1: sept '09, m/c #2: july '10
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