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RE referral and insurance relief!!

I am Marla SingerI am Marla Singer member
in Trouble TTC

So- I never thought that PCOS would have any positives. I am finding that it makes insurance coverage possible!!

Last week I was facing $1500 in medical bills related to my Clomid monitoring. I know that PCOS is an allowable diagnosis code- and just thought that they had coded my u/s' as Infertility.

I called today to perhaps pay for the first installment and the awesome billing girl totally made my year! She said that the office visit was billed as IF, but the u/s was PCOS- my insurance lumped them together and denied it. I called the insurance company and they stated that billing could re-submit the u/s with the allowable code- and they would pay it.Billing girl said that the other charges had been sent with PCOS as primary, so they theoretically should go through!!! Long story short- I may have spent 30 minutes on the phone to save myself $1200!!! 

I also am getting a referral to an RE about an hour from home (also for PCOS- so it should be covered), and I go see him in February! I am so nervous and excited, and can't wait to see what we can do!!!

So- word to the wise- PCOS is an endocrine disorder- and the SIDE EFFECTS are Infertility- so whenever possible make sure your primary diagnosis code is PCOS.

Sorry that got long! 

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Re: RE referral and insurance relief!!

  • MToomsMTooms
    That is really good advice!
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  • punkymamapunkymama
    That's great news for you!  YAY!
    <3 Tons of love and hugs to Ricola & Baby Alex <3 <br> MySweetBaboo, IRL friend, always rooting for Baboo #2, love ya girl!<3 <br> 7.7.11 BFP | 3.19.12 EDD | 3.14.12 Baby Girl's BDay
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  • JNKS2328JNKS2328
    Thats great advice for the girls who are starting out their treatment. Thanks.
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  • JennPierogJennPierog member
    imageI am Marla Singer:

    So- I never thought that PCOS would have any positives. I am finding that it makes insurance coverage possible!!

    Last week I was facing $1500 in medical bills related to my Clomid monitoring. I know that PCOS is an allowable diagnosis code- and just thought that they had coded my u/s' as Infertility.

    I called today to perhaps pay for the first installment and the awesome billing girl totally made my year! She said that the office visit was billed as IF, but the u/s was PCOS- my insurance lumped them together and denied it. I called the insurance company and they stated that billing could re-submit the u/s with the allowable code- and they would pay it.Billing girl said that the other charges had been sent with PCOS as primary, so they theoretically should go through!!! Long story short- I may have spent 30 minutes on the phone to save myself $1200!!! 

    I also am getting a referral to an RE about an hour from home (also for PCOS- so it should be covered), and I go see him in February! I am so nervous and excited, and can't wait to see what we can do!!!

    So- word to the wise- PCOS is an endocrine disorder- and the SIDE EFFECTS are Infertility- so whenever possible make sure your primary diagnosis code is PCOS.

    Sorry that got long! 

    do you have no IF coverage? I had no coverage, my insurance company told me they would pay for no treatment or monitoring. Ws that the same case with you? did they cover it beacuse of the pcos?






    2004- DX with PCOS

    6/2011- Gonal-F + Ganirelix + Oviderl and Crinone= BFP

    7/7/2011 Beta #1 119 Beta #2 563 Beta#3 4178



    Lilypie Premature Baby tickers



    http://tinypic.com/r/25z7709/8

    Report Reply
  • JennPierogJennPierog member
    imageI am Marla Singer:

    So- I never thought that PCOS would have any positives. I am finding that it makes insurance coverage possible!!

    Last week I was facing $1500 in medical bills related to my Clomid monitoring. I know that PCOS is an allowable diagnosis code- and just thought that they had coded my u/s' as Infertility.

    I called today to perhaps pay for the first installment and the awesome billing girl totally made my year! She said that the office visit was billed as IF, but the u/s was PCOS- my insurance lumped them together and denied it. I called the insurance company and they stated that billing could re-submit the u/s with the allowable code- and they would pay it.Billing girl said that the other charges had been sent with PCOS as primary, so they theoretically should go through!!! Long story short- I may have spent 30 minutes on the phone to save myself $1200!!! 

    I also am getting a referral to an RE about an hour from home (also for PCOS- so it should be covered), and I go see him in February! I am so nervous and excited, and can't wait to see what we can do!!!

    So- word to the wise- PCOS is an endocrine disorder- and the SIDE EFFECTS are Infertility- so whenever possible make sure your primary diagnosis code is PCOS.

    Sorry that got long! 

    do you have no IF coverage? I had no coverage, my insurance company told me they would pay for no treatment or monitoring. Ws that the same case with you? did they cover it beacuse of the pcos?






    2004- DX with PCOS

    6/2011- Gonal-F + Ganirelix + Oviderl and Crinone= BFP

    7/7/2011 Beta #1 119 Beta #2 563 Beta#3 4178



    Lilypie Premature Baby tickers



    http://tinypic.com/r/25z7709/8

    Report Reply
  • I am Marla SingerI am Marla Singer member
    That is correct- I don't have any IF coverage- however PCOS is a covered diagnosis- so they will cover it (hopefully). 
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