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Trouble TTC
bandwife928
member
Working the Insurance System
bandwife928
member
in Trouble TTC
I've been reading some old posts about insurance and the things they pay/don't pay. I've read several posts about people without IF coverage who have had doctors code things differently in order to get their insurance to pay all/a portion. This seems to happen most often for diagnostic testing.
So,if you are one of the unlucky OOP IF people, what have you been able to get your insurance to pay for, if anything? How did you go about this?
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Re: Working the Insurance System
If you are referring the post below that I wrote- let me explain:
I am not getting my Dr. to code things differently- I am just ensuring that they use the correct diagnosis code. I have a legitimate endocrine disorder that is covered by insurance. While any specific "Infertility" treatment is not covered- PCOS is covered. It is a fine line- PCOS has a side effect of infertility. It also can cause endometrial cancer, weight gain etc.
At some point- I will be crossing the line into ACTUAL infertility land- and then I will be completely OOP. For now- I am going to go forward with what my insurance will cover legally.
I'm 100% OOP with unexplained infertility. So we have no medical diagnosis (like PCOS) which makes it impossible to code things for anything other than IF. I was able to get some blood work paid for (thyroid, STD screening) and blood draw fees for other labs were covered, as long as a non-IF lab was ordered at the same time. That's the only we've gotten anything covered, and that's pretty insignificant. We do have a HSA. This way, even though nothing is covered, we are paying for everything pre-tax. That saves us some money, and I guess is better than nothing.
We don't have any prescription coverage for IF meds either. Anything that could be used in IF is specifically not covered. However, I am going through the university clinic, which has a deal with the state for cheap fertility meds, so at least I've got that going for me.
TTC #1 since 2009 with unexplained infertility
IUI#1-4 Jan.-Apr. 2011 = BFNs
IVF#1 Aug. 2011 = c/p, FET #1 Nov. 2011 = c/p, FET #2 April 2012 = BFP!
Beta #1 = 153, Beta #2 = 269, Beta #3 = 675
1st U/S = TWINS!! EDD 12/29/12
my blog: Journey to Somewhere
~~PAIFW/SAIFW~~
April IVF Spring Chicks
TTC#1 for 19 months with PCOS and MFI IUI#3 + injectables = BFP!!!! Beta#1-134(13dpiui) Beta #2-392(15dpiui)
#1 born December 2011
TTC#2 - Beta #1 -51@10dpo Beta#2 -1353 @16dpo
#2 born May 2013
TTC # 3 June 2014 BFP 12-1-14
#3 born August 2015
#4!!!!!!! due June 2017
I wasn't referring your post. I was actually googling various combinations of "thebump.com" and "OOP IF costs" and "insurance coding." I have irregular periods and a thyroid problem, so I wondered how/if things like that allowed your doctor to code things so that they would be paid for. It's not my intention to defraud my insurance. I just want them to pay for as much as can be covered and want to avoid paying for something that could have been covered had I just thought to ask if it could be coded thyroid-related.
Oh- ha! It just happened to be really close to my Ah Ha! post that I was thinking you meant me! I would definitely ask your Dr. to code things in your best interest- but in all actuality- they have a good idea of what is covered and what isn't by a particular insurance company. I had asked in the beginning when one of my blood tests wasn't covered- and I think it was a reminder to them to make sure to code it as PCOS and not IF. Thyroid problems should be covered- but that again is a fine line. If you have irregular periods- perhaps you do have PCOS? I also have a thyroid condition and that is covered too. I guess- never hurts to ask. Also- make sure you read your benefits package very well.