Did insurance pay for testing?

pennynjon · February 2011

I am so mad right now. I just got a notice from our insurance company that they aren't paying anything on all of the bloodwork my doctor ordred( that I requested) after our loss. He told me that the tests were expensive and he didn't want to order them if insurance wouldn't pay. I had met my maximum out of pocket expenses for the year after having Ella, so I was told that insurance would have to pay for anything else the rest of the year. That is why he ordered testing the same day that I found out I miscarried, because it was the end of December. Well now, they are saying we are going to have to pay 3,500 dollars for it. I am so mad. We work our butts off, pay crazy premiums, are still paying on hospital bills and now this. Is there anything I can do to get them to pay. Why would that not be covered after losing two babies?

DoingItRight · February 2011

Did they say why that they were not going to pay?

suntoto · February 2011

Did you check with your insurance before hand about what they would/wouldn't cover? They are *very* picky about what they cover. It isn't fair, but it is how our health care system is right now.

ColindaP · February 2011

Did the ins company tell you it would be covered? If so, do you remember the date you called and whom you spoke with? Those conversations are recorded. (And for future reference, always keep this info) Most ins companies have an appeals process for denied claims.

GuppyAmy · February 2011

Do you have a way to look up your policies coverage? Also you may want to find out how the doctor coded it- sometimes if the diagnosis code doesn't match something they'll cover. I'd make some calls on Monday. The worst that happens is they say no.

ColleenS629 · February 2011

GuppyAmy:
Do you have a way to look up your policies coverage? Also you may want to find out how the doctor coded it- sometimes if the diagnosis code doesn't match something they'll cover. I'd make some calls on Monday. The worst that happens is they say no.

This. We got a letter from insurance saying they wouldn't pay for DH's SA. Turns out it had been coded wrong- as a female infertility test. Once the RE's office resubmitted, everything was fine.

pennynjon · February 2011

The paper I got in the mail says "charges denied. the plan excludes benefits for this treatment."

I had to meet with the insurance lady at my OB's office when I found out I was pregnant. She is the one who went over my insurance with me and told me that whatever tests, ultrasounds, etc were done before the end of 2010 would be covered at 100% by my insurance because we had met the out of pocket maximum already. The day I found out I miscarried, my doctor said he would do the testing that day because it was already the end of december. I never called my insurance company. I honestly wasn't thinking about it at all at that point. I just wanted answers. I just assumed if my doctor ordered with my history that it would be covered. I am calling the insurance company monday. I know it probably won't get me anywhere. It just really makes me angry.

Scout05 · February 2011

I'm annoyed to say that no, even after four losses, they did not cover a vast majority of our testing. We were lucky enough to have an "advocate" at DH's work who had already gone through what they would and wouldn't cover, so we weren't blindsided, but most of our testing, RE monitoring and meds have been OOP.

I'm sorry Penny. It sucks that, like you said, we pay all these premiums and still don't get the coverage on this stuff.

butterfly843 · February 2011

Sorry they aren't covering it, maybe because of how it's coded? I would call and ask the insurance company about it. We did a bunch of testing after we lost our twins and my insurance covered it all except for my copay.

mdm2137 · February 2011

I am getting ready to have a ton of bloodwork done for my CD3 monitoring. The nurse told me to call and make sure it was covered b/c if not it will cost A LOT. My insurance won't pay for anything with infertility in the code. Did you call beforehand? I'm sorry you got a huge bill but maybe it can still be worked out through the appeals process. It's a pain and it's not fair! I hope you can get things taken care of.

ETA: I read that you are calling Monday. Good luck!

triple_sevens · February 2011

That's so terrible. I'm sorry. I fortunately live in an IF-coverage mandated state (New York), so all my testing, appointments and consultations, and my IUIs were covered. IVF would not be, though. I was so happy to have my RPL testing covered after only two "losses" (one a CP) and my embryonic tissue testing covered after only one.

It's absolutely criminal in my opinion that insurance companies balk at covering TESTING for a serious medical issue. Such _assholes.

KristysRedBarn · February 2011

We didn't have insurance at the time of our loss, we were between insurances, very stupid on our part. I would try appealing to your insurance company, if that doesn't work, ask for a discount from your hospital and testing company.

ala_1220 · February 2011

I don't have anything else to add that wasn't already said. I just wanted to say good luck when you call the insurance company tomorrow. Please keep us updated!!!

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