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TTC since 1/09. 4 rounds clomid, 1 miscarriage, 2 rounds IVF, and 1 successful frozen embryo transfer with a donor embryo! Pregnant with our miracle baby, due February 6, 2012!
Any IF patients having OLD claims returned to them from Tricare?
I came home today to a $615 bill from my RE. When I called they said that many of the IF clinics in the area were be audited by Tricare and a lot of old claims were being returned and no longer paid on. While my claims were from April and May (an endometrial biopy and transvaginal ultrasound), the RE mentioned that other patients have had their charts audited 5 years back, with some accruing more than $5,000 in bills that they were originally told were covered by insurance. To make things worse, the claims are just trickling in. So that means that in the coming weeks I may get bills for my other two endometrial biopsies, stimulation meds, etc. I am infuriated at this point and was just wondering if anybody had experienced anything similar.
TTC since 1/09. 4 rounds clomid, 1 miscarriage, 2 rounds IVF, and 1 successful frozen embryo transfer with a donor embryo! Pregnant with our miracle baby, due February 6, 2012!This discussion has been closed.
Re: Any IF patients having OLD claims returned to them from Tricare?
That's awful. As if having to deal with all that crap isn't enough.
I haven't received anything, but you can bet I'd be fighting it. For things that are normally covered, I suspect it's a coding issue that came from your RE's office. Coding certain IF things properly is crucial to having it approved, since Tricare will not pay for anything that's coded as "fertility treatment".
I'd call my RE first and ask them to clarify their billing procedures, and then I'd be on the horn with Tricare.
GL.
That was actually the first thing I did - called and asked about coding. As it happens, they were coded correctly. I don't want to appeal the charges though because there is a chance that they could then pull my entire record and see where they DID cover the services in the past, and thus they could retract those payments too. The one thing that REALLY pissed me off was that I was charged for my phenergan and dilaudid (anti-nausea and pain meds) for an in-office D&C that I had done in May. I had the option to do the procedure with anesthesia but they didn't have time to schedule me with an anesthesiologist and still get in for out May treatment cycle if that is what I had chosen to do. So therefore, I braved the procedure awake with some pain meds, pain meds that they are now saying they won't cover - but they would have covered the cost of an anesthesiologist had I chosen to go under? I am so angry over this nonsense. Regardless of what happens, this $41,000 baby will be SO loved ...