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Insurance

SaraevhSaraevh member
in Success after IF
My insurance is giving me a hassle about covering the NT Scan. I'm supposed to go next week and they apparently needed preauthorization for it ... fine, whatever. My doctor's office sent a note in. Now they call me today saying they are submitting it to the "board" for review. SERIOUSLY? This is my third kid. Having this scan covered has never been an issue before!  EVER.  AND the funny thing is I have ultrasounds every 2 to 4 weeks until week 34 because of past cervix and PTL issues and have had three ultrasounds already this time around.  Not sure why this NT scan is suddenly such a big deal?  

Anyway.  My husband got a new job so we're going to be back on United Healthcare as of June 1st. I thought, fine, I'll reschedule the scan for Monday, June 3rd. Well, called today and apparently I'll be too far along for the scan to be done by then so I can either *** around with insurance or just eat the bill. 

I'm so PISSED. What can I say or do? Anything?  IBackBevo you seem to be the queen of battling insurance.  Any advice?  
*My Loves, My Life, My Littles*

02/18/11, 05/24/12 and 12/03/13



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Re: Insurance

  • SaraevhSaraevh member
    imagecinciem:

    As a back up, I would investigate the charges in advance and ask if they have a self pay flat fee in case things go that way. IME, the flat fee is much cheaper.

     

    Good idea.  

    And I was sorda planning on just going ahead and appealing it afterwards just because I really want this scan done.     

    *My Loves, My Life, My Littles*

    02/18/11, 05/24/12 and 12/03/13



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  • Dragonfly1226Dragonfly1226 member
    I don't have much advice when it comes to insurance, but that would piss me off! I thought the NT scan was a standard part of prenatal care. I didn't even know it was something to be questioned. I hope it goes through!
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  • oooCarrieBoooCarrieB
    Do you have Hu.mana? I think they are only covering my NT scan bc I will be 35 when the baby is born. Last time around I had United Health.care and it was covered even though I was younger. Insurance is really frustrating!
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  • SaraevhSaraevh member
    Carrie, no we have some CRAP insurance called Prairie States.  We had them throughout my pregnancy with Jack though too and never had any issues with ultrasound coverage.  Super irritating.  
    *My Loves, My Life, My Littles*

    02/18/11, 05/24/12 and 12/03/13



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  • IBackBevoIBackBevo member

    Hey! Just saw your post.  I have battled insurance, but it is always after the fact.  They initially denied paying for my room in the hospital after my C-section (ridiculous), didn't pay for LO's NICU doctor because he was out-of-network (because, you know, I had a choice in the matter), denied my HSG and hysteroscopy after the fact when they had told me it was covered. The only one that I had to fight for a long period of time was for the HSG.  That fight went on for months.

    What reason are they giving you for denying it?  I would start with looking at your policy and trying to find a provision of your policy that would suggest it should be covered.  Ultimately, everything should go back to the policy.  If the policy covers it, it should be covered. 

    IF DX: DOR & Fragile X pre-mutation carrier
    2011: FSH 13.3 & E 99; AMH 0.54 2nd FSH 6.2 E 40's AFC: 8
    BFP from Clomid/IUI ~ Pre-e and IUGR during pregnancy ~ DS born 9/4/12
    Feb./March 2013: AMH less than 0.16 (undectable) and AFC = 4;
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  • IBackBevoIBackBevo member

    Another thing that I encountered - If you "cash" pay ahead of time, the price is usually much less than if your insurance denies it.

    On my HSG, the insurance only paid about $600 on it, but the doc and the facility tried to come back after the insurance had denied it and charge me over $3,000.  And no matter how much I argued with them, they would not take from me what they would have gotten from the insurance.  The radiologist was only paid $82 by the insurance, but tried to charge me $697.  If the doc and hospital would have been willing to take from me what they ultimately got from the insurance, I never would have fought the claim.  But they weren't willing to do that and I wasn't about to pay $3k for a $600 procedure that insurance had told me was covered before I had the procedure.

    Therefore, if they are still saying they are not going to cover it (or you are concerned about them changing their minds later on), I would go ahead and pay the cash price and then go after your insurance company for the payment you had to come OOP for.  At least that way you aren't stuck paying some crazy amount.

    IF DX: DOR & Fragile X pre-mutation carrier
    2011: FSH 13.3 & E 99; AMH 0.54 2nd FSH 6.2 E 40's AFC: 8
    BFP from Clomid/IUI ~ Pre-e and IUGR during pregnancy ~ DS born 9/4/12
    Feb./March 2013: AMH less than 0.16 (undectable) and AFC = 4;
    BFP from supps ~ DS#2 due May 2014

    May 2014 January Siggy Challenge:
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  • boxtonmom1014boxtonmom1014 member
    Get a hold of a manager and make a huge fuss. I had a big issue with my insurance not reimbursing me for something they should have, and it took quite a while but eventually they did. I had a direct line to a manager who was working with me, and when he started getting the run around from his own company, I sent an email to 3 or 4 of the top execs in the company. I had my check a week later.
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    TTC since 10/07
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