Insurance question?

Brookeadrenaline · September 2013

I know no one can answer this question about my insurance, but I'm curious about others' experiences.

My insurance covers diagnostic test, but not treatment. Right now they are covering my medicated and TI cycles, however, my Dr recommends an IUI. If my IUI doesn't work then I might get a second opinion. But my concern is that insurance will not cover the diagnostic tests if I go for the second opinion AFTER having the IUI (because that is treatment). And I know the second doctor will want to repeat all the tests.

I called my insurance and their answer was "we might cover it"! What??

hmz819 · September 2013

I can't help you but my insurance says that all the time! It drives me nuts

Anathera · September 2013

Insurance will typically cover IF it is medically necessary to get a second opinion. If you go for one have the dr call and get a pre authorization or a referral for it. There are soo many if ands or buts to all coverage (I pay insurance claims for a living

) if you want better clarification call back and ask again. Ask how they cover or what you would have to do to get it covered. Get the customer service reps name & location too! I had to call 3 times to understand my infertility coverage and I work for my insurance!

O2girl · September 2013

My insurance covered all of my meds but the cost of the procedure is oop 100%. Plus the whole first trimester is oop because the REs office isn't in network

Brookeadrenaline · September 2013

Thank you all! Insurance can be so frustrating

So Anathera- in what instance would it be medically necessary to get a second opinion? I just can't think of when insurance would say it was a necessity (even if I personally think it might be).

Hmz819- Sorry you have experienced the same!

O2girl- I didn't even think about the 1st trimester! Oh no!! But I think if I get to that point I'll be so happy that it won't be as bad as it might otherwise be.

Anathera · September 2013

When you or dr feel the "problem" (any aspect of health not just infertility) maybe easily misdiagnosed. The reason most insurances will cover a second opinion prior to procedures is in the long run it saves them money. Just a word of advise double and triple check not only coverage but if the dr & facility is contracted with them as well as in your network (if need be). I'm sure that's clear as mud but I work behind the scene not used to putting the wording I use into everyday language. I will look up some stuff tomorrow if I get the chance and see what I can find.

sunflowermama42212 · September 2013

Siggy****

I don't know about the second DR. But when I went to see a second DR they didn't rerun any test. They just looked over everything and gave me their opinion. Good luck!

twistsandturnsto2 · September 2013

Our insurance only covered diagnostic testing but our RE was in network so we did get a bit of a discount on b/w and u/s when we were doing IUI's and medicated cycles(I did almost all my testing with my OB). For the IUI and sperm washing itself, we just paid cash up front, didn't even send it through insurance. We didn't want them to start rejecting the in-network discounts we were getting!

O2girl · September 2013

@brookeadrenaline
Not everyone's RE will be out of network nor will it be 100% oop for the 1st trimester... Look into your ins coverage. I work at a hospital and they have it set up ins wise that employees are covered 100% for in network through physicians with privalages at our hospital... Our cost with our RE isn't "covered" so to speak but because it is out of network they do let it count toward our yearly oop expense... It's complicated but that's a hospital for you lol

Brookeadrenaline · September 2013

twistsandturnsto2 I asked about this and they told me it was insurance fraud! How is it insurance fraud?? I was so confused. Insurance won't cover IUI anyway so why do they need to know that I am doing it? I should ask again.

Sunny B · September 2013

Ahh, I hate when insurance companies say that.
All we have covered at this point is diagnostics and treatment of underlying issues.
So far, the insurance company has not denied any of the testing that my doctor has ordered. I'm not sure if it would be different if I were to get the same test elsewhere, but I feel like if it's a bit of time between it would have a better time of being accepted. Things can change! I would ask if there's potentially a time gap they like to see between the same procedures, even after the IUI.

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