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AnnaBella816
LIF Infant
Member since 1/11 72 total posts
Name:
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Did you know your complication before the initial RE consult?
I called my insurance company about getting information on the centers of excellence (I have NYSHIP Empire, so we get the best coverage and rates at these COE) and she told me that before they sent that, I should have a diagnosis code so I can get pre-certified.
In my head I'm thinking - wouldn't it make sense to tell me the centers that I'll be able to go to assuming we need IVF or treatment, so I get my consult there?
I was just wondering - did any of you already have a diagnosis code before your initial RE consult? I just found it confusing - I thought at the RE, they would do all of testing anyway.
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Posted 1/6/11 10:14 PM  |
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PennyCat
Just call me mommy :)
Member since 7/08 19084 total posts
Name:
Jib
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Re: Did you know your complication before the initial RE consult?
I knew I had PCOS before I saw an RE because I was diagnosed as a teenager.
I'm sorry this is so frustrating!!  
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| Posted 1/6/11 10:15 PM |
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AnnaBella816
LIF Infant
Member since 1/11 72 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
I mean - does it matter though?
We know the problem - does DH have to go to another doctor before the RE?
As I'm typing this, it sounds like such a stupid question LOL
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| Posted 1/6/11 10:17 PM |
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PennyCat
Just call me mommy :)
Member since 7/08 19084 total posts
Name:
Jib
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Re: Did you know your complication before the initial RE consult?
 I'm actually not sure.. def doesn't sound like a stupid question to me though! 
I hate how they have you jump through all these hoops! Amazing how some people can just  
ETA: Amazing avatar....... between you and angel333, I'm loving the cat trend!! 
Message edited 1/6/2011 10:20:52 PM.
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| Posted 1/6/11 10:20 PM |
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FlowerWife
Positive Vibrations...
Member since 1/08 8423 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
i had to go to the RE to get d/x with PCOS. because of that my first few appointments were billed as infertility and not PCOS. my insurance at the time had no infertility coverage and i had to pay out of pocket. after three appointments i asked the office to file under the code for PCOS. all of the appointments were covered after that.
you dont HAVE to get the code beforehand, it just might help if your insurance only covers certain things. if your plan has infertility coverage you should be covered either way, although you should still find out exactly how they will bill it to be sure.
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| Posted 1/6/11 10:22 PM |
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AnnaBella816
LIF Infant
Member since 1/11 72 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
Posted by PennyCat
I'm actually not sure.. def doesn't sound like a stupid question to me though!
I hate how they have you jump through all these hoops! Amazing how some people can just
ETA: Amazing avatar....... between you and angel333, I'm loving the cat trend!!
Thanks - They are my furbabies. I love them LOL 
I love looking at cat pictures, too haha.
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| Posted 1/6/11 10:26 PM |
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AnnaBella816
LIF Infant
Member since 1/11 72 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
Posted by FlowerWife
i had to go to the RE to get d/x with PCOS. because of that my first few appointments were billed as infertility and not PCOS. my insurance at the time had no infertility coverage and i had to pay out of pocket. after three appointments i asked the office to file under the code for PCOS. all of the appointments were covered after that.
you dont HAVE to get the code beforehand, it just might help if your insurance only covers certain things. if your plan has infertility coverage you should be covered either way, although you should still find out exactly how they will bill it to be sure.
We have really good coverage, so I guess I'll just hope the center we pick is a COE so that we can keep going there.
Yay! I think I'm going to call tomorrow and try and set up an appointment in the next couple weeks 
THanks!
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| Posted 1/6/11 10:27 PM |
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FlowerWife
Positive Vibrations...
Member since 1/08 8423 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
Posted by AnnaBella816
Posted by FlowerWife
i had to go to the RE to get d/x with PCOS. because of that my first few appointments were billed as infertility and not PCOS. my insurance at the time had no infertility coverage and i had to pay out of pocket. after three appointments i asked the office to file under the code for PCOS. all of the appointments were covered after that.
you dont HAVE to get the code beforehand, it just might help if your insurance only covers certain things. if your plan has infertility coverage you should be covered either way, although you should still find out exactly how they will bill it to be sure.
We have really good coverage, so I guess I'll just hope the center we pick is a COE so that we can keep going there.
Yay! I think I'm going to call tomorrow and try and set up an appointment in the next couple weeks
THanks!
just so you know my current insurance (not the same one i started with that i mentioned above) also does the COE thing. i just saw the RE that i most preferred, regardless of that.
everything has been covered so far with no issue. so pick the RE that makes the most sense for you - not just because they are considered by your insurance carrier to be a COE.
Message edited 1/6/2011 10:33:46 PM.
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| Posted 1/6/11 10:33 PM |
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AnnaBella816
LIF Infant
Member since 1/11 72 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
Posted by FlowerWife
Posted by AnnaBella816
Posted by FlowerWife
i had to go to the RE to get d/x with PCOS. because of that my first few appointments were billed as infertility and not PCOS. my insurance at the time had no infertility coverage and i had to pay out of pocket. after three appointments i asked the office to file under the code for PCOS. all of the appointments were covered after that.
you dont HAVE to get the code beforehand, it just might help if your insurance only covers certain things. if your plan has infertility coverage you should be covered either way, although you should still find out exactly how they will bill it to be sure.
We have really good coverage, so I guess I'll just hope the center we pick is a COE so that we can keep going there.
Yay! I think I'm going to call tomorrow and try and set up an appointment in the next couple weeks
THanks!
just so you know my current insurance (not the same one i started with that i mentioned above) also does the COE thing. i just saw the RE that i most preferred, regardless of that.
everything has been covered so far with no issue. so pick the RE that makes the most sense for you - not just because they are considered by your insurance carrier to be a COE.
I'll def keep that in mind.
I think the only difference between an in-network and a COE is that the COEs have no co-pays. I figured that could add up pretty quickly though
I guess the only way to know the real cost difference is to talk to different REs
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| Posted 1/6/11 10:38 PM |
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Re: Did you know your complication before the initial RE consult?
I knew I had PCOS but was later diagnosed with a few additional issues.
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| Posted 1/6/11 10:45 PM |
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ODonnell
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Member since 9/05 5983 total posts
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Re: Did you know your complication before the initial RE consult?
We have NYSHIP and I didn't have to provide a dx code or anything when I called to get authorization. We were authorized a year ago or more so maybe it has changed.
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| Posted 1/7/11 9:00 AM |
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DaisyGirl
LIF Adult
Member since 2/08 1650 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
I have NYSHIP as well. I don't know if there are different plans but I didn't have to get precertified or get a diagnosis code. I called NYSHIP before I went to find out about my coverage but my RE's office has handled all the paperwork.
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| Posted 1/7/11 3:07 PM |
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cowgirlkate
Twins times TWO!
Member since 1/11 1197 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
I have NYSHIP as well...I am still going to my regular OBGYN who is doing my clomid cycles...but I know that this is one of the centers of excellence under the nyship plan http://www.longislandivf.com/index.shtml
I don't go there so I can't say if they are good or not, but who knows! Maybe in a few months I will be asking them for help...
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| Posted 1/8/11 12:46 AM |
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bookworm
Two Little Rosebuds
Member since 8/09 2106 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
i have the same insurance and i am with RSofNY (a COE). i guess i went in specifically for recurrent m/c, but i still don't know the root. i don't know anything about a code or getting pre-certified, but i get great coverage there.
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| Posted 1/8/11 8:00 AM |
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NeedtoHide
LIF Adolescent
Member since 3/10 551 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
no, i didnt know my dx before my re appointment....and after a bunch of re appointments they still dont know
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| Posted 1/8/11 8:01 AM |
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ncf0410
LIF Infant
Member since 7/10 136 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
Posted by AnnaBella816
I called my insurance company about getting information on the centers of excellence (I have NYSHIP Empire, so we get the best coverage and rates at these COE) and she told me that before they sent that, I should have a diagnosis code so I can get pre-certified.
In my head I'm thinking - wouldn't it make sense to tell me the centers that I'll be able to go to assuming we need IVF or treatment, so I get my consult there?
I was just wondering - did any of you already have a diagnosis code before your initial RE consult? I just found it confusing - I thought at the RE, they would do all of testing anyway.
I have the same insurance as you and I go to RSONY in Mineola and theyare part of the Center of Excellence...when i first had my apptointment when I walked in the receptionist handed me and my DH a piece of paper to show that everything was covered at no copay...she did it all through the facility..if you go on empire's website you may be able to look up a COE and they should notify Empire to let them know. I hope this helps you...good luck!!!!!
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| Posted 1/10/11 2:37 PM |
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maybemommy10
Big Brothers to Be !
Member since 2/10 3868 total posts
Name:
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Re: Did you know your complication before the initial RE consult?
NO and two years later i STILL don't !
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| Posted 1/10/11 4:01 PM |
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PennyCat
Just call me mommy :)
Member since 7/08 19084 total posts
Name:
Jib
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Re: Did you know your complication before the initial RE consult?
Posted by maybemommy10
NO and two years later i STILL don't !
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| Posted 1/10/11 5:55 PM |
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