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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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IF benefits
I had the CD3 bloods, genetic panel and two visits to NS who are in network. I have a $12K lifetime max for IF.
I saw my benefits online and it looks like all of the blood panels were submitted. They submitted a total of $4K for all the bloods..what?
Is that going to go against my IF coverage?
I may have to call the doc office about it. I realize that they are only going to pay a certain amount which is far less, but it was just bloods.
I have to dig out my benefits at home and read it carefully. Sonos, blood? All against my IF coverage?
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Posted 6/20/08 8:55 AM  |
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Long Island Weddings
Long Island's Largest Bridal Resource |
MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: IF benefits
Donna and Pauline would probably be able to help you.
I want to say no, but I think it depends on your plan. I think if you're in network that sonograms are considered routine monitoring- but again, I think it would depend on your plan. I know w/ my last insurance plan (not current)- I was only allowed so many sonograms w/ in a certain time frame (I think 90 days)... which was overturned (case by case) when my dr's office called to supply them w/ more information that we were in the middle of an IUI cycle and needed almost daily monitoring... HTH!
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| Posted 6/20/08 9:00 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: IF benefits
My plan says that anything towards the diagnosis and treatment of IF. So I had a high FSH..is that going to be diagnosed as IF?
I guess I need to get my EOBs and see how they are diagnosed. Not that I would know the procedure codes.
I'm going to Cornell In August, I was hoping my benefit would all be intact before going there.
I'm really kind of bummed right now.
I can tell an Equity loan on my house is in our future...
Message edited 6/20/2008 9:08:43 AM.
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| Posted 6/20/08 9:06 AM |
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Donna
1 year already!!
Member since 5/05 3360 total posts
Name:
Donna
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Re: IF benefits
I don't have any IVF coverage but have always had sonos, blood, some procedures covered so I would think that your blood work is not going to go against IVF coverage $$
You mentioned that you're going to Cornell, I'm guessing Dr. Davis, he's very nice - are you aware that they don't take insurance?
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| Posted 6/20/08 9:24 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: IF benefits
Posted by Donna
I don't have any IVF coverage but have always had sonos, blood, some procedures covered so I would think that your blood work is not going to go against IVF coverage $$
You mentioned that you're going to Cornell, I'm guessing Dr. Davis, he's very nice - are you aware that they don't take insurance?
I hope this is the case. Yes, Dr. Davis..I hope he will work with me. I know they don't take insurance so I was hoping that anything that I have done up to this point wasn't going toward my IF coverage since I only have $12K lifetime and $10K for drugs.
I know I probably will incur some out of pocket expenses that never get reimbursed through insurance, especially if I go through more than one cycle...just trying to strategize now. Who knows what really will be when I go to Cornell.
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| Posted 6/20/08 9:50 AM |
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BA2008
Need to find some hope!
Member since 2/08 2485 total posts
Name:
Beth -Ann
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Re: IF benefits
I don't think the blood panel should go against your IF coverage. Hopefully that will be the case.
Do you have out-of-network coverage?
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| Posted 6/20/08 9:59 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: IF benefits
I do have out of network coverage, but I guess I'm worried that since my FSH was high they will diagnose me as IF.
I wonder if I should call NS to see how they diagnosed it.
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| Posted 6/20/08 10:00 AM |
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hope316
LIF Adult
Member since 8/07 1085 total posts
Name:
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Re: IF benefits
I'm a NS patient as well. I checked all the diagnosis codes during my workup and the were never infertility. I also had surgery and the primary diagnosis was endometriosis not infertility.
Definitely check but Dr R said they try to work with us
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| Posted 6/20/08 10:10 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: IF benefits
Posted by hope316
I'm a NS patient as well. I checked all the diagnosis codes during my workup and the were never infertility. I also had surgery and the primary diagnosis was endometriosis not infertility.
Definitely check but Dr R said they try to work with us
you think I should call them and see how they coded it? I would imagine they would try not to submit it as IF..everyone has some limit on their coverage.
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| Posted 6/20/08 10:19 AM |
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LisaW
Time for me to FLY!
Member since 5/05 13199 total posts
Name:
Did I ever tell you that I hate people?
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Re: IF benefits
there is a difference btwn IF coverage and Advanced IF coverage
12k is the advanced
sonos and b/w don't count towards that
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| Posted 6/20/08 12:24 PM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: IF benefits
Posted by LisaW
there is a difference btwn IF coverage and Advanced IF coverage
12k is the advanced
sonos and b/w don't count towards that
If this is the case, that would be awesome! Lisa, as always, thank you for your help.
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| Posted 6/20/08 12:31 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: IF benefits
Posted by Blu-ize
Posted by LisaW
there is a difference btwn IF coverage and Advanced IF coverage
12k is the advanced
sonos and b/w don't count towards that
If this is the case, that would be awesome! Lisa, as always, thank you for your help.
that usually is the case. Good luck!
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| Posted 6/20/08 2:01 PM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: IF benefits
Also , when a claim is submitted, a lot of time, the diagnosis code submitted is what is read and a claim is processed according to that. Its not always right.
My opinion is call and ask for every single Explanation of benefits for IF related services, get a benefit book so you have it at home handy and review , review , review.
Mistakes are made OFTEN...and really you have to stay on top of it IMO!
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| Posted 6/21/08 8:56 AM |
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