Insurance Vent

So Finance Dept at Dr's office just called & my IVF claim was denied...
After they told me & told them that i was 100% covered & they filled out a million forms & jumped through a million hoops.
I wont bore you with the details
They covered all my meds & I have already been stimming since Monday. I mean the claim was sent in 6+ weeks ago.
Ugh - For us there is no turning back now. Forunately we can afford to pay out of pocket, but the 11k definitely adds to the already high stress levels & feeling that this has to work.
VENT over

Re: Insurance Vent

this happened to me too and then I realized why...

My clinic got pre-approval from my insurance company. It sounds like you did too. And then after my first cycle, the insurance denied all claims. DH and I were NOT expecting that! So I called the insurance company several times until I got someone on the phone that was willing to do a little digging for me.

Turns out the code that the clinic used to get pre-approval was different than the procedure code they used to bill, which was why it was denied. The clinic re-did all their paperwork and re-billed my insurance. DH and I were left with paying less than $500 out of pocket... which is so much better than $10,000!

Did the insurance company tell you in writing that you covered? What exactly did they tell you?

Message edited 7/9/2010 4:07:02 PM.

Re: Insurance Vent

I wish our situation was the same.
The policy states that infertility treatment is 100% convered including a bunch of different procedures (iui, etc. ) It never specifically states IVF is included nor does it say it is excluded.
Intentionally vague & misleading.
So the women i was dealing with at Dr's office said she specifically spoke with someone who said that policy doesnt specificially exclude it & to go through whole claim process. The Doctor even had to send a letter explaining y it was medically necessary.

I had called the insurance company previously with the same question & all they told me was the i need to pre-notify & should have coverage.

And after all that, after it got through entire claims process it was denied. We are going to appeal, but i dont have very high hopes & will still have to pay out of pocket for now.
Its just so stressful. Im trying not to think about it, since stress is obviously a big no no in this process.

Im happy everything worked out for you though!

Re: Insurance Vent

I just went through this or well still am but I just got my claims covered. Like you I have a 100% coverage, insurance pre-authorized my last cycle and while I was in it called my Dr's back and denied it so I, like you paid out of pocket. Since then I have not stopped fighting and won't until I get refunded every penny I am owed. Who is your insurance company and do you have a copy of your covered benifets? Does is say "assisted reproductive services" any where as being covered? This is how they refer to IVF. Is your insurance through your job or your husbands? What I did was got my husbands HR department involved. They got on the phone with the broker who created the policy and she reached out to all of her contacts at the insurance company and people started helping me. It's been a long two months but I was finally approved in writing and then when it was billed it was denied again. I picked the phone back up and called everyone I could think of and finally had my claims approved. Now, all I am responsible is for $30.00 and I am now waiting for the DR office to refund me my money. Unfortionately for me, my first cycle didn't work so I had to do another but that I had to pay out of pocket because I only had $18k lifetime max. I was prepared to pay 1 out of pocket but not 2 which is why I wouldn't give up. I knew I was covered and just kept calling. They tried to make me appeal and i refused to do that and managed to get it worked out. Just be sure to document everyone you speak to, times and what you talk about. It helps build your case. If you need any help at all, let me know and I will be happy to look at your benfits to see what's covered and what's not. It sucks having to deal with this **** on top of all the other **** you have to worry about. I hope everything works out for you and again, if you need any help wth the insurance let me know and I will really be happy to help you.

Re: Insurance Vent

Thanks for this.
Im leaving it on the back burner for now, since we are very close to ER & i dont want any added stress.
But I will definitely begin fighting in August & may have some questions for you.
I have UHC. The policy doesnt state anywhere clearly that it is not covered, but it also doesnt say that it is.
So we will see, it can definitely go either way

Thanks Again

Re: Insurance Vent

ugh, I had a strong feeling you were going to say uhc. I seriously hate them. They pulled the same **** with me. When your ready and if you need help, feel free to FM me. I've gotten pretty good at decoding their benifits so if you want to send me your coverage I can take a look for you. Good Luck!!

Re: Insurance Vent

Sorry about that

We too are OOP and it royally stinks...The one thing I did end up doing that I wish I had done my 1st cycle was to put the bill on one of my air-mile earning credit cards instead of pulling the money directly from our savings I at least would have felt like I was getting "something" back
(hopefully in addition to a )....