Insurance Troubles

[mrsbunny]

A couple weeks ago, I thought I was doing great. Now I'm struggling. AF is due on Saturday. If she does indeed show her face (which I'm guessing she will), I'm scheduled to have my saline infused ultrasound on August 4th. I called my insurance to see if they would cover it. Here's where things get interesting.

If the ultrasound is all clear and looks good, it will be billed as medical and insurance will cover 100%. If it comes back as an infertility problem, it is billed as infertility (which my insurance doesn't cover treatments for) and I will have to pay 100%.

Great. Double whammy. So I called the RE to see how much it costs. $1800ish, but the hospital will cover 40% if insurance won't cover it. Which means I'd still have to pay $1000. 

Technically, we CAN swing that amount. But it's still a lot of money. I keep waffling between just wanting to know and not wanting to spend the money. I don't know what to do, and I'm pissed off that I have to figure this out. 

[mrsbunny]

jodippls, I have no idea why they have to be so awful. And the thing is, I don't have bad insurance. In fact, I've been very happy with my insurance until now. They've covered just about everything (I even got my new pair of glasses covered 100%!) and they covered the D&C. Previous IF testing have skated by as "medical" (DH's testosterone issues are "medical" and my previous testing have been "medical" as they dealt with vitamins, thyroid, etc.) But now they're just being dicks.

I don't get why so many insurance companies are so awful about IF. 

[ratherbepaddling]

Total BS. I overheard the nurse explaining to another couple that because her baseline ultrasound was coded with an "infertility diagnosis" she was out of pocket for the mid cycle ultrasound. Mine are being coded as PCOS and so far the insurance company hasn't billed me for it, but I wouldn't be too shocked if I got a big ugly bill in the mail on day soon.

[knx9211]

This is really shitty. I'm sorry.

[belle55]

This makes no sense at all. It's the same procedure regardless of outcome as PP mentioned. I'm sorry. As if dealing with IF isn't hard enough, insurance makes it even more difficult.

[mrsbunny]

I agree it makes no sense. I had the woman on speaker phone as I was talking to her and DH started laughing at the absurdity. I even flat out asked her, "So...if everything's good, you'll cover it, but if I'm infertile, you won't?" She kinda stuttered for a moment but confirmed that yes, that is the case. Ugh.

[ilovecandy]

I am jumping over from tttc but can you ask your dr how they bill it? Maybe either way they can bill it as medical and not infertility. I fucking hate coding for insurance. Lukcily the clinics i have been seen at seem to know how to code crap for my insurance to get them to pay instead of me paying out of pocket becaue for my insurance some infertility stuff is covered and otehrs aren't