Damn you, health insurance!!

[bronxgirl]

This is sort of a vent- hopefully I'll cam down soon, but anyway, here we go.
Background: 3 years ago when I got PG with DD I had fertility treatment and 2 rounds of back to back IUI. (a total of 4 procedures). Everything was covered by my insurance.
Fast forward to this summer when I went back for treatment and the same procedures. The doctor's office said they still take my insurance (the same insurance) and we proceeded the same as before. Since I had the same exact procedures, the same care providers and the same insurance I didn't do any additional research into coverage. A couple days ago I got my EOB for the first 2 IUIs and while they covered all my lab work and ultrasounds they didn't cover the IUIs. WTF??? All the stuff that was covered was preparation for the IUIs. Why would you cover prep for a procedure, but not the procedure itself? I am so mad. I'll call tomorrow, but if it's not covered than we're on the hook for about 2K. That would suck in any situation, but coupled with already feeling crappy about infertility it just sucks.

[Deleted]

Rrrg I'm sorry. How much OOP is it going to be and can you negotiate with them (if you wind up paying it)? I got an EOB from one of my IUIs and the RE tried to charge $200 for just the procedure but insurance only paid $70 so hopefully they'll knock the price down for you.

[yellowbrkrd]

I'm sorry, that totally sucks!

[CloudBee]

I'm so sorry. That must be incredibly frustrating. I hope that you have luck speaking with the insurance company.

[bronxgirl]

Thanks so much everyone. I'm feeling much calmer now. Since I posted I went to the gym and worked out which helped me feel a lot better. I also talked to my mom and she was really supportive and also told me that if I'm not able to get insurance to cover it then she and my dad will help us pay for it. Another annoyance that I think I left out of my OP- I went online to the ins co's website to read what I could about what is covered and that part of the site is down. Arrggh

[madringal]

That stinks! Do you know if your insurance has a lifetime cap for fertility treatments? A lot of them do. I think mine is capped at 10K.

[Ashley&Scott]

That sucks. If you are responsible then hopefully you can negotiate a better rate.

I'm surprised your clinic didn't check benefits. Plans often change from year to year.

[GailGoldie]

it's all so frustrating!

if you do have to pay for the iUi's- talk to your clinic- they should knock the price down for you to what they get back from the insurance company - which is ALWAYS less than what they charge for OOP patients.

I'm also shocked they didn't do a benefit check before so you would know ahead of time- mine does that and seems like most RE's do.

hopefully it's just a mistake and it will get covered!