Yesterday, J and I got a copy of the letter the insurance company sent to RE's office. It basically said that if the HSG would be covered if it was for fertility diagnosis, but not for fertility treatment. My RE's office took this to mean that it most likely will not be covered and that we will have to pay all $1,300 out of pocket. Why?! It is for diagnostic purposes! Sure, I've been treated for IF in the past, but the HSG is used to diagnose a kind of infertility that I've never been treated for (blocked fallopian tubes).
So, if we find that the HSG was not covered, how to we go about successfully appealing it? We spent almost 5 months dealing with our insurance company to find out whether or not it would be covered, so I can't imagine the kinds of hoops they would make us jump through to try and get them to actually pay for something.
What you need to do is call the insurance company and request that they assign you a case manager. Then, you tell the case manager your issues and she/he will take care of it and YOU don't have to do all the legwork. It's a lovely service, actually---but no one ever knows about it, because they don't TELL anyone.
ReplyDeleteHope that helps a bit...
ICLW#29
I'm surprised that your RE can't code your insurance claim with a code that says the HSG is for diagnostic purposes. It's your first HSG, right?
ReplyDeleteBesides, the case manager suggestion, is there an insurance/billing person you can talk to at the RE's office?
I have worked in health care, and I know that a determined Dr. can work the insurance system in your favor. Don't be afraid to ask for his/her help and to appeal if need be.
Good luck. The insurance game makes IF that much more yucky.
Sorry I can't give any advice on how to deal with your company. Our insurance covers nothing that even resembles infertility, so I don't even get to appeal. But I just wanted to commiserate with you and say insurance sucks. And that it does sound like you should have a good chance of getting it covered, so just fight for yourself!
ReplyDeleteArrrgh unfortunately no help BUT I do hope that you get it sorted!
ReplyDeleteICLW
#101
http://thegalwho.wordpress.com/
It's all in how your RE's office codes the insurance paperwork. They need to make sure they use a code that indicates the HSG is for diagnostic purposes or more specifically it is being ordered to find an explanation for your unexplained infertility.
ReplyDeleteGood luck.
~ICLW #31
As long as the office codes the charge as diagnostic testing, it's covered. Regardless if the results are for fertility diagnosis. That's how my insurance and RE worked. Even on some IF related tests, they would code it as diagnostic for me so I would have insurance coverage.
ReplyDeleteICLW
I hate insurance companies. They put us through so much to get our IVF covered. I'm so lucky it was covered, but getting access to that coverage was awful...I kept getting IUIs canceled, due to overstimming and risk of HOMs...then the insurance company wouldn't approve moving on to IVF because I hadn't had exposure to sperm!!
ReplyDeleteAll I can say is stay on top of it. I had to call the insurance company daily...and sometimes my RE's office too--they were better about paperwork, but not always. I just made myself known, and I took names and extensions so I didn't have to tell my story all over again. But that's pretty simplistic advice...
PP's comment about diagnostic makes sense, too, so I'd see about that..
I have no advice. I'm sorry...this stinks! None of our treatments were covered, only diagnostic tests and apparently they considered ours a test because it was covered. Just had to pay our co-pay
ReplyDeleteGood luck!
ICLW #28
I can't offer any advice. I have the same problem. I know I have infertility, but I conceived my child naturally after being on a break from a chemical pregnancy. So, I was told by my Dr that I would need to be re-evaluated on my infertility diagnosis when I began trying again b/c a pregnancy can change a person's body. So, when I went in there I had to have some of the same testing done I had already had done before my son, and they Dx'd me as Infertile before the tests ever came back thus meaning I had to pay out of pocket for everything, b/c my insurance is like your's only pays for diagnostics. Best of luck getting this situated and paid for.
ReplyDeleteICLW #33