Fun with my Fertility Clinic Billing and Insurance

Back on the phone with my insurance again today. Just last week I was calling about another claim from my Fert. clinic to get it re-submitted for payment. Does it ever stop. I think I should go into insurance by the time this is over lol.

I was upset that my billing lady told me that my insurance said they would not cover two codes for a aspiration needle/misc supplies fee cause infertility treatments are not considered medically necessary. That made no sense to me as I have ART coverage and it paid for 3 rounds of IVF last year. So if my insurance says IR treatments are not covered cause not medically necessary that is not true.

My husband laughed at me that I was going to call and fight this, he said good luck with that. Well ever penny counts and we paid over $1500 for these misc supplies and I don't even know what we paid for or why my insurance really won't cover it.

So I called them.

They agreed that if I have ART coverage those items should most likely be covered as part of the procedures performed just like any surgery supplies are covered for it. They said the main problem is the codes the clinic gave them are too general for them to determine coverage. On their system the codes come up as misc and they have to know what misc means to approve it. (ALSO THEY NEVER SUBMITTED THE CLAIM FOR THIS TO THEM, and they found no record in the call logs that they spoke to the clinic about it, REALLY!!!)

They said for billing purposes the list of misc. supplies/needle should of been broken down into separate codes for each individual item and sent to them, not lumped together. Example: the aspiration needle if it is image guided has a code of 10022 or if it was just a fine aspiration needle the code would be 10021 and both of those are covered items. If it's tubing or gauze or even a fee for the gown/cap I wore, whatever is in the misc supplies each of those things has a separate code to be billed under not just one/two general codes.

I told them I did not know what was included in the amount we paid other than misc supplies and needle so what they asked me to do was to get a detailed itemized descriptive list with pictures if need be, of each item that is included in what I paid. I am to then call them with that list and they can look up each item and code for it and tell me what exactly is or is not covered. Then they would want the clinic to submit these items under the right codes for payment from them.

I e-mailed our billing at the clinic about this and we will see what they say. I know I am entitled to have a list given to me so I know what misc supplies mean. The fun never ends but I am determined to ring every penny out of my insurance and should not have to pay for things that are covered. I could use that $1500 for the round of blood tests I need to do so of course I am going to ask questions and get to the bottom of this issue. If you don't you just get taken advantage of. Hopefully when I get the list most of the items are covered and I get some money back. That be awesome.

Also got pricing on the RPL blood panel from my insurance at a little over $1,000 to do the whole panel (much less than the $2,00 the clinic quoted me cause of our preferred rate) so if I can get some of my $1500 back I maybe able to get these tests done. Which would be a real blessing and be our next step to find answers. If I can get them done then it's on to see Dr. Kwak-Kim for her opinion on what to do for a FET with the findings.

One step at a time. I believe God will make a way. Now to wait and see what the clinic billing will do. I really like our clinic don't get me wrong just don't understand the way they bill. I know not many have insurance so they are used to people having to pay for it all but for those of us who do and was the only reason we could afford to do IVF they should know more how to bill or find out.

Thought for the Day: "Know that you do not stand alone in this world where it seems that good is always trying to be overrun by evil. God stands by your side and continually fights for you. Together with Him, you will be victorious." I hope you have a splendid day today my friends! – Elmer Laydon

"This is what the LORD says to you: 'Do not be afraid or discouraged because of this vast army. For the battle is not yours, but God's." (2 Chronicles 20:15 NIV)

 

2/19/2012 UPDATE: I finally got some answers. I am currently waiting for my insurance to send me a claim form in the mail be another 5-7 days. I will then fill out that form with the codes the clinic gave me and attach receipts of what we paid for those items. I send it to my insurance they process it and if everything is exceptable I will get a refund from my insurance company.  Pays to be persistent!