Several days after the IUI, my husband discovered that someone in billing from Doctor Superman's office left me a message on our home phone (the phone we never answer) regarding some pesky billing matter. After some delightful phone tag, "Venetia" left me a message that the procedure I had done was not "certified" and I needed "pre-certification" and my insurance company was unlikely to retroactively certify the procedure. She instructed me to call my insurance company to straighten things out or at least have the policy explained to me. Ever the dutiful patient, I called and was told that no, the procedure was not covered and that yes, I needed it to be pre-certified, and no, they wouldn't do it retroactively. My blood began to boil. "I AM NOT PAYING FOR THIS. YOU ARE", I screamed. The person on the phone quickly said, "I'm going to send you to super-special immediate assistance department." After that got me nowhere, they sent me to the fertility billing department to get me pre-certified for any other procedures "for the future." Apparently for the "fertility benefit" I have to have everything pre-certified. So the woman there asked, "What is your infertility diagnosis?" When I said that I didn't know what the hell she meant, because they don't know why I'm having problems, she said, "Well, what has your doctor diagnosed you with? They are supposed to give you a bunch of tests and determine the cause of your infertility." Oh, really? And what if they can't determine what it is? Like that's ever happened. I said, "it's idiopathic." Dead air. Then I said, "I'm a recurrent miscarrier." She was feverishly excited with that one, "I'm going to get the bonus of the year! Denied!" "The ability to achieve pregnancy, whether carried to term or not, is not defined as infertility. You are not eligible for the infertility benefit." So I said, just for the hell of it, "High FSH! Diminished ovarian reserve! Blocked tubes! Endometriosis! PCOS!" She ignored me. Then I said, "So, I've been trying to have a baby for THREE YEARS and I don't have one, NOT EVEN ONE but I'm not considered infertile because I've been able to achieve pregnancy in the past?" That's great, right? The REALLY FUNNY thing? It turns out that the IUI is covered under my general benefit and that the billing person mistakenly thought that I did an IVF cycle and apparently, that's what she tried to bill for. It wasn't an altogether fruitless call, I did learn that if I am ever recommended IVF it's likely going to have to be paid for out of pocket. And New York has mandatory IVF coverage. Wonderful.
Still spotting? Yes. Being driven mad? Quite. "P" word or not? I can't bare to face it.
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6 comments:
Oh my god, what asshats, what a horrible conversation.
It sucks. End of story.
For me, I might have gotten IVF covered under my insurance, but only by some guy at St. Luke's with a dreadful reputation. It wasn't worth it. So we paid through the nose. Bits and pieces were covered - like the u/s and b/w monitoring, but the IVF itself wasn't.
Did I say it sucks?
Here's hoping this one works for you.
Ugh. That does suck.
We had no coverage, and sometimes I'm almost GLAD because of the insurance hassles other people talk about. And I'm an INSURANCE AGENT.
I'm glad you got it covered. That's donkey bung that you're "not infertile" if you CAN GET pregnant. Awful. And not at all the actual definition. I'm surprised they'll do that.
That is a nightmare. I would have exploded. ANd don't you just love having to answer THAT question with the words, "oh um, well.. I... suffer from... recurrent miscarriage". Never fails to result in uncomfortable silence.
Have been desperately waiting for an update....I am hoping this is it..you have the heparin on your side...
Wow.
As if the treatments and the waiting weren't bad enough...
Urgh.
Uck,.
What an absolute load of red-tape wrapped bollocks.DOn't think much of that insurance co.
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