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Wednesday, January 13, 2010

CD7, Insurance Basterds

I cannot believe I'm about to write this super boring post, but I figure this is a big part of the IF experience, too, so I might as well take note of it.

Insurance woes!

(I'm going to try to keep this short.)

I'm a little worried about my insurance coverage.

2 weeks ago I was under the impression that we were fully covered for IUIs, and then I got a voicemail from my RE's office saying "can you please call us, we need to talk to you about your insurance." I got the voicemail at around 7pm, so I had to wait to call until the morning, and I couldn't believe how much agony I was in for those 12 hours. I thought for sure they were going to tell me that my insurance had cancelled me or something (how that would even be possible I don't know, but I was thinking worst case scenario). Turns out that I'm not covered for IUIs after all. Wait, what? I've already done 2 IUIs with you guys, and I spoke to someone in your billing department who told me "you're definitely covered, I checked twice to make sure." But now I'm not? Apparently now my insurance company is saying I'm not covered, I've never been covered, end of story. So, the good news is, it seems I'm covered for b/w and u/s and office visits. The bad news is the IUI itself is not covered, and it's $500. Which means as of right now I already owe them $1000, and in another week I'll owe another $500. Okay, not the end of the world, but certainly not good news.

Then today I opened a bill from the lab that processes my b/w. It was for $247 from a hcg/progesterone/beta test from 9/28/09. What? I've had a TON of b/w already and I've never been billed before. I then noticed in my drawer that I had a bill for a $20 copay from this same lab that I paid back in October, also for hcg/progesterone/beta, on 9/30/09. This one said that my insurance had covered it. Weird.

So, now I'm worried. And now I'm starting to think, maybe I'm actually not covered for anything... and maybe they just haven't been sending me the bills yet? Or maybe they've covered some of the b/w and u/s by mistake, and if I call about this bill it will alert them to the mistake and they'll tell me that I now have to pay for everything.

But, I couldn't just ignore the $247 bill, so I called the lab and asked why the b/w from 9/30 was covered, but the same b/w from 9/28 was not? They told me that they submitted the b/w that was not covered to my insurance company, and because my insurance was not "in network" with them, it was not covered. But the other b/w was submitted to my same insurance, but in a neighboring state (what?!) and that insurance company covered it.


Anyway, she told me she would go ahead and resubmit the bill to the insurance company that covered the other one and I could, for now, ignore the current bill.

I am so confused. And worried. If we had to pay $247 every time for the b/w, that would be about $1000 each cycle, plus the $500 IUI. And if it turns out the u/s and doctor's appointments aren't covered either, we could be looking at $2500 a cycle, I'd say. At that point I would consider it no longer worth it to do IUIs. $2500 for a 15% success rate doesn't make sense when you could spend $10,000 for a 50% success rate. Right?

Ugh, I don't know what to do. I'm too afraid to call my insurance company and draw attention to myself in case they've been unwittingly covering things that aren't really covered.

This was a much longer post that what I'd planned. And even more boring than I'd thought it would be! Sorry!

In other news, my last shot of gonal-f (75iu) is tonight. No shot tomorrow and then RE Friday morning, and we'll see if these estrogen patches have "fluffed" (thanks to Such a Good Egg for that lovely way of phrasing it!) my lining to a nice pillowy thickness!

Oh, also, I realized that in my next to last post (the one about the changes I was making this cycle) I wrote "no alcohol until I'm knocked up." As if I will begin imbibing again as soon as I see that second line. Let me clarify: no alcohol until after I'm done making (or not making, as the caase may be) a baby(s). Now let's see how long I can stick to that one...


  1. Poop! I hate that on top of all the stress we have to deal with for the possibility of having a child, money has to be part of it! Sorry to hear about your insurance coverage and hope this turns out to be a big mistake.

  2. I am having all of the same insurance issues. Some stuff is covered, some stuff isn't...and I don't want to rock the boat b/c as I understand it, I'm technically NOT supposed to be covered (a stupid more-than-one-year rule I could've gotten around if I'd been more savvy/white lited). It sucks! I hate burning through money like this. But we want a little one so badly, we can't just sit around...I hope it gets worked out and you are pleasantly surprised to hear you really don't owe anything close to $2500/cycle.

  3. Gosh, I hope your ins. can be straightened out. As billed, our IUI's were about $2500, but my ins. covered most of the bloodwork and ultrasounds. Our part of the cost (the bills) are a little delayed though, so it's possible that the bills are just now coming in from past cycles. I will be praying that this stress will be lifted soon!!

  4. I totally, totally hear you on your insurance complaints. I have to constantly struggle to make sure that I stay on top of what the insurance is supposed to cover and not cover. I thought it was their job to make sure they pay for what they're "supposed" to pay for, but they try to get out of paying for every little thing.

    For example, my first acupuncture appt was "denied" when they told me I was "out of netowrk." When I told them that I went to an "in network" clinic, they did a complete 180 and paid for it. Wtf! Had I not called & complained, I would have had to pay for it.

    My DH was hospitalized in the summer of 08. We are STILL getting bills for that, and are STILL fighting with the hospitals and insurance company to get them to pay for it. It's frickin ridiculous. I think if they don't bill within a year, it's their loss. But, that's not the way it works. We'll probably still be getting bills 10 years from now.

    Oh, and when I had a pelvic lap done, the hospital billed the insurance twice for it, six months apart. The insurance rejected the second bill, and the hospital tried to make me pay for it, when it was already paid by my insurance months earlier. Wtf! It's a constant, constant battle with hospital fees and insurance companies.

    Sorry that my response is so long, but the very topic of insurance gets me fired up. Good luck with your battles! =)

  5. Ugh, that is beyond frustrating!!! I seriously get overwhelmed with IF and insurance, it seems like everywhere I go I either owe money, or my insurance didn't cover something, etc. When we went for our first IF consult and did bloodwork...we got a $1400 bill from the lab that did our HIV/STD/Genetic Testing. I was like we haven't even done a real treatment yet...wtf, luckily they coded something wrong. But its like, don't I have enough to deal with here...can't you get this shit right?!?! I'm sorry you have to deal with this!!! Good luck tomorrow, hope you're nice and fluffy!

  6. Oh gosh I'm sorry =(
    I tell you though, I'm glad you have the price you have for your IUI's my bill is almost tripple that. If I found out I had to pay out of pocket I would die! Good luck with everything insurance related and with this cycle as well!