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Insurance rant


Forum: December 2013 Playroom

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  #1  
March 21st, 2013, 03:12 PM
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Join Date: Jan 2013
Location: St Louis, MO
Posts: 493
I just need to vent for a second. I just received a bill today from my insurance company saying that I owe $5137 because my blood work wasn't pre-determined.

First... how in the world is it possible for blood tests to cost $5137?

Second... both my doctor's office and I called the insurance company numerous times about any need for pre-approval. We were both told that there was no pre-authorization needed.

But, apparently because we were asking about IVF coverage, they didn't feel it was important to tell us that the lab work wouldn't be covered without pre-determination.

If these are tests that are required for IVF why in the world would they require a separate authorization than IVF?

The insurance company says I should have asked them about specific codes. I obviously don't have such codes, but then they said my doctor's office should. Well, the problem is, the doctor's office isn't the one that billed the insurance company - it's a lab that does that.

So HOW am I supposed to be a good consumer and find this stuff out before they charge me out the butt?

I HATE insurance companies!

Sorry - just needed to get that off my chest....
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  #2  
March 21st, 2013, 04:26 PM
Jessimaaka's Avatar Pink in a house of Blue
Join Date: Dec 2011
Location: Ontario, Canada
Posts: 16,273
I don't know much about insurance in the US as I am Canadian, but that sounds confusing to me! I hope you get it sorted out soon, $5K is super high for a little bit of blood!
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  #3  
March 21st, 2013, 05:06 PM
yvee80's Avatar SmileyMom
Join Date: Oct 2010
Location: McDonough, GA by way of Charlotte, NC and my home NY!!!!
Posts: 1,327
There must be a way that they can resubmit withe proper codes so that your insurance will cover it! That is ridiculous! Who is your insurance provider?
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  #4  
March 21st, 2013, 06:18 PM
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Join Date: Feb 2013
Posts: 362
Quote:
Originally Posted by yvee80 View Post
There must be a way that they can resubmit withe proper codes so that your insurance will cover it! That is ridiculous! Who is your insurance provider?
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  #5  
March 22nd, 2013, 12:31 PM
*Leah*'s Avatar TTC the newfashioned way
Join Date: Sep 2009
Location: Wisconsin
Posts: 3,399
Oh girl, I'm sorry! I agree, call the ins company, see what code they actually need and see if the lab will re-submit with the correct code. If not, I WOULD fight it, and put in a dispute claim, stating that you called and asked for ALL preauthorization for IVF and if the person on THEIR end didn't do the correct paperwork, that is not your issue. And they will have record of you calling for IVF pre-authorization.

Fight it. It's not over yet. ((HUGS)). My beta blood draws last year were $360/each...and that is just the blood processing, not the charges for collecting (another 30-40) and think of how much bloodwork you have during the cycle! ((HUGS))
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  #6  
March 22nd, 2013, 04:43 PM
Gamer_Princess's Avatar Mega Super Mommy
Join Date: Jan 2013
Posts: 4,034
So sorry I have Tricare so I know the process of having to jump through hoops but dang that is alot for blood work... I would fight it most def!
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  #7  
March 26th, 2013, 06:08 PM
~*Kixs*~'s Avatar Platinum Supermommy
Join Date: May 2007
Location: North Texas
Posts: 12,786
Call your doctors office and ask to speak to one of the nurses (or the insurance care coordinator if they have one) and explain the situation. A lot of times they will call the lab and ask them to resubmit with correct code.

One thing I have learned about insurance is the $$$ amount they give you is never the final answer but you do have to put in the work to fight it.
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