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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?
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))
TTC#1 BFP 10/2006, 5 failed IUI's, 1st IVF successful, Baby Girl 2/2011
TTC#2 BFP 9/2011, Natural Pregnancy! 3/30/12 M/C'd on 5/15/12 (9 weeks)
IVF#2 BFP 4/2013 M/C 6/2/13 (8 weeks)/FET #1 BFP 8/2013 - Chemical Pregnancy
IVF #3 - Retrieval Oct 31st, Txferred 2 on 5d - a Blast and Morula
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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.