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Have any of you had RIDICULOUS problems with your health insurance?


Forum: Trying to Conceive

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  #1  
March 22nd, 2011, 01:47 PM
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Join Date: May 2010
Posts: 210
So, after TTC for 6 months and no luck, my Gyno had me go through tests to see if everything's working. Had bloodwork and a sonogram. Everything came back normal. My insurance DENIED it on the claims that these procedures are TREATMENT for infertility, which they say is not covered under my plan.

Say what!? Getting my estrogen level measured is considered treatment?? I appealed and they still denied, saying that since my gyno recommended my husband get his sperm tested and that I use an ovulation predictor kit, that this is definitely infertility treatment, not diagnosis. Oh, I about had a total melt-down trying to explain this over and over again to the insurance company. How are tests equal to treatment? So, if I get a mammogram, I am getting cancer treatment? Even my gyno wrote them a letter on my behalf.

How can they do this and get away with it? It is MEDICA, so I do not recommend them to anyone, the crooks!

So now I owe the labs over $1000 out of pocket. With my plan, this should have been applied to my deductible. I've switched providers now, so there's no way I can recoup these costs. I'm having to put off more expensive tests like the x-ray to look at my tubes, until this new insurance kicks in.

Anyone else suffer through this?
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  #2  
March 22nd, 2011, 02:54 PM
nichol's Avatar Super Mommy
Join Date: Jan 2011
Location: Texas
Posts: 701
I had a similar situation with hormone labs a few years ago. Mine just turned out to be the billing dept coded it wrong. It was a year long battle but in the end they paid it. We wnt thru the whole "pre-exisiting" thing with it as well.
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  #3  
March 22nd, 2011, 06:43 PM
Mega Super Mommy
Join Date: Feb 2011
Posts: 1,764
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I just found out our insurance doesn't cover any infertility or "ttc" procedures but they will cover anything to sterilize or abort a baby. It made me sick to my stomach!!!! I went to the doctor and got clomid and they wouldn't cover the clomid and we'll see about the blood work. I will talk to the NP about coding it differently and seeing if they cover it if they don't.
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