If you remember my previous post from a few weeks ago I was a little nervous about getting a bill in the mail from my new OB/GYN. I didn't get one from them just yet, but I did get a friendly letter from my insurance saying that my visit cost $175 and they are not paying any of it. They kindly reminded me that my benefit plan excludes benefits for the treatment of fertility or infertility. (Oh really, I hadn't noticed).
So now I wait. I don't know why they billed my insurance as infertility. My last OB didn't do that.
What can I do?
Can I call the billing department of my doctors office and ask them to re bill it as something else? Or is that tacky?
Advice ladies- I would really prefer to not pay $175 if I don't have to.
Okay, I think I can call myself an expert at this. Not only is appealing denials by insurance companies to our hospital my job, but my insurance company has denied every single one of our visits to our RE because my plan doesn't cover fertility treatment. The thing is, to date, we've done no real fertility treatment. We've been treating other issues that could be construed as health issues.
ReplyDeleteI think the first thing to do is to sit down and write up what you had done at your visit. Was any of it fertility treatment? Or was it more female health maintenance?
Secondly, look closely at the wording of your health plan. They may not cover treatment, but do they cover diagnostic testing for infertility? A lot of insurance companies that don't cover infertility treatment will cover the testing required to diagnose it.
Thirdly, look at where what you had done fits with what your plan covers. If you can see even the tiniest possibility that you can claim it wasn't fertility treatment - and, let's face it, if you didn't have an IUI, IVF or any kind of medication, I think you can claim no IF treatment was given - then I would seriously look at appealing this.
Two things to remember. Firstly, insurance companies have a limited amount of money to work with - 90% of people who have insurance rarely or never use it, but those 10% that do take up the biggest most of the money any of us pay in - so they are looking for any reason they can get out of paying for your claim. Secondly, check with your OB/GYN's office. A lot of offices will appeal denials such as this as a courtesy to thier patients (not all, though. Because it's being denied as a non-covered benefit, the opinion varies on this as to whether the doctor's office wants to get involved).
If you need any help at all, please, please email me. I will gladly help you out by looking over the info for you and helping you draft a letter if you need it!
Oh, btw, every one of my denied visits to the RE? Successfully appealed and paid by my insurance company.
ReplyDeleteI'm going to second what Lynn said!! We had several bills that I have had to appeal. About 80% of them were later found to be "covered". The only thing I would add is that if you like this OB/GYN and you think you'll be with the practice for a while...talk to your doctor! When I told my OB/GYN (over two years ago) that we had very limited infertility coverage, she was very understanding. She actually put a note in their billing program that said before anything was billed to us as infertility, she would have to review it. We probably saved hundreds of dollars.
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