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MrsM429
Mama x2 <3
Member since 12/10 4946 total posts
Name:
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Benefit changes- help me interpret this
We just received the new benefit package for our insurance through DH's employer. Good news is we have a well known and widely accept insurance company (before we had humana and nobody accepted it lol). Of course Infertility services are strictly excluded, but it does say this
"Any and all testing up to the diagnoses of infertility will be covered under regular routine exam benefit"
Do any of you insurance experts know if this means that any testing such as the HSG would be covered? I can not call to confirm until we are an active member, and that will not be effective until Jan 1st.
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Posted 11/5/13 11:00 AM  |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Benefit changes- help me interpret this
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
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| Posted 11/5/13 11:05 AM |
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MrsM429
Mama x2 <3
Member since 12/10 4946 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by jessnbrian
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
Hmm, now how will I know if the billing dept will code it under infertility? I do have pcos, but can I request them to code it under that, or will they automatically know to do so once they call to confirm my benefits? If it makes any difference, I will be seeing a new RE what accepts my new insurance, so I'm sure they will have to run all of the introductory tests.
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| Posted 11/5/13 11:09 AM |
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PitterPatter11
Baby Boy is Here!
Member since 5/11 7622 total posts
Name:
Momma <3
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Re: Benefit changes- help me interpret this
Posted by MrsM429
Posted by jessnbrian
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
Hmm, now how will I know if the billing dept will code it under infertility? I do have pcos, but can I request them to code it under that, or will they automatically know to do so once they call to confirm my benefits? If it makes any difference, I will be seeing a new RE what accepts my new insurance, so I'm sure they will have to run all of the introductory tests.
You can ask them to code it certain ways. I have done this to ensure things are considered preventative care in the past.
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| Posted 11/5/13 11:34 AM |
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MrsM429
Mama x2 <3
Member since 12/10 4946 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by PitterPatter11
Posted by MrsM429
Posted by jessnbrian
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
Hmm, now how will I know if the billing dept will code it under infertility? I do have pcos, but can I request them to code it under that, or will they automatically know to do so once they call to confirm my benefits? If it makes any difference, I will be seeing a new RE what accepts my new insurance, so I'm sure they will have to run all of the introductory tests.
You can ask them to code it certain ways. I have done this to ensure things are considered preventative care in the past.
Thanks ladies! I'll see what they say come February
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| Posted 11/5/13 11:38 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Benefit changes- help me interpret this
Posted by PitterPatter11
Posted by MrsM429
Posted by jessnbrian
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
Hmm, now how will I know if the billing dept will code it under infertility? I do have pcos, but can I request them to code it under that, or will they automatically know to do so once they call to confirm my benefits? If it makes any difference, I will be seeing a new RE what accepts my new insurance, so I'm sure they will have to run all of the introductory tests.
You can ask them to code it certain ways. I have done this to ensure things are considered preventative care in the past.
Exactly this - tell them that you have coverage as long as the diagnosis code is NOT infertility.
FYI - I manage a medical office, and I've been in HC for 10+ years.
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| Posted 11/5/13 12:05 PM |
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MrsM429
Mama x2 <3
Member since 12/10 4946 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by jessnbrian
Posted by PitterPatter11
Posted by MrsM429
Posted by jessnbrian
Basically if they are putting ANYTHING under an "infertility" diagnosis, then it won't be covered, BUT if they use something else, like endo or pcos, then it will be covered.
Hmm, now how will I know if the billing dept will code it under infertility? I do have pcos, but can I request them to code it under that, or will they automatically know to do so once they call to confirm my benefits? If it makes any difference, I will be seeing a new RE what accepts my new insurance, so I'm sure they will have to run all of the introductory tests.
You can ask them to code it certain ways. I have done this to ensure things are considered preventative care in the past.
Exactly this - tell them that you have coverage as long as the diagnosis code is NOT infertility.
FYI - I manage a medical office, and I've been in HC for 10+ years.
I knew there was one insurance expert on here! Thanks!!
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| Posted 11/5/13 1:02 PM |
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hope123
LIF Adult
Member since 2/08 1097 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by MrsM429
We just received the new benefit package for our insurance through DH's employer. Good news is we have a well known and widely accept insurance company (before we had humana and nobody accepted it lol). Of course Infertility services are strictly excluded, but it does say this
"Any and all testing up to the diagnoses of infertility will be covered under regular routine exam benefit"
Do any of you insurance experts know if this means that any testing such as the HSG would be covered? I can not call to confirm until we are an active member, and that will not be effective until Jan 1st.
In my experience, the billing department at any established infertility clinic tries not to use infertility codes unless they really have to. For me hsg and laparoscopy were not billed under infertility. GL!
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| Posted 11/5/13 2:16 PM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by hope123
Posted by MrsM429
We just received the new benefit package for our insurance through DH's employer. Good news is we have a well known and widely accept insurance company (before we had humana and nobody accepted it lol). Of course Infertility services are strictly excluded, but it does say this
"Any and all testing up to the diagnoses of infertility will be covered under regular routine exam benefit"
Do any of you insurance experts know if this means that any testing such as the HSG would be covered? I can not call to confirm until we are an active member, and that will not be effective until Jan 1st.
In my experience, the billing department at any established infertility clinic tries not to use infertility codes unless they really have to. For me hsg and laparoscopy were not billed under infertility. GL!
ITA with this. Testing should never be considered infertility treatment and most RE billing depts know this. Plus, at least with my RE, the billing dept called my insurance ahead of time to find out what was covered.
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| Posted 11/5/13 3:41 PM |
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Ligirl12345
LIF Infant
Member since 10/13 91 total posts
Name:
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Benefit changes- help me interpret this
I have Magnacare, but our policy says the exact same thing, and NS LIJ seemed to navigate it well.
All of my visits, sonograms, were covered with $30 copay. Semen analysis (because it was testing) was covered. HSG was also, but required prior authorization by docs office. Fertility meds and IUIs were not so I paid oop for clomid. Funny thing was, Ovidrel was not covered by my prescription insurance so Dr. Mullin always gave me the trigger shot in the office- paid $30 copay for office visit, and nothing for the meds, bc however they billed it, the health insurance paid for it. Saved me a little money.
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| Posted 11/6/13 11:46 AM |
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MrsM429
Mama x2 <3
Member since 12/10 4946 total posts
Name:
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Re: Benefit changes- help me interpret this
Posted by Ligirl12345
I have Magnacare, but our policy says the exact same thing, and NS LIJ seemed to navigate it well.
All of my visits, sonograms, were covered with $30 copay. Semen analysis (because it was testing) was covered. HSG was also, but required prior authorization by docs office. Fertility meds and IUIs were not so I paid oop for clomid. Funny thing was, Ovidrel was not covered by my prescription insurance so Dr. Mullin always gave me the trigger shot in the office- paid $30 copay for office visit, and nothing for the meds, bc however they billed it, the health insurance paid for it. Saved me a little money.
I am really hoping this is what it means because this will help out tremendously. It's driving me crazy I can't call to find out now, I am so impatient!
Thanks
Message edited 11/6/2013 12:24:26 PM.
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| Posted 11/6/13 12:24 PM |
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Ligirl12345
LIF Infant
Member since 10/13 91 total posts
Name:
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Re: Benefit changes- help me interpret this
Good luck! Every little bit helps! We did 6 IUI cycles self pay, but now we have to move on to IVF. I'm applying for jobs with infertility coverage now..... It really adds up!
You RE office should also call and confirm everything before you really get started.
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| Posted 11/6/13 4:53 PM |
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