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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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HOLY CRAP- with update Holy Crap
So I just got home and going through my mail and I see the statement from NSUH about what they have billed my insurance for. The total for this cycle was $24919. I am freaking out!!! I know that my insurance will only pay there customary rate which is a lot less than this and since they accept my insurance they agree to that rate. BUT.... how much lower can it be? I only have a 10K lifetime benefit.
Now I am wondering if I should cancel this cyle and wait until I get my new health insurance, whatever that may be. How can I find out what my plan will pay? Also I am not sure that I had every procedure listed. Like I know I did not have AH and it mentions an embryo co-culture which I was not aware I had.
Ok I am totally freaking out right now. This is absurd.
ETA : If I go over my 10K there is no way I can afford 25K. I knwo I have said I would pay if I had too, but 25K is alot more than I had planned. OMG OMG OMG!!! WTH am I gonna do
Message edited 1/31/2006 9:29:02 AM.
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Posted 1/30/06 6:06 PM  |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: HOLY CRAP
calm down first off. Lemme tell you the insurance will pay a LOT LOT LOT less. Probably less then 10K without a doubt. I know for my IUI's my dr charges $550 or so and we pay $125-$150 so thats an example.
Do you have online access to yoru insurance claims? You need to look each one over.
And stop worrying. I have told you before , so trust me ok.
FM me details if you need help.
Does the bill hold you responsible for anything?
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| Posted 1/30/06 6:15 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP
they all say insurance pending, except for a few that say insurance form submitted and amount due now which totals 3361.00 under patient responsibility. (I think its because there is a caption that says if payment is nnot received from insurance within 30 days they seek payment from me- but I am pretty sure that will go away).
But is this how mcuh they will charge me when I go over my 10K?
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| Posted 1/30/06 6:18 PM |
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sylvester
LIF Infant
Member since 10/05 325 total posts
Name:
Rosanna
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Re: HOLY CRAP
with my insurance i have the 10K limit lifetime also and had 3 ivfs and 5 iui's, and all the sonograms and consults ( i still have some left on my coverage)
What i did was call the insurance company and ask them how much i had left towards infertility coverage and my 10K. They put me on hold for a little while and told me. I don't think they count everything as infertility.
Maybe you could call your insurance company and ask them if they paid that $24,900 claim, what they paid and then ask them how much infertility coverage you have left. Maybe you could find this out tomorrow.
Good luck.
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| Posted 1/30/06 6:20 PM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: HOLY CRAP
Posted by rose825
they all say insurance pending, except for a few that say insurance form submitted and amount due now which totals 3361.00 under patient responsibility. (I think its because there is a caption that says if payment is nnot received from insurance within 30 days they seek payment from me- but I am pretty sure that will go away).
But is this how mcuh they will charge me when I go over my 10K?
lemme fm you
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| Posted 1/30/06 6:21 PM |
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LisaW
Time for me to FLY!
Member since 5/05 13199 total posts
Name:
Did I ever tell you that I hate people?
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Re: HOLY CRAP
Back when I had coverage, I had a 10k limit too.
My insurance co at the time (Oxford) told me that only ER and ET goes toward that 10k limit b/c that is considered advanced fertility treatment. Plus, they are added at the agreed rate. The rest (sonos, b/w, etc) gets billed under infertilty where there was no limit.
I did 2 IVF's under that insurance and only hit about 3k of the limit.
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| Posted 1/30/06 6:27 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP
thank you thank you thank you. Lisa I think this is the same plan I have. When I was at RSNY they told me that the IUI's didnt even come out of that 10K. I so hope this is the case. I am just annoyed that I get this now when I cant do anything until tomorrow.
DH just got home and I NEVER keep secrets from him. But if he sees this he is going to lose it big time and I am hoping tomorrow I will have it figured out.
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| Posted 1/30/06 6:31 PM |
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LisaW
Time for me to FLY!
Member since 5/05 13199 total posts
Name:
Did I ever tell you that I hate people?
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Re: HOLY CRAP
Pauline, is your RE out of network? When I went to Kreiner I had to pay 20%.
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| Posted 1/30/06 6:35 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP
nope, in network
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| Posted 1/30/06 7:48 PM |
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Re: HOLY CRAP
If you know what insurance you are switching to, call them and ask what they cover. I did this last year when I needed new insurance to cover the RE.
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| Posted 1/30/06 7:51 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP
Another HOLY CRAP, but this one I am much calmer about. So I called my insurance company to find out what came out of basic and what came out of advanced(my 10K limit). About 5400 was basic and the other 17K advanced. Then I asked her to tell me their rate for the procedure codes and although I knew their rate was less than what would be billed I am SHOCKED by the difference. I didnt go through all the codes but most. Here is an exmaple: ET billed 1500 insurance pays 292.05. For a group of claims totalling 10,700 they will pay 1158.87.
I am appalled and I think I am more mad at the providers that bill these enormous amounts when they know they will accept so much less. People who are self pay... do they have to pay these higher rates. This is absurd.
Thanks for keeping me sane yesterday. I owe the ability to sleep last night to you girls!
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| Posted 1/31/06 9:28 AM |
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redstar
Delay is not denial
Member since 5/05 2220 total posts
Name:
Michelle
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Re: HOLY CRAP- with update Holy Crap
I am so sorry, Pauline. This truly hits every aspect of our lives, emotional, physical and even financial. I hope this resolves itself !!!
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| Posted 1/31/06 9:36 AM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP- with update Holy Crap
It does seem to be resolving itself. Thanks
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| Posted 1/31/06 9:51 AM |
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Re: HOLY CRAP- with update Holy Crap
Posted by rose825
Another HOLY CRAP, but this one I am much calmer about. So I called my insurance company to find out what came out of basic and what came out of advanced(my 10K limit). About 5400 was basic and the other 17K advanced. Then I asked her to tell me their rate for the procedure codes and although I knew their rate was less than what would be billed I am SHOCKED by the difference. I didnt go through all the codes but most. Here is an exmaple: ET billed 1500 insurance pays 292.05. For a group of claims totalling 10,700 they will pay 1158.87.
I am appalled and I think I am more mad at the providers that bill these enormous amounts when they know they will accept so much less. People who are self pay... do they have to pay these higher rates. This is absurd.
Thanks for keeping me sane yesterday. I owe the ability to sleep last night to you girls!
I have noticed this with other procedures when I got my statements from my ins. (I was hospitalized a few times because of my asthma.) It's absurd.
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| Posted 1/31/06 10:14 AM |
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karacg
Babygirl is 4!
Member since 5/05 17076 total posts
Name:
Kara®
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Re: HOLY CRAP- with update Holy Crap
Ahhh Pauline I am so sorry, I know what you are going through.
To give you an idea....my insurance pays $3,000 maximum. The rest is out of pocket. For my IFV - which we haven't even done yet - the cost is $16,000 -- $3,000 insurance and the rest out of pocket. This includes all the office visits, sonograms, blood work, etc. If you FM me a fax number, I can send you the break-down from my Dr. just to give you an idea...
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| Posted 1/31/06 10:37 AM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP- with update Holy Crap
Kara if your insurance works the same way as mine your 3K will go farther than you think. Even though the insurance plans pay less the doctors agree to accept that as full payment (if in network). It seems that the contracted rate is about 20% of what they bill. So if your 3K is what your insurance company pays, then it should cover about 15K of servces, leaving you with much less out of pocket expense. If it works the same way you should be able to get a full cyle out of it.
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| Posted 1/31/06 10:50 AM |
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karacg
Babygirl is 4!
Member since 5/05 17076 total posts
Name:
Kara®
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Re: HOLY CRAP- with update Holy Crap
HA --- Nope. Bill was $16,000 knowing we only get $3,000 from insurance. So we have paid $13,000 out of pocket..... already paid for...
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| Posted 1/31/06 11:33 AM |
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Donna
1 year already!!
Member since 5/05 3360 total posts
Name:
Donna
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Re: HOLY CRAP- with update Holy Crap
Posted by karacg
HA --- Nope. Bill was $16,000 knowing we only get $3,000 from insurance. So we have paid $13,000 out of pocket..... already paid for...
Kara - you should be able to put in a claim for the dr visits, blood work and sonos. I paid out of pocket too and was able to get some $$ back, less than 1/2 but it was still something
Def. try it and see what happens
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| Posted 1/31/06 11:48 AM |
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Donna
1 year already!!
Member since 5/05 3360 total posts
Name:
Donna
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Re: HOLY CRAP- with update Holy Crap
Pauline, I'm glad this situation is getting resolved.
Good luck!
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| Posted 1/31/06 11:49 AM |
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michele31
LIF Adult
Member since 5/05 3372 total posts
Name:
Michele
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Re: HOLY CRAP- with update Holy Crap
You may want to call the new insurance company. Many don't even cover any advanced treatments. Can you speak to your RE's office and get a full explaination of what is expected of you financially now that you have seen this.
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| Posted 1/31/06 8:04 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: HOLY CRAP- with update Holy Crap
My new insurance will cover all the blood and sonos and I will have a 20% copay for all the advanced procedures (IVF).
kara-is your RE out of network. If they are in network they should bill your insurance first, then you pay whats left.
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| Posted 1/31/06 9:49 PM |
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