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I think my insurance company just suggested I commit medical fraud
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Bxgell2
Perfection
Member since 5/05 16438 total posts
Name:
Beth
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I think my insurance company just suggested I commit medical fraud
I decided to call my insurance (federal blue cross blue shield) - I know IVF isn't covered, or, the procedure itself that is, so I wanted to get confirmation that lab tests, xrays, ultrasounds, etc, leading up to the IVF procedure itself, were also excluded.
The guy told me it all depends on how my RE reports it. If she submits claims for it as just IVF it won't get covered, but if she submits a claim for it as a regular diagnosis, as a procedure or lab that is required due to a "medical condition", it WILL be covered.
i asked, isn't that medical fraud for my RE to report it as necessary for a medical condition when it's really just for the IVF.
He said no.
But, that's not what my RE said. Last time I talked to her, she said as long as it's for IVF it isn't covered and if she submits it as a regular claim, it's medical fraud.
I'm confused. Does this make ANY sense??
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Posted 7/22/08 1:22 PM  |
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LaurenExp
Waiting patiently for baby sis
Member since 8/06 11613 total posts
Name:
L-Diddy EDD 11/11/11 :)
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Re: I think my insurance company just suggested I commit medical fraud
You could be having this same diagnostic testing for IUIs, which are covered, right? So really...you diagnosis should just be IF and not IVF...KWIM?
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| Posted 7/22/08 2:01 PM |
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Donna
1 year already!!
Member since 5/05 3360 total posts
Name:
Donna
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Re: I think my insurance company just suggested I commit medical fraud
Posted by LaurenExp
You could be having this same diagnostic testing for IUIs, which are covered, right? So really...you diagnosis should just be IF and not IVF...KWIM?
exactly. My insurance does not cover IVF but I've had all procedures (HSG, cannulation, etc), b/w, testing, sonos, etc covered.
even during my cycle, while the actual procedure wasn't covered, the meds were as were all office procedures.
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| Posted 7/22/08 2:06 PM |
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BA2008
Need to find some hope!
Member since 2/08 2485 total posts
Name:
Beth -Ann
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Re: I think my insurance company just suggested I commit medical fraud
Yeah. I don't have IVF but my meds were covered. And I was having a problem with coverage for my anesthesiologist from the IVF cycles. Get this...they covered the first one no problem. the 2nd one they did not cover. SO, I get huffy with them only to learn that they should not have accepted the first one. which the nice guy on the phone told me he would just ignore and keep it the way it is. So, now I have to do something to get the other one covered.
But, I think that I am also going to try to get a breakdown billing report from my current RE to get covered for anything on my IVF cycles. Its worth trying at least.
The question is, will your RE submit it correctly?
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| Posted 7/22/08 2:22 PM |
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MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: I think my insurance company just suggested I commit medical fraud
Posted by Donna
Posted by LaurenExp
You could be having this same diagnostic testing for IUIs, which are covered, right? So really...you diagnosis should just be IF and not IVF...KWIM?
exactly. My insurance does not cover IVF but I've had all procedures (HSG, cannulation, etc), b/w, testing, sonos, etc covered.
even during my cycle, while the actual procedure wasn't covered, the meds were as were all office procedures.
My insurance doesn't cover IVF at all, and we did the grant- but suprisingly my insurance covered my meds initially.... so we were told we'd be getting some $ back like 4 months after our IVF cycle over... not sure how they were covered, I guess it really is all in the coding. They had to order me more menopur and that was not covered (the refill) which I don't understand, but again, I guess it was the coding.
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| Posted 7/22/08 5:03 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: I think my insurance company just suggested I commit medical fraud
dont forget if you are on stims, you medically require monitoring for OHSS
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| Posted 7/22/08 5:11 PM |
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hope316
LIF Adult
Member since 8/07 1085 total posts
Name:
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Re: I think my insurance company just suggested I commit medical fraud
I'm in the same boat they say that labs estradiol are nover covered for ivf but covered for iui etc.....
doesnt make sense!
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| Posted 7/23/08 4:09 PM |
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