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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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UGH-stupid UHC
I called them weeks ago to have someone explain the IF benefit exactly. They said it could take 10 days for someone to respond. Um..Ok..
So today, 4 weeks later I get a voice mail saying that my IF benefit is $12K.
Ok, first, that's wrong, it's $15k and I wanted details. Exactly what is considered IF and what is not..etc..
Now I have to call and open up a can of whoopazz on these people.
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Posted 9/18/08 3:18 PM  |
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Angel321
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Member since 4/08 15553 total posts
Name:
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Re: UGH-stupid UHC
I have a letter from my RE that they asked me to send to my health insurance place. If it helps - i can fax it to you!!!
Maybe you can send to them or fax to them!
ETA: I have UHC as well... It's a letter that asks them to outline for you EXACTLY what they cover.
Message edited 9/18/2008 3:27:29 PM.
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| Posted 9/18/08 3:25 PM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: UGH-stupid UHC
that would be great. Can you fax it? I will FM you with the number.
They are real idiots over there. It took them 4 weeks to tell me something that was wrong.
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| Posted 9/18/08 3:27 PM |
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maybeamommy
Blessed beyond belief
Member since 10/07 17048 total posts
Name:
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Re: UGH-stupid UHC
I called my insurance company and asked them to send my Schedule of Benefits.
They send me a three-page printout of my infertility coverage.
Be careful when looking at someone else's because every company will have differet things that they cover - even with the same insurance provider.
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| Posted 9/18/08 3:34 PM |
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Angel321
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Member since 4/08 15553 total posts
Name:
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Re: UGH-stupid UHC
Posted by maybeamommy
I called my insurance company and asked them to send my Schedule of Benefits.
They send me a three-page printout of my infertility coverage.
Be careful when looking at someone else's because every company will have differet things that they cover - even with the same insurance provider.
Hang on - i'll type it out quick...
it's not a letter talking about MY benefits - it's asking for a written doc from the insurance company about POINT BLANK THINGS....meaning - how much is covered for this - what about that...
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| Posted 9/18/08 3:39 PM |
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Angel321
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Member since 4/08 15553 total posts
Name:
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Re: UGH-stupid UHC
To Whom it May Concern -
Attached, please find an itemized listing of services to be rendered. I would appreciate it if you could provide me with detailed benefit information about these services. Additionally, please advise if medical criteria has been met for infertility coverage.
What is the annual deductible, coinsurance and out of pocket maximums for both in and out of network services? To date, has the deductible, coinsurance and out of pocket maximum been met? If not, how much remains to be satisfied?
How many cycles of In Vitro Fertilization (IVF) are covered?
Is Intracytoplasmic Sperm Injection (ICSI) an elegible benefit? The cost is $2500 and the CPT-4 code is 89280 for less than 10 oocytes and 89281 for more than 10 oocytes.
Is embryo cryopreservation a covered expense? The cost is $1000.00 and the CPT-4 code is 89258. Is a separate storage charge after the initial 12 months covered?
Are Frozen Embryo Transfers covered? If so, is there a limit on number of attempts?
is there a dollar maximum associated with my infertility/IVF coverage? If so, what services will be counted against my dollar max? Are medications included in the dollar maximum? To date how much of dollar max has been used?
The primary diagnosis is (THIS IS BLANK). Based on the diagnosis, tests performed and or treatments rendered thus far, the next viable treatement is In Vitro Fertilization. Please respond in writing and address ALL (bold, underlined) questions above based on my benefit plan. Please be advised that as a member of (insert insurance name here) I am entitled to this information in writing.
Sincerely,
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| Posted 9/18/08 3:43 PM |
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MrsRbk
<3 <3 <3 <3
Member since 1/06 19197 total posts
Name:
Michelle
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Re: UGH-stupid UHC
Jess - Just as an FYI... they include this in the financial packet they give you at RMA - but my financial person said I didn't have to do anything with it. RMA will do EVERYTHING! Not once did I have to deal with my insurance company!
They will make all the phone calls to your insurance carrier and make sure how they treat you is covered. If something is not covered, they will call you and let you know
Message edited 9/18/2008 3:48:17 PM.
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| Posted 9/18/08 3:47 PM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: UGH-stupid UHC
I don't know how helpful this will be. This doctor is out of network. I have out of network benefits. If they cover 70% of benefits (I imagine it's 70% of r&c) then what is my liability?
Say the IVF cycle costs $12K at Cornell. I submit it and they pay 70% $8400? That's not even R&C..that's just a flat 70% i'm figuring.
So I have a $15K benefit. Does that mean that if they cover $8400 of the cycle..My out of pocket for each of the first two cycles (hoping it won't come to that but it's reality) will be 7200?. That's assuming is not based on R&C. I don't even know if R&C is a factor with IVF.
make sense or am I just babbling?
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| Posted 9/18/08 3:54 PM |
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Angel321
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Member since 4/08 15553 total posts
Name:
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Re: UGH-stupid UHC
Posted by MrsRbk
Jess - Just as an FYI... they include this in the financial packet they give you at RMA - but my financial person said I didn't have to do anything with it. RMA will do EVERYTHING! Not once did I have to deal with my insurance company!
They will make all the phone calls to your insurance carrier and make sure how they treat you is covered. If something is not covered, they will call you and let you know
They told me to send that to them... I have in writing what my benefits are (on my UHC website) - but one thing there was a question...so she told me to send that in.. I didn't think i HAD to...so i'm talking with someone in HR about it...
I thought it might be helpful for Blue.. 
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| Posted 9/18/08 4:00 PM |
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Angel321
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Member since 4/08 15553 total posts
Name:
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Re: UGH-stupid UHC
Posted by Blu-ize
I don't know how helpful this will be. This doctor is out of network. I have out of network benefits. If they cover 70% of benefits (I imagine it's 70% of r&c) then what is my liability?
Say the IVF cycle costs $12K at Cornell. I submit it and they pay 70% $8400? That's not even R&C..that's just a flat 70% i'm figuring.
So I have a $15K benefit. Does that mean that if they cover $8400 of the cycle..My out of pocket for each of the first two cycles (hoping it won't come to that but it's reality) will be 7200?. That's assuming is not based on R&C. I don't even know if R&C is a factor with IVF.
make sense or am I just babbling?
It makes sense - but my main concern is what the doc charges and what the insurance company pays are NOT the same thing. They always have to work out a lower number, etc... so i'm not sure how that would affect you - being out of network.
For example - my RE charged let's say $900 for my visit on Tuesday. That's what they billed them for. I was talking to a nurse friend of mine and she said the doc's office MIGHT get paid $450 and that's it...
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| Posted 9/18/08 4:14 PM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: UGH-stupid UHC
Cornell just takes your credit card and charges you. Then you have to submit it.
So what I'm questioning is how much will they pay? 70% or 70% of R&C.
I don't know if there are R&C guidelines for IVF. It's not a regulated medical procedure. That's why so many insurance plans don't cover it. It's not standardized.
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| Posted 9/18/08 5:09 PM |
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rose825
Best Friends
Member since 6/05 10228 total posts
Name:
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Re: UGH-stupid UHC
Posted by Blu-ize
Cornell just takes your credit card and charges you. Then you have to submit it.
So what I'm questioning is how much will they pay? 70% or 70% of R&C.
I don't know if there are R&C guidelines for IVF. It's not a regulated medical procedure. That's why so many insurance plans don't cover it. It's not standardized.
usually when they say it 70% , it means 70% of R &C. So if Cornell charges you $20,000, but UHC R&C is $10,000, then they will only reimburse you $7,000. You will have paid $13,000 OOP, but you will get that $7,000 for 2 cycles.
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| Posted 9/19/08 7:06 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: UGH-stupid UHC
I wonder if everything will be classified as IF. Say a beta or stimming blood tests and sonos.
That's the key, finding out the diagnosis codes for everything.
I have a call into the billing office to find this out.
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| Posted 9/19/08 9:03 AM |
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mom2mgn
Love my family
Member since 2/08 2267 total posts
Name:
Christine
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Re: UGH-stupid UHC
Posted by Blu-ize
I wonder if everything will be classified as IF. Say a beta or stimming blood tests and sonos.
That's the key, finding out the diagnosis codes for everything.
I have a call into the billing office to find this out.
Yep, this is a whole other issue. I know most of my monitoring wasn't classified as IVF and didn't count towards my IVF maximum. Apparently, my clinic codes it as monitoring for OHSS. The only things that went against my IVF maximum were the actual retrieval, the anesthesia for the retrieval, the lab fees, ICSI, assisted hatching, transfer and freezing. The beta, blood work and monitoring weren't included.
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| Posted 9/19/08 9:25 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: UGH-stupid UHC
yes, that's what I hear.
I have a call into them about the diagnosis code for the office visit. It was classified for IF. Come on, cut me a break. The office visit was IF!???
So I'm waiting for their answer.
They should be able to work with me without breaking any laws.
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| Posted 9/19/08 9:53 AM |
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