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MrsM84
LIF Adult
Member since 2/13 2352 total posts
Name:
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Letter from Insurance Company?
Hi, ladies. Today I came home to a letter from our insurance company (Empire NYSHIP -- I'm a teacher) regarding "Notice of Adverse Determination". They are claiming that some of the bloodwork DH had done at our initial LIIVF visit does not meet the criteria to be considered clinically necessary. Since they aren't covering it, I would be on the hook for about $400. I can appeal this decision and try to fight it to get it covered. Has anyone ever gotten this letter? Did you appeal? I've already called and left a message for my financial case manager at LIIVF. I'm hoping they will know what I am talking about, have dealt with this with other patients iand can provide some kind of paperwork that I can submit with the appeal? Any advice would be greatly appreciated!
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Posted 3/24/14 7:17 PM  |
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MrsGoldie
<3 Miracles can happen <3
Member since 9/12 1700 total posts
Name:
R
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Re: Letter from Insurance Company?
I would definitely speak to someone at the RE office that is responsible for the billing. Perhaps there is another diagnosis code they can bill with. They can also call the insurance co for you.
Good Luck!
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| Posted 3/24/14 8:16 PM |
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ANewDayHasCome
Love multiplies, not divides
Member since 11/12 14481 total posts
Name:
Me
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Letter from Insurance Company?
Smart move to call your financial case manager at LIIVF. They will def handle it and hopefully resolve it. Nothing is ever easy
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| Posted 3/24/14 8:21 PM |
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MrsM0829
... With a cherry on top!!!
Member since 11/09 1332 total posts
Name:
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Letter from Insurance Company?
Good luck! Your financial case manager should be able to help you. A lot of these things come down to coding. Unfortunately, unless the exact right code is used, the insurance company can't/won't figure out that it should be covered.
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| Posted 3/25/14 10:23 AM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: Letter from Insurance Company?
You can appeal anything, though you usually only have a certain number of days to file an appeal.
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| Posted 3/25/14 11:36 AM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Letter from Insurance Company?
LI IVF told me if I ever got a bill for something like that they would take care of it. Did you actually get a bill? You may not. I had sooo much testing done there and never paid out of pocket unless I was told I would in advance (i.e. 100 for genetics, 400 for Sperm fragmentation)
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| Posted 3/25/14 12:46 PM |
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MrsM84
LIF Adult
Member since 2/13 2352 total posts
Name:
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Re: Letter from Insurance Company?
Posted by Michelle1110
LI IVF told me if I ever got a bill for something like that they would take care of it. Did you actually get a bill? You may not. I had sooo much testing done there and never paid out of pocket unless I was told I would in advance (i.e. 100 for genetics, 400 for Sperm fragmentation)
No, no actual bill from the insurance company. Just the letter saying I could appeal the decision. Still waiting for my financial case manager from LIIVF to call me back. Hoping its an easy fix. Thanks for all the help, ladies!
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| Posted 3/25/14 1:24 PM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Re: Letter from Insurance Company?
Posted by MrsM84
Posted by Michelle1110
LI IVF told me if I ever got a bill for something like that they would take care of it. Did you actually get a bill? You may not. I had sooo much testing done there and never paid out of pocket unless I was told I would in advance (i.e. 100 for genetics, 400 for Sperm fragmentation)
No, no actual bill from the insurance company. Just the letter saying I could appeal the decision. Still waiting for my financial case manager from LIIVF to call me back. Hoping its an easy fix. Thanks for all the help, ladies!
I'll bet you you never receive the bill.
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| Posted 3/25/14 4:55 PM |
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