I need advice.

[hopefulinwv]

My doctor called me out of the blue last week and said that they told my insurance i was infertile so i will have to pay for everything out of pocket from now on. My DH called our insurance company to see what the coverage for "infertility" is. The insurance claims that my doctor did call them one time but it was just a normal call to make sure i was covered under DH's insurance. They said there was no mention of "infertility" and that if i was infertile they still cover blood tests & etc just not the actual treatment (surgeries, fertility drugs,etc) They said the only way i will have a problem is if the doctor codes it as treatment when it's not. I notified my doctor of this and they are refusing to code it as anything but infertility even though all i had done was one blood test. I have had a couple of people tell me that his rates are reasonable compared to what they had to pay. Should i stay with him suck it up and pay it or find another doctor who may code it correctly? I was sent this list of fees.

https://i1328.photobucket.com/albums/w537/hopefulinwv/82c9ea00-a607-4d74-bded-e577a98ebb7a_zps39f6ed76.jpg

 

[wantbump]

I can't really help but didn't want to rnr. But I know doctors will have to code and insurance companies will always take steps according to the codes sent by doctors office.

 

[ByHisGrace08]

Hello! I am so sorry to hear this I have also had trouble with insurance and Dr.'s.

First of all how did the Dr. diagnose you as infertile? This not a diagnose that is easily reached and cant be determined just through one test.

Also, as with any diagnose it should be discussed with the patient before it is recorded in any medical record or insurance record.

I would personally steer clear of this Dr. The diagnose "Infertile" could have major repercussions. Personally I was told by my insurance company once that diagnose is in your record they don't have to pay for anything related to women's services (yearly exam or birth control) Luckily I have a Dr. who is able to play the insurance game and codes my visits as trying to restore cycles.

 

[hopefulinwv]

Hello! I am so sorry to hear this I have also had trouble with insurance and Dr.'s.

First of all how did the Dr. diagnose you as infertile? This not a diagnose that is easily reached and cant be determined just through one test.

Also, as with any diagnose it should be discussed with the patient before it is recorded in any medical record or insurance record.

I would personally steer clear of this Dr. The diagnose "Infertile" could have major repercussions. Personally I was told by my insurance company once that diagnose is in your record they don't have to pay for anything related to women's services (yearly exam or birth control) Luckily I have a Dr. who is able to play the insurance game and codes my visits as trying to restore cycles.

Off of one blood test. That's all they ran. He didn't even use the word "infertile" to me. They called me out of the blue saying i'd have to pay everything out of pocket because my insurance didn't cover infertility. It hit like a ton of bricks.

 

[ByHisGrace08]

Hello!

That is a tough place to be in for sure. Do you really love this Dr. or would you be willing to check out other Dr.s and switch to someone new? I would also call insurance again and make sure they haven't labeled you as infertile. If they have you can appeal it. I am so sorry this is happening to you but you can fight it!!!!

Blessings & Babydust,

 

[hopefulinwv]

Hello!

That is a tough place to be in for sure. Do you really love this Dr. or would you be willing to check out other Dr.s and switch to someone new? I would also call insurance again and make sure they haven't labeled you as infertile. If they have you can appeal it. I am so sorry this is happening to you but you can fight it!!!!

Blessings & Babydust,

My dh talked to them. they refused to even run anything to see if they'd pay (which we know they will) so DH told them they need to call the insurance back and gave them the right number. They just called and guess what?!?! I am covered. They were the wrong ones!! I love proving people wrong but now i am scared of what else they may try to pull. I do like the doctor a lot i just don't want billing trying to screw me over again

Blessings and baby dust to you too!

 

[hunni12]

I am happy it all got sorted out hun, if they try it again I would def be looking into another doctor

 

[hopefulinwv]

Thank you. I definitely will be watching them closely now.