Tuesday, October 18, 2005

Windfall!

Insurance is a pain in the tuckus (or however you spell that).

When we first were told, in January, that we would need IF treatment, the financial coordinator at the clinic called my current (henceforth known as primary) insurance (from M's company, based in CA), and said that they would cover only testing and diagnosis, not IF treatment. She then told us how much the various components of an IUI cycle would cost - about $1K for the drugs, ~$333 for the ultrasounds, and $461 for the IUI itself.

Since we live in the great state of MA, where infertility coverage is mandated (if you have in-state insurance), I looked around to get a supplemental policy, and found one for $300 a month. It would cover 80% of the treatment costs, not including the drugs. With that in place, each cycle would end up costing us only about 50% of the quoted price (FC suggested it would probably be around $2500/cycle, ended up being closer to $4K), so I thought it was a good plan.

After that was all squared away, I called and ordered the medications, and put the first lot through the insurance - figured you never know, they might cover it, right? A few days later, heard back from the pharmacy that the coverage was denied. So rather than be a pain for the pharmacy, I paid for the drugs for the rest of my cycles myself.

Then we started getting the explanation of benefits (EOB) from the supplemental insurance, I was really glad I'd done it - the coordinator neglected to tell me about the costs for the blood tests, which actually were higher than the ultrasound cost (which totally surprised me - $364 for an e2 test?). So all in all, this extra insurance ended up cutting my cost per cycle by just about 50%, what I had estimated.

Then yesterday I got an EOB from my primary insurance. You could have bowled me over with a feather - they listed about eight of the e2 blood tests, and covered everything that the supplemental insurance hadn't covered, i.e. the 20% I had thought I would have to pay. Score!

After that, I went and looked at their website, where you can see claims, and if they've been processed, how much they've paid out.

Well. Turns out that they covered all of the 20% that the supplemental insurance didn't cover.

AND.

Are you ready for this?

They also PAID FOR THE DRUGS!!!!

For the first cycle, that was submitted to them (I have no idea why the pharmacy told me it was denied). HUGE score. So now I'm going to submit the receipts for the drugs for the other cycles, and hopefully get reimbursed for those as well. Woo-hoo!

But, had I not had the supplementary insurance, my primary insurance would apparently have covered all the blood tests and ultrasounds - the only thing they wouldn't cover is the actual insemination. So I'm super pissed at the financial coordinator from my clinic now. If she'd actually done her job, and asked about the individual components of my primary insurance coverage, they should have told her that the bloodwork and scans would be covered. So we actually ended up spending more money on the supplementary insurance than we would have if I hadn't gone to the trouble of getting it. You can bet I'm going to make a stinky about it.

But I can't be that pissed, because we just got a $7K windfall!!!

10 comments:

Jenn said...

WOW! That's great! I had the same thing with my old insurance that would only pay 50% for infertility. For a lot of blood work and even most ultrasounds they paid it all. For some reason they didn't "count" as infertiity related.

thalia said...

That's great news. What are you going to do with the $7K?

pixi said...

I'm glad it worked out so well. Still it bugs me that you had to go through all that red tape. This IF business is tough enough without the added hassle, you know?

I guess it's good that you know more about the insurance system, now. Your post has taught me not to accept "no" if that's the first response I get.

k #2 said...

AWESOME!!! We ended up scouring through my DH's plans and choosing to add his. Between the two, I have milked them both for all it is worth. It pays to read the small print sometimes. How great MA has mandatory coverage!

I agree with pixi. I never take no for an answer with insurance. I think sometimes they say no assuming you won't question it.

I hope this is a good sign!

elle said...

Holy crap! That is awesome! I think it's a sign of things to come. You & DH should treat yourselves!

Kim said...

Awesome!

April said...

Sweet jumping jesus on a pogo stick - that's FANTASTIC.

Woo!!!!

Katie (WannaBeMom) said...

Seriously, that is seriously awesome. I would be floored... Our insurance pays for NOTHING but the drugs, but our loving pharmacist likes to tell us how much they would cost without insurance every time we're there. (Which is a lot!) It makes me feel a little better...

But I am in total agreement with Elle-- GO OUT!

T said...

That's excellent! Just be careful - sometimes they will not pay once they find out it's related to infertility treatments.

Ova Girl said...

Great news Nico, yay you!

And...have just caught up with your posts, fingers crossed for the IUIs. May that stormed castle produce a little prince or princess (or varying combinations of both!)