Well, apparently the insurance company wasn't trying to approve my lap at all. Apparently, all that crap was for them to approve the consult I had with the RE in January. Can you freaking believe that?
Sigh.
I finally connected with the surgical coordinator at the clinic. She explained that the RE had not completed the necessary paperwork for them to request the procedures. His notes say something about me deciding whether or not I wanted the procedure done with him or with my OB. The RE didn't want to process the request and run the risk that the insurance company would see it as fertility related rather than pain related (which is totally legit--I do have some freaking painful cycles). His line of thinking was that the OB would be better able to stress the pain angle and get the procedures approved at 100% less the copay of $250. Through the RE, there is a chance that my insurance company might consider the lap/hysteroscopy as fertility related and only cover it at 50%. (I have 50% coverage for diagnostics, IUI's, and IUI medication only. I have 0% coverage for IVF or meds. Got to love CA.)
Tomorrow I have to get a hold of my OB's office and see if they can give me any idea of what they think might happen should they try to process the request. If they think it is going to be the same outcome, I may have to say screw the whole thing. Yes, 50% would be better than nothing, but it still may be too much for us to swing right now.
Nothing is ever easy. Silly me, thinking that there was already an authorization in the works and things might go my way.
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7 comments:
God, how maddening! Good luck getting the approval.
what a pain!!! I hate the BS that insurance companies bring with them!!! I've seriously called 3x on the same topic before I've gotten a clear, legitimate answer. SO ridiculous. I hope the OB approves it and it's 100% covered. That was thoughtful of your RE but man alive he should have communicated that to you or your OB, something.
Ha, I think I know who your insurance company is just based on that crap!! I can tell you if it is who I am thinking, go the OB route, we didn't and got stuck paying over 5 grand for a LAP/Hystero. I really put a dent in our savings account!!
I know waiting is hard, but if it saves you a ton of money, I say go with the OB!! Hang in there sweetie!!
Hugs,
Erica
ugh !
I'm sorry !
I'm sorry Stacie :( It sure does seem unfair. I don't know the laws were that bad in CA. For us here, infertility is covered, but not for us "kind" of people. I get the paying out of pocket business. Do they give you a reduced rate for paying out of pocket?
-C
Oh man just thinking about all that makes my head spin. We have it so much easier up here with our healthcare. I hope it all works out for you without a huge headache.
Hope you get your insurance stuff all figured out. Sounds like a PAIN!
ICLW
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