Monday, June 11, 2012

Coding + Insurance = SUCK

My doctor's office decided recently to start coding my visits at "infertility" instead of "premature menopause" or "ovarian failure." For no reason. And even though nothing at all has changed in the past eight months since I've starting seeing them. So I've been getting smacked in the face with some lovely bills from my insurance company. Apparently they cover "infertility" at only 50%, which is better than many places but kind of a shock to the system for the half-dozen visits I made during my May bout with Menopur. When I've not been getting charged a dime beyond my $35 co-pay since November of last year.

I spent a good half hour on the phone with my insurance company this morning trying to figure out why I started getting bill after bill after bill out of nowhere. The lady was a complete biz-natch. She kept saying the same things over and over, despite the fact that she wasn't making any sense. She offered to get the doctor's office on the phone for a three way call and when I enthusiastically said "yes, please, let's do that!", she blew me off entirely.

So I feel a little stuck right now. If I call the doctor's office, do you think there's a chance they would go back and code the bills differently and reissue them to the insurance company? I mean, insurance will cover at 100% anything coded as my CONDITION... which is the same as infertility... so I call foul on this whole effing system.


Any advice?

Also, my little sister (age 25) is going to her OBGYN this Thursday and asked me yesterday what test she should ask for to see if she has premature ovarian failure. There's a higher incidence of the condition within families. I told her to request an AMH level, which I guess gives an indications of how many eggs are left. Since she's on the pill, she won't get a "real" reading on her FSH and estradiol numbers. I'm sure she is freaking out and I'm hoping against hope that the test comes back with a stellar AMH.

Anyway, that's all I have today. I'm still feeling pretty blue. This weekend was better than expected though, with the wedding we attended out of town. I actually had fun! The copious amount of booze might have helped.


  1. That is super sucky! Hopefully you get some answers from your Dr's office soon!

  2. I'd definitely call your doctor's office about that! It should be coded for what you are being treated for (your condition) and not what the hopeful outcome is (a baby). Sorry that insurance was unpleasant to deal with :( When I had a coding issue near the beginning of our journey, I called the business office of my doctor's office (they handle the billing) and made a case for PCOS and endometriosis being women's health issues, not just infertility issues. They resubmitted some of the tests under a different code and it ended up saving us a lot of money. Totally worth the effort of calling insurance and my doctor's office! Good luck!

  3. Yes, they can definitely change the codes. BG went through this years ago for a different problem, but in the end all that was needed was for the doctor's office to submit a different code and the bills went away.

    I would also ask them why they changed how they were billing insurance. It can be a lot easier to work with the doctor than insurance. Good luck!

  4. I'm sorry you had to deal with that insurance lady. Hopefully your doctor can to the required changes and you won't have to pay (as much) out of pocket.

  5. This totally sucks, I am soo angry for you!! Honestly, like you don't have enough on your plate already. I think the only thing you can do is speak to your doctor and complain as loudly as possible. This is a condition (as is general IF not that insurance companies care about that!) and they should be assisting you however they can. thinking of you!