We finished the last of our five unsuccessful rounds of IVF with our local clinic almost three years ago in May of 2005. That's not counting the two IUIs we did before my RE convinced me I was such a "high responder" that it made more sense to move to IVF and not waste time on IUI. Five. Unsuccessful. Two of those with PGD that showed horribly messed up embryos (we're talking five of one chromosome, none of another, etc.) After which my RE told me the chances of me having a biological child with my own eggs was like "finding a needle in a haystack." And then proceeded to tell me that the Big Clinic we planned to go to for a second opinion (just to put our minds at rest that we did everything possible) would never accept us because I was too much of a "risk factor" to their statistics, given my horrible track record (Five. Unsuccessful. Remember?)
After we had success at Big Clinic, I tried not to dwell on the fact that we "wasted" SO much money at the local clinic before we went to Big Clinic. I justified it by telling myself that without the benefit of the hindsight of those five cycles, my RE at Big Clinic might not have been able to come up with the exact right protocol on the first shot. But it still made me shudder when I added up, mentally (and on our tax returns for purposes of medical expense deductions) how much we had spent. We were lucky enough to have some insurance coverage- 50% for most cycles- but with PGD and ICSI (not covered by insurance) we were easily out upwards of $50,000.
Last week in the mail I received a bill for $2,000 for a cycle from MARCH 2005. It's now April 2008. Trying to decipher the transactions on the bill, all I could make out was that even though the original charges were incurred in 3/05, something didn't happen with our insurance (an "adjustment"-- I am guessing that is their deduction for the agreed-upon price the clinic can charge according to my insurance company?) until March of this year.
My first reaction was rage. How can they send us a bill for a cycle from THREE YEARS AGO when we had checked numerous times after we left the clinic to make sure we had paid everything that was due? Luckily, I am pretty anally organized and had the paperwork on hand from that cycle, including an itemized statement showing that we paid a 50% co-pay of $3250 in addition to $5000 for PGD and $2000 for ICSI. Just looking at that statement- and all of the other statements in that pile of paperwork- made me want to throw up. If we had just a fraction of that money back today, it would seem like a fortune. At the time, I was working in a well-paid job and we could afford it, but now that I'm at home with the kids, money like that seems like an outrageous amount.
So of course I then spent the next several days gathering information, trying to get answers from the billing office, my clinic, and the insurance company. Each pointed to the other one-- "we don't know why you owe that amount-- check with [your insurance company, the billing office, the IVF clinic]." And it didn't help that the billing manager at the clinic ignored my phone calls until I sent an email, which I copied myself on in case I had to go to the doctor, which was my next step. She must have felt a little more accountable for a request that was in writing vs. my voice mails (no documentation) because she got back to me PDQ after I sent the first email.
From what I can tell (and this whole thing is so complicated and convoluted I really don't know which way is up any longer), they are claiming that the 50% co-pay the clinic charged us at the outset was not enough to cover the costs not covered by insurance, and that they did not get the final word from our insurance as to what it would cover until last month due to a lot of back-and-forth getting billing codes correct, etc. This is despite the fact that the policy of the clinic was to collect the full co-payment up front (after verifying with insurance how much I would owe) before the cycle. And despite the fact that we paid $10,250 for the cycle anyway. (OK, that makes me want to gag again. That was for ONE of our SIX cycles).
If anyone out there knows anything about medical billing and insurance reimbursement, do you have any insight into this? My response in the end was to mail the billing office a copy of the statement from our cycle- which showed that we paid the $3250 co-pay which was supposed to cover, among other things, the two services they are now billing for (retrieval and culture/fertilization) and requested a full explanation of why that co-pay did not cover what they are billing us for now and why it has taken three years for this charge to come to light. I want to put the burden on their shoulders to unravel this complicated web of insurance and medical charges because despite the fact I am an intelligent person (I'm actually an attorney- go figure...) I have NO idea why we're being charged for this now, or even if they can bring this up three years after the service. I have a sick feeling we're going to end up having to pay this in the end- to a clinic that basically kicked us out to the curb- but I'll fight it tooth and nail before we do.
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3 comments:
This is 10 kinds of awful. And makes me freaked out about what could crawl out of the mailbox.
I've fought plenty of IF insurance battles, but don't know how helpful I can be.
Get a copy of your insurance policy from that year. Find the IF benefits section. (And check to see if there is a limitation.)
Pull your insurance statements for this charge. Generally they show what the clinic billed and what the clinic was paid. Call the insurance company if you need a copy of it.
IF your copay is NOT 50% of what they did bill to insurance, you might be out of luck and have to pay. But you should still write a letter, with a copy of your insurance policy, and better still if you can also find in writing the clinic policy that says they determine in advance the copay. If it was their (the clinic's)mistake, point it out. Hopefully they'll cancel the charges.
If it IS 50% of what was billed, then it's a problem between your insurance company and your clinic, and your letter should focus on that. Your copay was 50% of billed, as per your policy (again, enclosing that portion of the policy) and therefore you are not responsible for any further charges. Then call your insurance, get a case manager, and submit the same information to them. Make them see it's a violation of the clinic/insurance company agreement - NOT something you need to pay.
It might be a lot of work. But damn it, we pay for insurance and they really need to cover what they're supposed to cover!
The other thing you want to do is look closely at your insurance policy. Many times there is written language that says that if the provider (in this case, the RE office) is contracted with your insurance, then you should not be responsible for any amount that the provider is trying to "balance-bill" you.
In other words, if the contract that the RE signed with the insurance company says that the insurance will only pay for X amount, then by agreeing to this amount, the RE cannot charge you for the remaining amount that the insurance did not pay.
This is speaking from a nurse that works on the HMO insurance end of the spectrum.
And yes ... I agree with the above post. Get an RN Case Manager from your insurance company. Usually we're the ones that end up straightening these stuff out.
Good luck!
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