I was diagnosed september 2004 after my ob/gyn ran a series of blood tests. I never heard anything from my insurance company at the time (Anthem) so I just assumed the tests were covered. Then today (feb 2006) I get a letter in the mail from Anthem saying that the blood tests were a fertility treatment and they are revoking coverage and I owed $600. I explained that I didn't get any treatment - just bloodwork, but they are refusing to pay. Anybody else run into problems like this and how do I fight it. They said I could appeal but I'm not sure if that will be a waste of time.
What was the cause of getting the tests ran? Were you having trouble ttc, or was it another symptom that alerted your doc? If it was anything other than ttc, I would fight it all the way. PCOS is not just a fertility problem, there are other health issues involved. And not every woman with it has fertility problems. So how can the ins. co. assume that you were there for fertility reasons. Also, you may want to check w/ your docs office and see how they coded the billing. And wouldn't there be a time limit on how long they can wait to tell you they didn't cover? Insurance is no fun to deal with. I wish you the best of luck!
__________________ Starlite
Me-28, DH-29 DD 1, born Sept 17th, 2007 DD 2, born June 9th, 2009
Can't wait to start WW again and loose the other 15lbs I gained with the last pregnancy and the 30lbs I still needed to lose with the first one.
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i kind of ran in to that problem, i had Blue care network when i was DX, then i moved and got Priority Healt, (small insurance group up here in MI, the hospital i work for is self insured) anyways i go to this dr and bc she put down that i have a metabolic problem in her DX they sent me a letter stating that they wont cover her $60 fee, HOWEVER, if i see her after Jan 18th ( my 6 months in there) that they would cover her costs??? now how crazy is that????
__________________
Mandie
Surprise BFP on 4/4
TEAM GREEN
Dx with GD 9/10
Induction Date: 12/7
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I think your doctor probably coded the tests wrong - a lot of times, if they're coded as TTC, they're not covered (depending on where you live). I'd ask the doctor to write a letter to send in with the appeal. Then you should be okay.
__________________ Dominici was born May 2006!
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Miracle Baby Boy Rivelino, born too early to live on October 6, 2004 at 24 weeks and 6 days. Never to be forgotten, always to be remembered, forever my source of inspiration.
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I've had to do an appeal through my health insurance company on a completely different topic. I just wanted to say that the appeal process isn't as bad as it sounds. Basically you tell the insurance company that you want to appeal it. They send a letter in the mail to you confirming that the appeal process has started. Then a worker who is assigned to your case calls you on the phone to discuss why you want to appeal it. The worker then makes a report on your behalf and submits it. You'll then get a letter from the insurance company that says the results of the appeal. You can then do a secondary appeal, if they did not rule in your favor. That's how it was for me anyway. I have Keystone Health Plan East.
__________________ Carrie (Pa) 31 y.o., married, 1 stepdaughter (10 yrs old). Diagnosed with PCOS in Aug '05. No current treatment.
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insurance coverage problems 
