I just received a statement from my insurance company denying my two doctor's visits. When I called them, I explained that I had been recently diagnosed with PCOS and the appointments should have been covered. They told me that the diagnosis code that the doctor's office used was not covered under my plan - infertility - so I would have to contact them to change the code. When I talked to the doctor's nurse, she asked if I had come to see the doctor regarding infertility, which of course I had, but while I was there was diagnosed with PCOS. She stated that they couldn't lie to the insurance company which I told her I was not asking her to do at all and the code that was used was PCOS and infertility. She passed me on to the billing person, who of course was gone for the day and told me to ask her about the dianosis code.
Has anyone else had these problems with insurance companies? I feel like PCOS is my main concern at this moment and since I didn't know I had it until I went to see the infertility specialist, these procedures and visits should be covered. BTW, I also had a HSG, which is close to $1,000. I called my insurance company prior to having the HSG and explained that I had PCOS and that the doctor recommended I have the HSG. They told me it would be covered, now I am wondering if I am going to get billed for that too!
Just wanted to vent a little and see if any one else out there has had this problem. If so, how did you resolve it? Or did you just pay out of your pocket for everything?
Hiya sorry you have to go through this. Here is my story..... 6/03 I went to see my endo and I got a referal (sp?) from my PCP and pay my $10 co~pay. 6/04 I get a bill for $50.00 So I called billing at the endo's office to ask why am I getting a bill from a yr ago. She told me that the insurance company said that I have to see a fertility specialist for PCOS. I didn't understand this because I seen the Dr two times after this date and they were paid. So I called the insurance company and they told me that the reason they didn't pay was because they didn't get a referal from my PCP. When I mentioned that the Dr's billing office told me another reason the insurance company told me that was untrue. I understand $50.00 isn't alot of money but why should I pay when I did what I was suposed to do and I also pay enough money for my health insurance. So I am sorry that I couldn't help you as to what to do with your problem but wanted you to know that your not alone.
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PCOS is NOT the same as infertility and I can't see how in the blazes the code would be the same. For the love of PETE!
oK, I had some steam to blow off there...I'm very angry over the amount of posts I keep seeing from ladies complaining about insurance issues. It's ridiculous.
First of all, PCOS is an ENDOCRINE DISORDER and it is very different from saying IF. For crying out loud, the damned doctor should have put the PCOS diagnosis somewhere as the primary reason for your visit. I would personally be on the phone screaming at the doctors people for that. And, I'd also take it up with the doctor too. IF is IF. PCOS can be a cause for IF or it can be the cause of a great many things. If that's the diagnosis, then that's what should be on the paperwork.
Good luck with these idiots and let us know how it all turns out...those visits get pretty frickin expensive...
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That is so unfair!
Your situation just makes me feel even more grateful that I live in Canada and have OHIP! Sure our health care system has its problems but at least we don't have to deal with ignorant insurance companies!
Insurance companies have computers that input the billing codes and have "automatic edits". Your doctor's billing person probably put in an infertility code beginning with 628 rather than a code that showed ovary dysfunction starting with 256.
The doctor probably does a lot of infertility stuff, but you should let him know that his billing person needs to be careful about billing for the PCOS diagnosis.
Incidentally, I'll be surprised if your insurance company pays for the HSG. Blocked tubes are not a usual problem of PCOS, HSG is clearly for fertility issues. That will put the insurance company on notice to scrutinize your bills from that particular doctor and other tests that he may order. So his staff needs to be extra careful to properly code your billing.
Insurance Question 
