Wednesday, April 1, 2009

Screwed!

Thank you UnitedWealthcare! Just got off the phone with my insurance company. I’m pissed. Now I know that many of you have no IF coverage at all, but I was counting on some reimbursement for my transfers. My bank balance is scary. I have some IF coverage, but it has a cap. A fairly low one. There’s no way it would cover another IVF with my eggs, but I should still have enough coverage for these last 2 FETs.

I called UnitedWealthcare in December to check on my international coverage. I was told it was treated as out of network. So theoretically, I should be reimbursed 80% of “reasonable and customary” charges. When I returned from Canada after my transfer in February I submitted the bill for the transfer. I kept checking the status on the website, and it said “In Process.” On March 11th I called to check what was going on. The recorded information said the claim was denied, so I got a person on the phone. I was then transferred to a Resolution Specialist. She told me the claim needed to go through the International Claims Department. She said she would transfer the claim over, and it should be process in about 10 days. I was also given the International Claims Department address, so I could submit the next bill properly.

Fast forward to today. Boss is out, so I had the privacy to call and follow up. This time after being transferred and put on hold a few times, I’m told that my international coverage is ONLY FOR EMERGENCY CARE! WTF!! I was absolutely not told this before. The Resolution Specialist I spoke to today said I could appeal the denial. I will, but I doubt it will help. I feel completely misled.

Any suggestions for the appeal? There’s no reason for UnitedWealthcare to know that the embryos were moved to Canada from MI. The MI clinic would not treat me because I’m not married, and moving them to another US clinic would likely have been impossible due to FDA regulations. I thought I’d write in the appeal that I went to Canada for treatment because that’s where the embryos were, and that embryologists feel that it’s risky to move embryos and thaw them in a different lab than where they were created. Some embryologists do believe this, and some clinics have terrible thaw rates with embryos from other clinics. Also, what do you think about pointing out that because Canadian fees are lower than the US, that they would have had to pay out significantly more if I’d had the transfer here?

DAMN!

**************

In other news, no news. Too soon to POAS. Today is 7dp2dt. Any symptoms can be attributed to the estrace and progesterone. For some reason (self protection?) I’m not feeling as hopeful about this cycle. Even though everything looked good and went smoothly, I’m feeling low.

23 comments:

debbie said...

Sorry to hear about the insurance problems. I do not have any suggestions but keeping my fingers crossed for you.

Nikki said...

I would appeal the denial and talk to everyone possible for getting the claim approved. Specially because you called in December and were told that international coverage is treated as out of network!

Good luck! Insurance crap really sucks!

Phoebe said...

I'm sorry for all the crappy news. Stay away from the pee sticks if you can!! They have brought nothing but grief for me.

Michelle said...

Insurance companies are the worst! Sometimes I think they do the stuff on purpose. I definitely would write them and stay on it. They hope that people will just get frustrated and give up. Sorry you have to go through this, it is the last thing you need.

Kristin said...

Grrrr...so the fucktards from insurance company hell strike again. Things like that make me soooo angry. {{{Hugs}}} my friend.

calliope said...

ugh!! I HATE insurance run arounds. Hoping like hell the appeal goes through and they start treating you right. Just beyond maddening. I get furious about all the crap us single gals have to put up with.
xo

Another Dreamer said...

I'm sorry your insurance denied it. I think you should move forward with the appeal... no good advice, but I think explaining the stuff you put on here would be an idea... That is so terrible.

I still have my fingers crossed about this cycle. Good luck hun.

Cara said...

Oh Man - now I'm pissed too! If they had waivered and said it was a possibility in the beginning...then that is one thing. But this is just plain miseading.

sorry - fight it...for sure (do they record their conversations for quality assurance????)

Dora said...

Thanks, everyone.

Cara, re "do they record their conversations for quality assurance????"

I think the recording says "This call MAY be recorded for quality assurance." They do have a notation in the file that I called asking about international coverage in December. I don't know if it was recorded. I hope it was, because I KNOW she did NOT say the coverage was for emergency care only.

musicmakermomma said...

Oh Dora, I'm so sorry about your stupid insurance company! I had similar problems - so excited because our new insurance supposedly covered IVF, then after my confirming everything - they say NO donor coverage at all, and my part has already been paid (we did a 3x option last year, before this insurance) SOOO frustrating.

I would absolutely tell them you had to go to Canada for the embies - which is true. Just because the embies made a little side trip is not their problem. If you had been able to do it in network you would have!

Grr. I'm annoyed for you - and hoping the next few days go by fast!

Aunt Becky said...

Lord do I hate insurance companies. I'm sorry, Dora. Just what you needed.

'Murgdan' said...

Damn insurance...GRRRRR. So sorry you have to go through this.

Andrea said...

Oh, that is HORRIBLE!! Stupid insurance companies, I hate them!

Crossing my fingers those embies are snuggling in tight for the long haul!

battynurse said...

That sucks. I would appeal, yes mention that the embryos were there and that you were told in December that you were told international was covered. Good luck. I hope it works out to your benefit.

Golden Goose said...

Aw, sorry to hear that. Crossing my fingers and toes that everything will work out!

Leah said...
This comment has been removed by a blog administrator.
Pepper said...

Throw in the phrase "detrimental reliance" somewhere, meaning that you relied on their misinformation to your detriment.

Best of luck. I've fought the insurance beast and she is definitely but a bitch.

Celia said...

First of all, nag them. Do not take a no from a person who cannot say yes. So no flunkies. Also, start logging everyone you speak to. Also, when I had a problem with Comcast, I found out they have a department that tracks how bloggers/twitter/the internets in general feel about their company. So, think about how many people now know about this and that companies name.

What I would suggest is to go back and scrub anything that might work against you out of your blog posts. Then , edit the comments that mention what might hurt you. THEN, tell everyone you deal with how many people are hearing about their denial of a previously approved claim.

Furthermore, you did ASK if it was covered and they said yes. So do not scruple at twisting their arms to pay this. They will likely have a negotiated rate to pay for this that is much lower than what you would pay. Do not be afraid to fight dirty.

My last insurance company denied coverage for my emergency ultrasounds to diagnose my miscarriage. It was horrible, getting that bill and then having to fight about it. Lots of times they will just try to deny coverage and see if you cave. They only have to hold out till you give up. So don't give up.

Good luck,

Celia

Shinejil said...

Ugh. Insurance companies. What scumbags.

My second cycle, I was less than hopeful, too. I think you just get inured to hope after a crushing disappointment. But it was the cycle that worked.

So you never know.

perchancetodream said...

I would absolutely appeal. When I had to (with a different company) after I found out that the abortion mill that did our D&C (it was over Xmas and no one else would take us) left the insurance plan 5 days earlier even though their receptionist told me they took their plan.

I wouldn't even spend too much time, if I were you, on explaining WHY you had to go to Canada. Your case will depend on your ability to convince them of the fact that you were told that you WERE covered in Canada.

Best of luck!

S said...

they wouldn't treat you because you're not married? isn't that direct discrimination? WTF. asshats.

Is there some way you could write a letter - not to claims - but someone in management - and quote the days/times/persons you spoke to, who said that it would be reimbursed and whose advice you relied on to make the claim?? Ironically, I'm still waiting to hear what the hell my private fund is doing...I claimed my recent d&c/hysteroscopy on it, and although I was told it covers IVF and obstetric...I'm waiting. Not holding my breath though!

Please don't feel low. I know, tell her to STFU right? I woke up bawling my eyes out today. I'm a bundle of nerves. The pressure to perform is insane, I know you know what I mean! Its almost tragic - everything hangs in the balance. But I realised (after 2 solid hours of weeping like a softcock) that I need to get a grip, or the 2ww is going to be seriously f#cked. I left in my previous comment the attitude I'm trying to employ for a while. The PUPO attitude. The men in black have erased my memory and my past cycles attitude. I want to behave as if this were my "FIRST EVER IVF CYCLE" (insert multiple excited girly shrieks!!) while letting my brain know its just a defence mechanism for when I get bad news. Please hang in there. You have 4 awesome little embies in there, and I'm hoping like a mad hatter that at least one of them takes... at least one damnit!

xx

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