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Insurance companies: Making dreams come true… when they feel like it

Ha ha ok funny story.  Remember how I wrote yesterday about fertility coverage and how all y’all were commenting and telling me how lucky I am, how great it is to have fertility coverage?

Hold on, let me just put down this crossbow here for a second.  (Don’t want to accidentally knock over the kerosene.)

Ok, we’re good now.  So, all that I told you?  Well, there seems to be one little nurse at the insurance company who insists on being a little bitch and ruining our lives. 

Chris talked to the insurance company today.  A week and a half ago, somebody there told him he may or may not be required to enroll in this “program.” I’m not sure what exactly the “program” is for, but I think it has something to do with “helping” people achieve their dreams of a child.  In the cheapest way possible.  At the utmost emotional expense of the parents-to-be.  Also, I think they kill puppies.

This nurse from the “program” called him last week and hung up without calling back.  So she finally gets back to him today.

Puppy-killer: We have to ask some questions before we can enroll you in fertility benefits. 

Chris: Um, well we have already been getting benefits for 5 months now..

Puppy-killer: Silence, you.  So how long have you guys been trying?

Chris: Four years.

Puppy-killer: Oh. And did you try-

Chris: Yes.

PK: And have you tried-

Chris: Did it.

PK: How about-

Chris: Didn’t work.

PK: Uh huh… So have you tried Clomid?

Chris: Yep, The first time was three cycles, then 6. Then when we went to CRM we did another 4.

PK: I see.  Well statistically if Clomid didn’t work in 4 cycles, then you need to move on.

Chris: Ok, well let me just get back in my time-machine here…bitch.

PK: And what else have you tried?

Chris: We did four cycles of IUI.

PK: WHAT? What do you mean? That was done at a clinic that is not accepted. 

Chris: Well, the claims went through just fine.

PK: Well, those claims never should have been paid.

Chris: Well, they were…

PK: We only have two clinics in Minnesota that are approved Centers for Excellence, and your clinic isn’t one of them.

Chris: We are starting an IVF cycle in a week.  So what are we supposed to do?

PK: Well I don’t know.  But if you go there, we won’t be paying for any of it. If you want coverage, you can go to one of these other clinics. Your clinic was obviously not billing the procedures correctly because we never would have approved those IUIs. And if you have a puppy, I need to see it.  We need to take a look at it.

So.  Chris then called the Customer Claims department, because Puppy Killer didn’t have access to the claims (wonder why).  Guess what? They told us our clinic was in-network, our doctor was in-network, ART is out of network, but still approved for reimbursement.  So then he called his HR department and explained the situation, hoping the poor lady understood what he was asking.  She wrote everything down and said she will look into it.

Here is where we stand, 6 days from the start of our cycle: If this nurse from the “program” is correct, going against what everyone else has said, we have two options.

A) We can stop the cycle, spend a few months trying to get into another clinic that this lady says is a place they will cover, get set up with another specialist, make sure all the records are sent, and try to get pregnant with a clinic with a worse success rate

Or, we stay here, give up our fertility coverage, pay $12-14,000 out of pocket at the best fertility clinic in the state, with the highest success rates.

We have absolutely no idea where to go from here.  We don’t know who is right.  We don’t know if our IVF is truly covered anymore.  We have had no idea if we have to enroll in this program with Sataness herself.  Whore.  I bet she has five kids.  I bet she eats little children.

Or, this women is completely bat-shit crazy and doesn’t know what she’s talking about.  I am hoping for this.

What to do?  What to freaking do?

No really, I’m asking, what the hell do we do?

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Impatiently Waiting
Guest

First off, I am laughing so hard with your remarks!
Second, I work with insurance companies daily. I am the one that submits the claims… Let me tell you… you can a million different answers in five minutes! I hate insurance "customer service" reps. I really hope you do have coverage!

Kasey Attianese
Guest

I'm so sorry on top of everything else the last thing you need or deserve is insurance confusion. It sounds like she is clueless. Insurance companies don't just pay things and if they paid for your IUI's I'm betting they are covered. I would ask your REnoffice they're be knowledgeable about your insurance.Praying they resolve this for you stat!

jAllen
Guest

This is just MHO but I would be skeptical of the bitch from the "program" I got a phone call to enroll in my indurance's prenatal program
PK: congratulations on your pregnancy!
Me: thanks, but I'm not pregnant
PK: oh I don't know why I had a referral on you
Me: especially as we're infertile
She didn't have access to any of my claims
I'm sure your RE also knows who they participate with. I wouldn't trust the PK

Aramis
Guest

I have a feeling that the Puppy Killer doesn't have an effing clue what she's talking about, and that if you talk to someone else you'll get a different answer. Try as hard as you can to get that answer before you start your cycle, but if not? If you can afford it, go out of pocket with the good clinic. If it doesn't work, then you can go to the crappy one later with coverage. But I'm betting you won't need it.

Sarah J
Guest

Ugh, I really despise insurance companies, even if I appreciate some of the decent coverage I get through them.

I have found that you can get different answers from different people when it comes to all things insurance, so hopefully that is the case here and the puppy killer is on crack and doesn't know what she's talking about. By the way, you crack me up!

Fingers crossed you get good news on the coverage and can stay at CRM!

Cristy
Guest

I'm with everyone else. I'm willing to bet very good money that PK has no idea what she's talking about. I'm also willing to bet she'd fight tooth and nail before she admits that she's wrong, so see if you guys can talk with someone who's higher up to get this resolved. On that note, I'm willing to bet that CRM's financial person can help guide you through some of this. The usually know the ins and outs of this stuff and may have some insight. That said, let's play devil's advocate and say she's spot on. That leaves you… Read more »

Aubrey
Guest

Oh my gosh! How frustrating!! I'm so sorry. I feel like the puppy killer just sounds bat shit crazy. I'm going with that option!

Catwoman73
Guest

Ugh. What a mess! I wish I had some sage advice for you, but I'm just so stunned that they really don't have their shit together. IF is such a roller coaster anyway- you certainly don't need to be dealing with all this red tape right now. Best of luck- I hope it all works out in your favor… and quickly…

AuntMimi
Guest

Wow, what a mess. I think you should call back and ask to speak to a supervisor. This girl is trippin'!

Well-intentioned
Guest

OMG…I'm so angry at the Puppy Killer on your behalf!!! I wish I had a recommendation to propose…maybe demand that you speak to her supervisor(?). But of course…if you have to deal with her going forward then that might be an even worse idea. Fingers crossed that it all works out and you can STAY at your clinic!

Ann Foster
Guest

I would call back and demand to talk to someone who knows what they are talking about. I would I also ask to speak to PK supervisor and inform him or her of her actions. I'd like to ask PK when she became an RE….oh wait, she's not. I HATE ill-informed people. Really…if we wanted her advice or any other know-it-all then none of us would be wasting our time and our precious money going to see specialist. UGH! Seriously! People are so dumb. I'm sorry. I pray that you are able to stick with your clinic. My friend had… Read more »

Jenny
Guest

I have no experience with insurance companies, but my gut is telling me that PK doesn't know what the eff she's talking about. It seems very odd to me that your insurance would cover IUIs at a clinic that they're supposedly not supposed to cover. You'd think they'd pick up on that and let you know.

If she's right…I'm not really sure what to suggest. I like Cristy's advice, so I'd say go with that. Good luck!

jAllen
Guest

Just also wanted to add how frustrated I am for you that you had to spell out everything you did, as yeah..if I worked you wouldn't be on the phone with her! I'm surprised she didn't suggest just relaxing with a bottle of wine and wearing socks after sex whilst standing on your

jAllen
Guest

*head*

Egg Timer
Guest

I think you should talk to the people at your fertility clinic. Guaranteed they have dealt with every trick the insurance companies use to get out of paying. They may be able to figure this out quickly for you. Good luck… hopefully you will be starting you cycle very soon!

JenS
Guest

I agree with everyone else that puppy killer doesn't know what she is talking about. Not that anyone at an insurance company can be trusted, but I would believe the people in the claims department. there is no way an insurance company pays a claim they aren't supposed to. Don't they try their hardest to avoid paying any claim they can? If there was any reason to deny your claim, they would have.

Infertile625
Guest

My money is on the puppy killer is bat shit crazy. Aren't all puppy killers?

yetanotherbitterinfertile
Guest

Ugh… insurance. They make it so complicated that not even all employees of the same company can agree on how to interpret a policy. 🙁 I wish I knew what to tell you. I hope you get it figured out, one way or another.

Jamie
Guest

Eep! What a mess! I'm throwing my vote in with the "hunt down PK's supervisor" camp, and not only (hopefully) get to the bottom of this, but let her/him know that PK needs to grow some fucking tact and customer service skills!

Thinking of you!

Risa
Guest

Ugh I'm hoping so too. Insurance companies are just so frustrating!

Risa
Guest

Yes, that is a huge thing that makes no sense. I highly doubt every US, every procedure, wasn't "supposed" to be covered. Maybe the insurance company paid for it out of the goodness of their own hearts?

Risa
Guest

Ha! Yep, I got a thing in the mail about three months ago when we were starting our IUIs about "my pregnancy" and working with a prenatal case manager. Facepalm.

Risa
Guest

I know, I totally hear ya. I mean, I know if it comes down to it, were are staying at our clinic. But I am hoping she just doesn't know shit.

Risa
Guest

EEEE thanks! I hope we can stay. I mean, it would be incredibly stupid for us to switch clinics. I am so frustrated because I hate getting different answers. Although the general consensus is everything is fine, because she is the only one saying something different.

Risa
Guest

I did think about asking our IVF coordinator at the clinic. And I do want to go above her, but I don't know if it's better to leave it alone and just not call her back. I mean, she can't see our claims, so she can't have that much clout, right? And you are very right. They know me there and I just can't see going to a clinic whose IVF success rates are nothing compared to this one. I like the wine/beer idea. Maybe it would be better to just get hammered and talk about how broke we are… Read more »

Risa
Guest

Ha ha I'm going with that too. What I wouldn't give to say that to her face…

Risa
Guest

No kidding! As if there isn't enough to deal with. Ugh! Thanks, dear. I hope so too.

Risa
Guest

Ha! Yeah I know, I'm tempted.

Risa
Guest

Ha! I feel sorry for her if she had to work with us in the future. Women isn't going to know what hit her 🙂

Risa
Guest

Yes! Yes, yes and yes. I agree with what your friend did. The funny thing is, wouldn't you think it would be cheaper for the insurance companies to go with the BEST clinic because then they have to only cover IVF once! There's a thought..

Risa
Guest

Yeah no crap. I highly doubt they would be paying these claims if they didn't have to. Grr. I wish it were me that talked to her.

I like Cristy's advice too! I'm going with that.

Risa
Guest

Ha ha no kidding. Maybe I should have brought that up to her… covered my bases and all 😉

Risa
Guest

I know, that's good advice. I think I will do that. 🙂 And thanks! I do too.

Risa
Guest

Yep, you would think. So hoping she is just heavily into crack or something.

Risa
Guest

Well you know, you're right. I mean, they do all act very similar.

Risa
Guest

Thanks, dear. They suck! Suck!

Risa
Guest

I know! That's a good point. I didn't personally talk to her (sadly) but she sounded pretty negative and rude. Thanks, Jamie!

Shelley
Guest

Does your clinic have an insurance coordinator? When I did my first IVF, I got a nice form from the coordinator detailing out what my insurance covered. It seemed pretty standard as if there are a few different types of coverage that insurance offers (i.e. lifetime max, limited coverage, etc.), so that we would know what to expect to pay out of pocket.

I hope this all works out and the PK has the info all wrong. I hope this all resolves itself so that you can go into this cycle without all this unnecessary stress!

inconceivable12
Guest

Yikes! What an awful, awful woman. I'm somewhat convinced (based both on your post and on personal experience) health insurance companies seem to go out and find the nastiest, meanest people they can to do customer service. I wish I had some good advice on this, but the best I've got is to be polite, but very, very firm in insisting that you get to speak to someone with enough authority to actually answer your questions correctly and resolve the situation one way or another. Hopefully, they'll realize that the PK is wrong (and also that the PK is rude).… Read more »

Em
Guest

So I'm obviously SUPER behind…sorry about that. And sorry that you have to deal with all of this confusion and decision-making! Also, what clinics are part of the "program?" I'd be curious to know. Midwest Center for Reproductive Health is excellent (We'd have stayed there rather than going to CRM if our insurance had covered it, so we had the opposite problem. We LOVE Dr. Corfman – more than our current doc). And from what I've heard, Reproductive Medicine and Infertility Associates in Woodbury is great too. I've known people who have had success there. From what I've heard about… Read more »

Amber
Guest

Oh. My. Garsh. So rediculous! I'd say she really is bat shit crazy. There is no way you would have bad coverage all along and it be incorrect. I would also assume your clinic would know if they weren't an improved clinic for your insurance. Most all doctor's offices, dentists, etc. check that out from the very beginning. Obviously, you've already (hopefly) started your cycle by now. I'm WAY behind and hoping to catch up soon! Good luck!!