Infertility Coverage

[LegalNeoPhyte]

What is the name of your state?What is the name of your state? NJ

I have two issues regarding infertility treatment for my wife:

1. Infertility Bill from 10/2003 (received in 12/04) for $6,000
My provider verified the treatment with insurance company before providing the services and my insurance company is denying the claims. During 2004, I asked my provider if there were any outstanding bills. All along I was told that there are no outstanding bills.

2. Excess of limit (approx 6,000)
During beginning of 2004 my provider said my insurance company is not covering infertility. I contacted my employer who inturn negotiated with my insurance company and reinstated the coverage. I have letter from my employer saying my coverage has been reinstated (no mention of the limits of coverage). When I gave the letter to my provider they contacted the insurance company who gave them the details of the coverage including the limits.

My provider has provided services of $6,000 over the limit and never mentioned to my about the limit. I was totally unaware of any limits. My only basis of coverage was from my employer. My employer says they negotiated the contract with insurance company and they did include every detail in the letter. The coverage limits were informed to the provider.

I started getting the bills for 10/2003 in 12/04. I received several other bills from provider and did not mention any thing about outstanding balance of $6,000 for services provided in 10/2003.

Now, I have two big payments due totalling 12,000(approx). Neither of these payments were known to me before my provider provided the services.

What are my options now?

Thanks a lot