What is the name of your state (only U.S. law)? AZ
I'm wondering if I have any recourse....
I sought treatment for infertility. The doctor recommended IVF and directed me to his billing specialist who could provide cost and payment details.
I provided my insurance information, which would pay for up to $4K for the treatment of my choice. The billing specialist provided cost breakdown for me. Basically, I was told that the overall cost would be $15 : minus $4K for meds = $11K...minus $4K of insurance = $7K. Based upon this information, I began IUI treatment instead, because as I told the billing specialist, "$7K was $7K too many".
1 year of treatment, and 1 miscarriage later, I spoke with a DIFFERENT billing specialist from the office who informed me that I SHOULD have used my insurance money for IVF. I told her that the balance of $7K was too much and she said, "oh no, no no! That's not how it works!" She proceeded to explain that it didn't matter what the doctor charges, only what the insurance pays". She then looked up the average payment for IVF for my insurance company and explained that it was about $3,800-$4,200 for a COMPLETE IVF cycle and that the doctor would have accepted it as FULL payment! But, that if I'd spent ANY of the available insurance dollars, and was so much as a penny short, I'd be considered a cash patient and would have to pay the entire $15K myself.
It was shocking to discover that I COULD HAVE DONE IVF ALL ALONG and now, it was too late - my opportunity was gone due to misinformation! Given the dramatically higher success rates for IVF vs IUI, my entire medical and personal history might have been very different had I received the correct information from the start. I also spoke with my insurance company prior to beginning any treatment and they couldn't give me a list of treatments available to me, because they said, "it depends on the doctor" (presummably it depended upon what the doctor charged).
I had a good chance with IVF. I was 37 and had two successfull pregnancies prior to seeking treatment.
Do I have any leg to stand on?
Thanks,
Kristine
I'm wondering if I have any recourse....
I sought treatment for infertility. The doctor recommended IVF and directed me to his billing specialist who could provide cost and payment details.
I provided my insurance information, which would pay for up to $4K for the treatment of my choice. The billing specialist provided cost breakdown for me. Basically, I was told that the overall cost would be $15 : minus $4K for meds = $11K...minus $4K of insurance = $7K. Based upon this information, I began IUI treatment instead, because as I told the billing specialist, "$7K was $7K too many".
1 year of treatment, and 1 miscarriage later, I spoke with a DIFFERENT billing specialist from the office who informed me that I SHOULD have used my insurance money for IVF. I told her that the balance of $7K was too much and she said, "oh no, no no! That's not how it works!" She proceeded to explain that it didn't matter what the doctor charges, only what the insurance pays". She then looked up the average payment for IVF for my insurance company and explained that it was about $3,800-$4,200 for a COMPLETE IVF cycle and that the doctor would have accepted it as FULL payment! But, that if I'd spent ANY of the available insurance dollars, and was so much as a penny short, I'd be considered a cash patient and would have to pay the entire $15K myself.
It was shocking to discover that I COULD HAVE DONE IVF ALL ALONG and now, it was too late - my opportunity was gone due to misinformation! Given the dramatically higher success rates for IVF vs IUI, my entire medical and personal history might have been very different had I received the correct information from the start. I also spoke with my insurance company prior to beginning any treatment and they couldn't give me a list of treatments available to me, because they said, "it depends on the doctor" (presummably it depended upon what the doctor charged).
I had a good chance with IVF. I was 37 and had two successfull pregnancies prior to seeking treatment.
Do I have any leg to stand on?
Thanks,
Kristine