Tuesday, June 15, 2010

Insurance and who's contracted with whom?

I'm really frustrated today by this health insurance business. My company was located in Nevada and we had basically zero infertility coverage. We were purchased by a company in Rhode Island and poof, in January 2010 I was eligible for their insurance that had IVF coverage. Color me happy! I thought..."WOW! I can just keep doing IVF over and over until it works dammit!" Not so fast Sister.

I also had decided to start working with CCRM because they are the best and still close enough to drive. I checked to see if CCRM accepts Blue Cross and they did. So far so good! So I get there for my one day work up and I am told that the "lab" and the "surgery center" are legally separate entities and do not contract with Blue Cross. I thought..."Well, annoying, but okay...I have 80% coverage whether it's in-network or out. No problem." That was until I got my reimbursement check from Blue Cross. Of the $500 I forked over for blood tests, I got back $31. WTF! Apparently, I only get 80% of the "usual and customary" amount, not 80% of the actual. With some research, I have found that a lot of clinics are doing this. It's their way of duping patients into thinking they have insurance coverage when really, the amount you are covered for is just a consolation prize. And you are certainly not guaranteed to take home a baby.

This is a despicable practice and it needs to stop. Fertility clinics need to either accept insurance or not. Make a decision for the love of God! I wonder what would people say if they walked into Lenscrafters and was told, "Well...your exam is covered, but unfortunately (Bill Lumbergh tone of voice) the frames and lenses are not because that part of Lenscrafters is not contracted with your insurance. So sorry..." I may have to become an activist when all of this is said and done. SOMEONE needs to stand up and fight for the rights of the infertile!

No comments:

Post a Comment