Uphill

Last year I was on my husband's insurance. We used up the majority of the fertility treatment benefits and were nearing the lifetime maximum so we decided that I would switch over to the insurance offered by my employer. Before switching, we were debating whether it was necessary to keep me on his insurance as a secondary insurance. I verified with the clinic that, should there be no coverage by insurance (I like planning for worst case scenario), we would still receive the self-pay rate offered by my husband's insurance. Per the supervisor, we were approved as long as one of us was on that insurance, and since he was staying on his own, we decided I would switch without keeping his as secondary since there was no point.  I submitted the insurance information as soon as I got it (mid-December) even though I knew they couldn't do anything until it became active on 1/1 but so that they can verify it as soon as possible and to avoid any last minute scramble.

January 1 comes around and the wait begins.  We were told it takes 4-6 weeks to verify insurance. Once insurance is verified, it's an additional 2-3 weeks for preauthorization. We could have technically started a cycle the second week of January but we waited for insurance to kick in. We were verified January 20 and submitted for authorization. Response came back on February 3 that authorization was denied. The reason? We don't have "documented infertility for a minimum of 2 years." We requested a peer-to-peer review and the doctor had the appointment on Friday, however insurance is not changing their mind. As frustrating as it is, I feel responsible for not checking the fine print more carefully before switching. Even though we didn't really have another option since we had reached nearly the lifetime maximum on the previous insurance.


Meanwhile... I saw that it was taking a while to get the answer back from insurance and didn't want to miss another cycle start date so I confirmed with the clinic that the previous self-pay rate was still active.  I received the worst email in response:

"So I spoke with my supervisor again this morning just to confirm the rate. She did not realize that you were not on the actual plan, that it is just your husband's plan. If this is the case, we cannot extend the rate to you. You, as the patient, actually have to be on the plan, even if it is only as secondary insurance, to receive the rate."

I was just completely floored.  I had ASKED. I VERIFIED! We purposely had multiple conversations about this!  Then I took the information YOU gave me and made decisions based on it!  These decisions affect me until January 2017!  You're going back on it because someone didn't realize something??  I was livid. I couldn't see straight. I couldn't type a response without tearing up. It took me several deep breaths to collect myself and start the week-long discussion with the clinic about how we shouldn't be penalized for their lack of communication skills.  I kept the emails professional and to the point, knowing they file everything. They kept calling it a "miscommunication" to which I replied that while for them it's being referred to as a misunderstanding, for me it means that I made a decision based on information I received from their office that will make a difference of thousands of dollars, possibly multiple times. They promised me an answer by Thursday. I got no answer by Thursday and nothing on Friday. I escalated the issue twice until I got to the management team, who told me to expect "worst case scenario" and that they hope to get me an answer by Monday. 


Good business sense and customer service dictate that if your office makes an error then you should rule in favor of the customer in order to keep the customer happy. Even if it means making a few less bucks now, you'll keep the customer coming back and make more money in the long run. I don't think that happens in the IVF world because they know you need them and will pay whatever they require. I'm curious how they will respond to this. 


As it stands right now we have no insurance coverage and no cushion in terms of self-pay. We also don't qualify for any of the financial programs they offer because we're just shy of the eligibility requirements. I definitely plan to fight for the insurance benefits but it's not going to get resolved overnight and in the meantime, I have a baseline appointment scheduled for Tuesday which I plan to keep regardless of the answer we get tomorrow.