Insurance

Last week I was hit with the news that we have nearly $9000 of pending claims that were denied that we may be responsible for. I didn't understand what was going on since I've been on top of the bills and there was no indication of this on any of our statements, nor was it mentioned when I called in December making sure our account was clear in prep for the next FET.

In August we did IVF 8. Prior to the cycle we got pre-authorization and got the all clear. In December, when we were getting finances ready for the next FET, we were told we had exhausted our benefits. We were expecting as much and knew we would have to pay for the FET out of pocket. I verified our account had no other outstanding balance (it did not) and I decided to make a pre-payment for our FET to get the tax credit for 2018.

Turns out that our Aug claims weren't submitted until much later than the cycle - closer to Nov/Dec. When we received the notification in Dec about our benefits being maxed out, it was actually notification of our Aug claims being denied though no such wording was used. The pre-payment for the FET was then disbursed among all the open/denied claims and the $9k is the remaining amount.

To say I was livid is an understatement. I was so, so, so upset. First, no one bothered to tell us what was going on. We would still be in the dark had I not reached out the them with a question. I got a Feb statement for $1100+ and I emailed the financial counselor, confused, since our account was clear in December. She said she'll look into it and get back to me. I followed up FIVE days later and she said she's still looking into it. Later that day I got the shocking news that not only do we definitely owe the $1100+ but there is a whopper of a bill coming up because of all the denied claims. I asked about the prepayment and she said it's gone, disbursed among the open claims. I followed up with four additional emails in quick succession asking WHAT THE HELL in various ways, pressing send before I fully formulated the thoughts to try to get her before she left for the day.

The next day I felt my heart racing. I called the doctor taking my doc's patients while she's on maternity leave. I left a message and said I don't want to over react but I also don't want to under react if this is something that needs to be checked out. Doc called me back a few min later and as we were talking I started sobbing. I said I wasn't sure if I should go to urgent care or try to get in with my PCP or what but I'd rather feel silly for coming in rather than regret ignoring something important. She offered me to come in to see her so that's what I did. My blood pressure was in the 160s, my pulse in the 90s, and I couldn't stop sobbing. The doctor was so kind and patient and understanding. Through sobs I explained about the unexpected billing issue. I also shared my incredible fear of miscarrying again, especially in a traumatic way like last year because that had also been on my mind. BP was checked again, it was lower in the 140s. Then she went to the financial office to try to get some answers. In the old clinic the doctor would never get involved in the finances. She got the financial counselor to come talk to me to try to explain what's going on, but more importantly to promise to get a supervisor involved and get back to me with answers.

Then she listened to my heart for a while and said she couldn't hear a skipped or missing or extra beat like what I was describing. She said she can order an EKG for me if that's what I wanted. Toward the end of the appointment I was feeling better and said I will skip the EKG but follow up with the pcp if I felt the need. She recommended doing things to help me relax, like massage, exercise, music, etc.

I'm normally a rational, logical person. I've had a few instances in the past where my anxiety got the better of me (basically right around my husband's varicocele surgery where I couldn't stop thinking worst case scenarios), but for the most part I feel like I have it under control. When it starts manifesting in a physical way is when I start freaking out. Having something bother me that I don't address starts compounding (in this case, fear of mc) and then when there's a trigger I wasn't expecting (in this case, the billing situation) it just blows up. It's easy for me to say that now, a few days later, because hindsight is 20/20. But at the time it felt like the sky was falling and I was drowning. I am lucky the doctor didn't dismiss me, took the time to see me, and gave me the time I needed to get through it. I am extremely grateful.

Toward evening I had mellowed out significantly and my blood pressure was back to normal and so was my pulse. The next day I tried doing my own research about what we owe. While waiting for the supervisor from the clinic to call me back, I called my insurance. It sounds like yes we did indeed max out our lifetime fertility benefits. Our Aug claims only had about $900 covered and the rest of the cycle was not. For some reason the clinic didn't submit the claims until December which is why we only received notification at that point. I don't know why we weren't told about the pending/denied claims earlier. I don't know why we weren't told about disbursement of the pre-payment for pending claims. The insurance person went over all the claims that we may owe that are still pending.

One piece of surprising news in all this: while on the phone with insurance, I was told that the Aug - Dec claims were denied but one of the claims submitted in January was covered. Huh? Thanks to some policy change that we didn't know about or realize happened, turns out the plan we signed up for was slightly different than last year and that change resulted in an entirely new plan which means that as of 1/1/19 our lifetime maximum for fertility benefits has been renewed. What!!!!! I didn't even know that was an option!

So we're still on the line for thousands of dollars until we hear otherwise but hopefully having a renewed lifetime max will mean that we don't have to put anything on hold. I'm still very upset with the clinic for screwing up our billing, but I'm holding out for the supervisor and give her a chance to fix it before going nuts on them. And I've also learned not to let things fester. If something is bothering me, I need to take care of it. I thought I was managing fine -- I wasn't crying, I wasn't actively depressed -- but clearly I was in denial that something was bothering me. I will need to be more aware in the future to prevent another meltdown.