Monday, June 19, 2006


I chatted with my BIL (former OBGyn, currently in private practice) this weekend about my insurance woes, having the HSG payment denied by my insurance company. First off, he agreed with me that in theory the HSG is an infertility diagnostic test that should be covered under that heading. I told him that I had spent time on the phone with both the insurance company and OB's office and got nothing resolved. I said that I guessed I would just have to pay it and continue to fight the insurance company. He strongly advised against doing that. For one thing, once you pay the bill you've lost the doctor's office as an interested party in trying to help you get it resolved. Second, you lose the chance to negotiate any discount. If I remember his explanation correctly (it was after a couple of shots and several glasses of sangria!) it's something about that the doctor's office can't give you a "discount" without offering the same discount to government-paid patients, which of course they don't want to do. However, if you don't pay the bill and it comes down to either sending you to collections or negotiating a lower fee with you, they'll oftentimes take what they can get. He said to delay payment as long as I can and when they threaten to send me to collections, call them up and say that I can't pay the full amount and can they help me out in some fashion. Most insurance companies don't pay the full amount that the doctor bills so most of the time they don't get that much money anyway. The other thing he suggested is investing some more time on the phone with the insurance company and basically stay on the line until you get someone high enough up to explain to me why the HSG isn't covered. He then suggested mentioning to them that they'd hear from my lawyer about it and to also tell them that I would be contacting my congressman about the whole experience. He said insurance companies don't like to get a lot of complaints like that; makes them look bad or something.

I thought I'd share this with you; advice from a doctor about insurance! He went on to say what a crock insurance companies are and how much time his staff spends trying to get them to pay. I told him my experience with trying to get the OB's office to return my call. He didn't seem that surprised. I don't hold out a whole lot of hope that my OB's office is a very "interested party" to begin with, but I am going to take his advice of trying to delay payment as long as possible and then asking for a discount. I am also going to get on the phone one day this week with the insurance company and persist till I get an answer. It'll give me something to do to take my mind off the fact that CD1 should arrive anytime now but doesn't seem to be anywhere in sight!

1 comment:

trisomymommy said...

I'm sorry you have to deal with all of this. My insurance company covers diagnostic testing, but not treatment, for infertility. They covered ALL of the testing, including two HSGs, sperm analysis, blood work, lap and others I'm surely forgetting about. I don't understand why yours wouldn't cover the HSG -- if it's not a diagnostic test for infertility, what is it? Just a fun little radioactive party for your parts? Puleez. Was your doc's office supposed to get preapproval for you and fail to do so? If so, it's their fault! Good luck resolving it -- what a pain.