• Fri, Feb 15 2013

I Completely Gamed My Insurance Company To Cover My Infertility Treatment & I Don’t Feel Guilty

health insuranceI had been trying to get pregnant for more than two years. I had already been through one traumatic ectopic pregnancy, where I lost both my child and one Fallopian tube. So when I headed to my OB-GYN to have a long talk about miscarriages and late periods, I was prepared to hear bad news. I was prepared to pay plenty of money to figure out what was going on.

Sure enough, my doctor ordered rounds of tests, each one more invasive and expensive than the next one. Some of the tests were purely for the purpose of trying to have another child. But there were a few measures, such as a transvaginal ultrasound and hysterosalpinogram (pushing dye through your Fallopian tubes while under an x-ray), that were technically to check my risk for future ectopic pregnancies. Those who have had one are much more likely to have another and ectopics can be dangerous if they go unnoticed.

The obvious fact of the matter is that we were worried about future ectopics because we were struggling to have another child. We were going to the doctor because of infertility. But through our struggle, we had learned a sneaky lesson about all of these tests and treatments. If you could claim that they were something, anything, other than infertility, insurance companies might just cover them.

Like the majority of insurance plans, our’s does not cover any office appointment, medical test or procedure that has a primary diagnosis of “infertility.” But there were ways to work around this little issue if one knows how to look.

So like any lady trying to save a buck, I started doing what I could to cover at least a portion of my upcoming tests. The process went a little like this.

First, I spent roughly an hour on the phone with the hospital, being shifted from desk to desk, attempting to find out the procedure codes for my upcoming day of tests. This could have been a relatively painless task if it wasn’t for a certain billing person’s sick day, throwing the billing office into disarray.

Armed with the codes, I made the first call to my insurance provider, asking which procedures even had a chance of being covered and under what circumstances. Some were immediately turned down, but others were provisional. The provision was always the same, “As long as the primary diagnostic code is not for infertility.” As long as you can say that you’re having this test for reasons other than getting pregnant.

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