My CCRM IVF Journey

Our successful journey through IVF #2 at one of the world's top fertility clinics

Insurance Woes

Posted by auntiem10 on April 24, 2010

We are fortunate to have insurance coverage for some diagnostic testing associated with infertility. Before the ODWU, we called both of our insurance companies and made sure CCRM is in-network. Although we have no coverage at all for IVF or associated medications, we were happy that a large portion of our ODWU testing would be covered.

CCRM’s business office told us that my husband K’s insurance company is not contracted with CCRM’s lab, so we had to pay his fees up-front and then submit claims for reimbursement. Okay, this was no problem. We received completed forms in the mail the week after our ODWU, and promptly mailed them to the insurance company. Based on the coverage, we anticipated receiving a refund of about $1K.

For the past week, we’ve been monitoring the claims online. Yesterday we realized that although some of the claims were being processed, no money was designated to be sent to us. K has been swamped with work this week, so I called the insurance company to find out what was going on.

As it turns out, even though CCRM is an in-network provider, their lab (Fertility Laboratories of Colorado or FLC) is out-of-network. This particular insurance company’s policy is that if you visit an out-of-network provider, they will cover some of the claim, but any leftover monies are only applied to your deductible. In other words, they do not refund any money when you go out-of-network.

Honestly, I am kind of upset. I don’t feel like CCRM’s business office thoroughly explained to us that FLC is a separate entity that may or may not be in-network. We thought we were doing our homework by checking to see if CCRM was an in-network clinic. It never even occurred to us that an in-house lab might be out-of-network. We had never even heard of FLC before we arrived for our ODWU; we thought all testing was done through CCRM. I know that regardless, CCRM would have required us to do this testing at FLC, but it would have been nice to know so that we wouldn’t have been pinning our hopes on a refund.

And just like that, we will have to postpone our IVF one extra month. We had built that refund into our IVF budget. We needed to wait until August anyway (so that K can accrue more vacation time), but now we will have to wait until September to pay the cycle fees. So our desired plan will be to start BCPs in August, and schedule the stimming/egg retrieval, egg transfer in September. This isn’t a huge postponement, and we might have had to wait this long anyway if I lack the beta-3 integrin and need two months of Depot Lupron, but it is still disappointing!

Moral of the Story
To anyone with diagnostic coverage who is planning your ODWU: I suggest that if you have coverage for diagnostic testing, make sure that BOTH CCRM and the Fertility Laboratories of Colorado are in-network providers! Learn from our mistake!


4 Responses to “Insurance Woes”

  1. sue said

    oh no 😦 so sorry to hear that…you would think ccrm would have let you know before hand, but they don’t!..gggrrrr….for our ODWU some of our testing was sent away to other labs (quest and genzyme), maybe (hopefully) yalls insurance would cover them?

    don’t let this get you down! it’s a small speed bump towards your goal…

    • auntiem10 said

      Thanks for the heads-up about the possibility that some testing may have been sent to another lab, like Quest. I talked to the business office this morning, and some stuff was sent elsewhere. It’s just frustrating that we didn’t know about all this beforehand, but you are right–it’s just a speedbump! Thank you for commenting! : )

  2. Ugh. We didn’t have any insurance coverage for anything so we never dealt with any of this paperwork crap (other than writing monstrous checks 🙂 ) however I think I have heard that FLC is not contracted with any insurance companies, so it’s always a deal where you submit your own claims. Maybe they’re not really in network with anyone? Who knows but I know it sucks. Sorry for the delay.

    • auntiem10 said

      Thanks for your comment! I am so annoyed by all of this paperwork crap, but I guess it’s the price we have to pay to get access to the best clinic. I am not looking forward to writing one of those monstrous checks you mentioned!

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