Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Insurance Vent
Oh, I hate insurance! Mind you - I've never really had to deal with medical insurance before. I've always been healthy, and I still had my parents insurance as secondary insurance until this past December. So any bills that came, I gave to my mom and she would always pay.
So before we started doing any of infertility appointments and such, I called my insurance and asked what all was covered with infertility. I had selected to speak to someone in the benefit plans option. I guess I didn't ask the right questions or what. I was told that testing and diagnostics was covered. Sounds good, right? Well, it is, but it's definitely not what I expected. When I was finally able to log into my profile, and was able to check out the benefit plans myself, for Infertility Services, I see that it coveres diagnostic examination and tests only. Yes, I knew that. It says that Physician Office Services - $20 PCP/$20 specialist copay per visit then 100% of eligible expenses. It also says Outpatient Service received at a Hospital or Alternate Facility - 80% of eligible expenses after satisfying deductible. (I will say, I did misread that last statement the first time).
So..when I was able to get on for the first time, I noticed we were going to get billed for about $120 of the labwork I had down at my OB's office. I thought this was testing and diagnostic? So, I called United HealthCare and spoke to someone in claims (much more helpful). She explained that the labwork is done by a 3rd party, so it's considered an alternate facility. I was thinking she told me we were responsible for 20% of it (I misunderstood her as well - see note above). Okay, fine, no big deal. We have $1000 in DH's HRA from his employer we will use for that cost.
Okay - going forward to earlier last week, when I had my HSG. I had called the hospital to find out around how much the HSG would be. I'm thinking we would be paying 20% (since I had misread the 80% AFTER satisfying deductible). So, I'm thinking at most, we'd be paying $300 or so for the HSG.
Well, fast forward to today. I log into my insurance, and I see the claims from the 2 different bloodwork and the claim from visiting the RE. Well, it says that we will owe about $110 for the RE. I'm confused and thought it was covered?? I called and spoke to a very nice lady in the claims department. She explained it for me. She said that you have the $40 copay, but any xrays, labs, etc he would do in the office, we're responsible until we meet the deductible. She said after the deductible, then the insurance pays 80% and we're responsible for 20%. So, now I understand our testing/diagnostic benefits a lot better. Needless to say, after the HSG gets billed, I will have met my deductible for the year. LOL
I still don't understand thes labs/x-rays/etc if it's done in the doctor's office?? It's not outpatient services received at a hospital or alternate facility. But it is what is is. I called DH and told him I completely misunderstood our benefits, and his first question was...how much are we out. I did tell him that when I talked to the lady at the hospital, she told me they have a 36 month payment plan we could do (no interest or anything). I don't know if I'll do that or not. I'll wait to see until I get all the bills.
I do know, my open enrollment is coming up (starts June 1st), and I'm thinking it would be a good idea to sign up for the FSA. I believe I can use the FSA account for any of the infertility stuff. Does anyone know that for sure??\
Vent over. Hope everyone is having a fabulous Friday.
TTC since June 2012
Re: Insurance Vent
I had an hsa before I went on DHs insurance, and that could be used on our fertility appts. Not sure what the differnce is between the two..
TTC since March 2012
BFP 3/14/13!!!
U/S 4/15: Identical twins!
Lost my angel boys at 10.5 weeks
My Chart***My TTC blog
@ky29 - the only big difference between the HSA and FSA that I know of is - The HSA you're able to carry over from plan year from plan year. My dad has one, so they've been putting in a bunch of money into the HSA (since it's tax free) for when they retire and don't have as good as insurance. The FSA does not carry over. Our plan year is from June 1 - May 31, so whatever money I have in the FSA at the end of the year, you would lose.
But I definitely think I'll look into it. At least maybe put in enough that covers 1 IUI. I'd be looking at roughly $58/paycheck...but that would lower my taxable income as well.
Other than that, I don't know the differences. lol
TTC since June 2012
I do payment plans all the time for medical care. I've never had a problem. I call up ahead of time to any testing, surgery, etc to find out what the payment options are. If we go to the emergency room I set up a monthly payment plan with them. It works well.
Between the two of us last year we paid close to $9,000 out of pocket. The year before was about $7,000. Looking at that now that could get us a car. Or be part of a down payment toward a house. I have a feeling this year won't be any cheaper then 2013.