I need to deal with a big bill, and I need help on next steps. TW for infertility.
Hi all,
My husband and I have been doing IVF for 2.5 years in Mexico City (we live in the Midwest US). It's a lot more affordable there. Unfortunately, after four egg retrievals and three failed transfers, we haven't had luck yet. About a year ago, I had a ReceptivaDX biopsy taken, which came back positive, indicating the potential for endometriosis. I suppressed with Lupron before my third failed transfer. I don't have any huge major red flag symptoms of endo, but I have some symptoms that fall under that umbrella.
As a next step, I had a laparoscopy and hysteroscopy on Oct 30th. Before surgery, I noted all symptoms and history to my surgeon. Now I'm starting to receive my EOBs, and unfortunately this surgery was coded under "infertility", which I do not have insurance coverage for. So my total bill comes to about $25,000 and all the claims were denied. I made many calls before surgery, to my insurance company, to the cost of care line, etc. I was given estimates around 5-7k.
This is not a bill we are able to easily pay. I've contacted the billing department of the surgery center, and they are adamant that the coding cannot be changed. I have a post op appt with my surgeon next week. I think it's highly unlikely that he will be able to make changes, but I will ask. My understanding is that if this surgery were coded under "endometriosis", it might be partially covered. But I'm not 100% sure. I was hoping that I had enough evidence (the positive biopsy result, and the symptom of painful sex) to have this fall under the category of endo, not infertility.
If I have no luck with this, my plan is to apply for financial assistance. I am hoping for some help because this bill is 1/3 of our joint AGI.
Has anyone had success 1) having a doctor edit their coding/billing after the fact? Or 2) applied for financial assistance and received aid? I'm so frustrated. The amount of advocating patients have to do it really unfair. Thanks for any insights! |
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