Finally, Some Good Financial News!

I don't think I've blogged about it yet (oddly enough), but I've been fretting quite a bit lately about finances, especially as related to our baby-making expenses.

You see, when I first started shopping for a reproductive endocrinoligist, I found one that was out of network for my insurance but two minutes from work, and others that were in network but much farther away.

I checked with my insurance company and was told that, either way, they'd cover infertility treatments at 50%. The only difference would be my out-of-pocket limit; $1000 in network vs $2000 out of network.

I asked them, to be sure, "So, once I've spent $2000, I won't spend any more?" "Right!"

Ok, not so bad, so I went with the one closest to work.

It is pretty pricey ($295 for an ultrasound - I've had three so far; $295 for the IUI, etc) but, hey, we're only paying half that, and it will stop at $2000, right?

Well, maybe not so much.

When I started getting Explaination of Benefits papers from them on some of the other testing I've had, I realized that they aren't paying 50% of what the doctor is charging, rather it's 50% of some number they made up for what they think the doctor ought to be charging.

And the other 50% of that number is credited toward my "out of pocket" limit.

And the rest of the charge - well, we get to pay that, too.

Example:
For the HSG, the radiologist charged (for the two minutes she spent in the room with me) $129.00. The insurance company looked at it and said, "Um, no. We think that procedure is worth $14.15. We'll send the doctor $7.07, and give you credit for $7.08 toward your out-of-pocket." Then the doctor sent me a bill for $121.93.

For the $295 ultrasounds, the insurance company says that they are actually worth $139.32, so they are paying $69.66.

Based on the radiologist's bill, I was afraid we'd end up paying about $225 per ultrasound, and only getting credit for about $70. At that rate by the time we fulfill my $2000 "out-of-pocket" we will have actually spent closer to $6500.

Except that we won't. Because we don't have $6500.

Then, I noticed a few more words on the Explaination of Benefits:
Patient may not be balance billed.

Hmm . . . does that mean what I think it does?

Oh please let it mean what I think it does!

So, I made yet another call to my financial coordinator at the RE's office, then talked to another person there, then faxed her a copy of the EOB.

Yesterday, my guy called back and said that "After doing some more investigating, we've determined that we do participate with your insurance, and you'll only be responsible for the 50% coinsurance."

Woo-Hoo!!!

So, to summarize, I started out thinking we'd pay $147.50 per ultrasound (for example) and get credited for that amount toward the out-of-pocket. I could live with that.

Then, we thought we'd pay $225.43 and only get credit for $69.66. That's not doable, at all.

Now, it turns out that we'll pay $69.66 and get credit for that.

That is so cool!

Especially given that we've already paid in full for everything so far, so we've got lots to be credited to our account. That means that, however the beta turns out next Friday, we probably don't owe them any more money for at least a couple of months.

Now, we just have to decide whether to go back to Dr. B once I'm good and pregnant and the RE releases me, or to find an OB/Gyn who delivers at the hospital that's in network.

Based on what we've learned so far, I'm worried that we'll end up getting stuck with a huge bill if we deliver at the local, out-of-network hospital where Dr. B works.

You know, in most industrialized nations this would all be covered automatically.

And then I'd get to take a year off work to, you know, actually be with the child I've birthed.

Oh, and in many of those countries, we'd be married.

God bless America.