I had to pay out of pocket to the provider for a service my insurance covers.
Hi, everyone. I hope you're doing well.
To begin, I had a vasectomy several months ago. When I went to my initial consultation, my provider informed me that I would need to pay out of pocket for a fertility kit and sign some documents. I informed them that my insurance covers the fertility kit. My provider's staff informed me that is not possible and pushed for me to pay out of pocket.
During the consultation, I reached out to my insurance and they confirmed that as long as I pay the co-pay, the fertility kit should be covered. Despite informing the provider staff about my insurance being able to cover the fertility kit, they informed me that I can reach out to my insurance for a reimbursement claim. I proceeded with paying for the kit, but I did not sign the document that stated that I agree that the kit is not covered by my insurance.
Couple weeks later after the consultation, I had my vasectomy. Before the vasectomy began, I was offered Pronox. The provider staff informed me that I would have to pay out of pocket for Pronox. I called my insurance and was informed that as long as I paid the copay, Pronox would be covered. I informed the provider staff this information, but they informed me that I would still have to pay out of pocket and seek reimbursement from my insurance.
After some back and forth with my insurance and the provider, I was denied several times for my reimbursement. What my insurance informed me is the following:
The fertility kit and pronox was not preauthorized. I asked for further clarification and the rep wasn't able to answer. Another insurance rep informed me that since there isn't a CPT code listed for the fertility kit and the pronox on the itemized bill, they are unable to provide my reimbursement. I've reached out to my provider's billing department with and without an insurance rep and they informed me that since they don't have a CPT code listed for the fertility kit and the pronox, they can't bill it to my insurance. I was denied since the insurance paid for those services, I would need to reach out to the provider to seek reimbursement
There are other conflicting statements, but every time I reach out to my insurance and my provider I get a new explanation as for why I am not able to get reimbursed despite receiving current confirmation from my insurance that is something they cover.
Has anyone ever experienced a similar situation? Were you successfully able to get your reimbursement? Would you have any advice for tackling this issue?
submitted by /u/King-of-the-Sky
[comments]
