Covered then not covered?

Meritain Kansas

So under my plan, treatment for infertility is not covered. I went to a clinic, and they do testing prior to treatment (ultrasounds, blood tests,etc). They consider that testing part of their treatment, and so would not send in the bill to my insurance, thinking it wouldn't be covered. I sent it in, and my insurance covered it. This submission included the detailed invoice with the diagnosis and treatment codes all right there, as supplied by the clinic when I asked for it.

I paid out of pocket because the clinic wouldn't send it in, and now that the insurance is basically telling the clinic to pay me back, the clinic is now sending medical records to my insurance to fight it.

I am a single mom by choice – no partner – and so based on the medical terms in my plan, and pretty much every other plan I've seen, I do not qualify to be diagnosed with infertility which I'm assuming is their basis for trying to reverse the insurance decision.

Can someone please let me know, in your opinion, whether the insurance is likely to reverse their original decision?

submitted by /u/TimePatient7769
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