Current clinic refusing to submit claim to our insurance. They are saying we aren’t covered. However, we were covered for the same procedure at a different clinic and they’ve been incorrect about our coverage before. Any advice?

Background: We have been going to see a fertility clinic to have IUI done. As part of the process, mid-cycle scans are required. Our insurance covers infertility but not assisted fertilization. At the previous clinic (associated with a private university), the mid-cycle scan was covered by our insurance and billed as a pelvic ultrasound. The IUI was not covered as was expected.

Current Clinic (associated with a public university): For our initial visit, they claimed that our insurance does not cover infertility and that we owed them $300 for the visit. We told them this is a mistake and to submit to our insurance anyway. They submitted to our insurance and our insurance said it was covered and we owe the copay only of $30. We go forward with the IUI with this clinic. This clinic then claims that the mid-cycle scan is part of the IUI and, because our insurance doesn’t cover assisted fertilization, is not covered. We claim that the mid-cycle scan would be done whether we were simply monitoring, inducing ovulation, or using assisted fertilization techniques and that it should be billed as a pelvic ultrasound like with our last provider. We asked them to bill it to our insurance anyway and they refused to instead saying that we are welcome to submit a claim with our insurance manually. I’m not sure what to do after this point.

Questions:

I recognize that with something as complicated as health insurance mistakes, technicalities, and intricacies are everywhere. Has anyone run into this issue before?

Can they just refuse to submit to insurance like that? They were incorrect the first time and still submitted it. Are they really allowed to just not do it? Even if they’re associated with a public university?

Is our reasoning sound that because the scan would happen whether or not we used AFT, our insurance should cover it? Our insurance seems to agree with this standing as they accepted the scans at our previous clinic 4)Is there a problem with submitting the claim after we get billed by the current clinic? One reason I want them to submit directly to insurance is that I’ve previously had my insurance use a code review process to get things the were coded incorrectly corrected. Do I still have the ability to do this process if I submit a claim manually?

Thanks for the help!