r/HealthInsurance • u/Tough_Cauliflower767 • Apr 11 '25
Claims/Providers 96k bill not covered
My wife and I are seeing a fertility doctor. The MD was adamant my wife needed surgery to clean out the fibroids and polyps in her uterus to improve conception. Prior to surgery, i confirmed over the phone that this was covered by my insurance. The fertility clinic said it's covered beside a $400 anesthiesia fee and good to go. Post surgery I got a bill for $3500 because apparently not everytning was covered. I reached out to the clinic and they don't know why it was denied. I sent an appeal to bluecross after that. Just got a notice in the mail that the appeal was denied and we owe 96k!?!?
It's after hours but I will follow up with them tomorrow. Praying this is a mistake. I feel like this is a he said she said with the insurance coverage. How can they tell me it's covered and then send me bills. Am I liable. Who os at fault.
Thank you
6
u/catsmom63 Apr 11 '25
Coverage for fertility issues would be outlined in your policy.
I’d check online for coverage, and then call to discuss.
As someone who worked in insurance ( not health insurance) never ever take a doctors word for whether something is covered or not.
They ( your doctor) would not know in most cases, you need to refer to your health insurance policy contract which should be online.
My sis suffered infertility (Endo) and went through multiple rounds of IVF to no avail. Luckily her hubby’s policy was the best of the best insurance wise and covered everything.
Not all insurance carriers will cover infertility issues or surgeries related to them.
You will need to speak to BlueCross to get your answers.