Wednesday, August 5, 2009

Insurance companies

Now, I bet you all think this is going to be a post ranting about the bad practices of the insurance companies... Not so! (Not today, anyway!) My insurance company has actually helped me to save quite a bit of money lately. Let me share my "secret", maybe it will help someone else!

My insurance pays for any infertility related services (excluding drugs) up to a lifetime maximum cap of $10k. After that, they pay nothing. So basically, after all my diagnostic testing and 3 IUIs, I was on my own, having reached the lifetime cap. However, I still did 2 IVFs and more diagnostic testing at a new clinic, so I ended up spending about $30k altogether. But it could have been a lot worse.

If you've never heard of the insurance contract rate, you should become familiar with it. Basically, it's the rate that your insurance company agrees to pay your doctor or lab for specific services. For example, I might get a bill from my OB for a regular, prenatal care ultrasound for $250, which is covered by insurance. The insurance company gets the claim, and they "adjust" the $250 to the agreed-upon contract rate of $100 for an ultrasound. Then, the insurance company tells me I have to pay my 15% coinsurance ($15) and the insurance company pays the rest of the contract rate ($85). So the doctor has agreed to accept $100 for an ultrasound, instead of $250.

However, if you're not covered by insurance, the doctor bills you for the full $250, and expects you to pay $250. They expect to get paid MORE by an individual than they are willing to accept from an insurance company.

So here's the trick. I've noticed that on the explanation of benefits (EOB) that you get from your insurance company, they list the contract rate for the procedure in question. Even if they deny the claim because you've hit your limit. With that information, you can negotiate with your doctors and labs to only pay the contract rate. Some real examples I've negotiated:

1) IVF Clinic full rate for IVF w/o ICSI (not incl drugs) = $9410. Contract rate = $7820. Savings = $1600 (x2 for two IVF's = $3200!)

2) Lab full rate for initial bloodwork testing at new clinic = $840. Contract rate = $230. Savings = $610

3) Lab full rate for E2 and P4 bloodwork = $330. Contract rate = $60. Savings = $270 (I saved this at lunchtime today)

That's over $4k in saving right there, and these are just a few examples! My insurance company has a website where you can view and print all of your EOB's. So every time I get a bill from a doctor or lab, I go online and look at the EOB. If the service is not covered, I call the doctor or lab and negotiate to get the contract rate. It's more hassle and more legwork, but it is extremely worth it. The doctors are harder (I had to write a formal letter for the IVF discount, but heck - I basically got paid $1600 for writing that letter!), but my lab (Labcorp) is very easy. They say right on their invoices that if your EOB says to pay less, then you can pay less. I simply call them, tell them what the contract rate is, pay by credit card, get a confirmation number, and poof - I saved $270.

So I am grateful to my insurance company for providing me the contract rate even if the procedure is not covered, and for having a simple to use online system to easily look up old EOB's when needed!

Of course, even better would be if they covered everything, but that's a whole other blog post!

Two other cost saving tips:

1) If your lab is nearby, go to them directly when possible for bloodwork, rather than to your doctor (you'll need the doc to give you a requisition for the blood tests needed). When I was doing the IVFs, and having to go in for regular bloodwork, I realized that the clinic would charge $50-$100 for an "office visit", PLUS you would also have to pay the lab. If you go directly to the lab, you only pay the lab, no "office visit" charge. (I would only do this if it was a bloodwork only visit. If I needed an u/s, too, it was too much of a hassle to visit both places and still get to work on time!)

2) If you get pregnant (yay!), and your insurance doesn't cover infertility related services, make sure your clinic immediately starts classifying the beta tests, ultrasounds and office visits as "prenatal" instead of "infertility". Most insurance covers prenatal care, and once you are pregnant, the services are no longer infertility related. My clinic classified the first visit after becoming pregnant as infertility, so it wasn't covered, but I made them resubmit the claim under prenatal care, and that saved me a few hundred

That's all folks!


  1. That was so nice and helpful of you to post all that information. I hope it helps someone out there and has obviously helped you out a lot.

    Remember my divine (NOT) outside monitoring clinic? I asked them if they would only charge me the contract for my second cycle rate b/c every single penny was out of pocket. They flatly refused me. They said that only if I had a contract with them would they charge me a contract rate. So it's nice that your clinic was cooperative.

  2. I am so glad you outlined this here. I know this information, especially the $$ amounts was a huge help to me. I came home last night and asked my husband if we were able to get that rate, would he consider it?? Flat out say, YES!!! That is all thanks to you!!
    I had a great time last night and it was wonderful to meet you.
    I am sure your child is happy, healthy and strong. I hope you have a great time at the big U/S today--I just know you will!!!!
    Can't wait to hear all about it.