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Post by twoboyzmom on Jul 18, 2016 15:43:58 GMT
**update posted reply 12**
So, I'm at my 5 year mark for replacing my IUD. I chose not to go to the Dr who's done the last ones, as they changed location and are farther away. I went back to a Dr I used years ago. I went in for a yearly a few weeks ago, and so they could order iud. I get a call last week, and says since they don't have them in the office and it has to be ordered, it isn't covered under my pharmacy benefits (if they had one in office medical benefits would cover 100%)!!
I don't have $1000 to pay for it!
I called the old office and I will have to take time off to get another exam (even tho just had one!)
Then they have to schedule a different day for the iud.
I'm beyond annoyed. Who would you call first? Insurance Co to see what to do? Dr Office u already just saw and wants $ up front?
I'm running out of time on the 5 year mark to replace!!!
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Post by pierkiss on Jul 18, 2016 15:49:22 GMT
Insurance company.
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Post by freecharlie on Jul 18, 2016 15:49:40 GMT
I would see how much an office visit at the old place costs as your insurance won't cover a second one.
Don't stress too much on time, I went well over the 5 year mark and was fine (you might use back up until you can get it).
My insurance covered 100%, but I did have to have separate appointments and pay the co-pay for the 2nd visit.
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calgal08
Pearl Clutcher
Posts: 2,519
Jun 27, 2014 15:43:46 GMT
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Post by calgal08 on Jul 18, 2016 15:49:43 GMT
Maybe the doctor isn't listed as one of your preferred providers? That's the only logical reason I can come up with. A phone call to the insurance company should be able to clarify the exact reason.
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Post by twoboyzmom on Jul 18, 2016 15:52:26 GMT
Well they since since it's ordered thru a certain pharmacy my pharmacy benefits don't cover. It's dumb. But I have to have an exam then iud replacement. They can't bill for both on same day.
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momto4kiddos
Drama Llama
Posts: 5,151
Jun 26, 2014 11:45:15 GMT
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Post by momto4kiddos on Jul 18, 2016 15:53:46 GMT
Insurance company should handle it. As someone pointed out, they are not going to want to pay for another exam either so you're going to have an issue. You should call them to get it worked out.
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momto4kiddos
Drama Llama
Posts: 5,151
Jun 26, 2014 11:45:15 GMT
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Post by momto4kiddos on Jul 18, 2016 15:55:21 GMT
Well they since since it's ordered thru a certain pharmacy my pharmacy benefits don't cover. It's dumb. But I have to have an exam then iud replacement. They can't bill for both on same day. If you have another exam at your previous MD to have it done, they are not going to want to cover the two exams for the same reason (not talking about the placement exam.) |
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Post by twoboyzmom on Jul 18, 2016 15:56:29 GMT
Well they since since it's ordered thru a certain pharmacy my pharmacy benefits don't cover. It's dumb. But I have to have an exam then iud replacement. They can't bill for both on same day. If you have another exam at your previous MD to have it done, they are not going to want to cover the two exams for the same reason (not talking about the placement exam.) That's what I thought. And I also asked if I can transfer them my records from that exam but they said no. I will call the insurance company first. |
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Post by SallyPA on Jul 18, 2016 16:25:37 GMT
I order IUDs at our office. I do not order from a pharmacy (unless you have tricare). I order from The manufacturer directly. Our office pays for the IUD, then when we code/bill insurance, we get reimbursed. It doesn't matter one bit where the IUD came from. The insurance company doesn't even ask that info.
Had your insurance changed since your last IUD? Affordable Care Act mandates contraceptive coverage (including IUDs) but there are a few older, grandfathered plans that do no cover contraception and in that case, the patient is responsible for paying out of pocket first.
You should definitely call your insurance and take with them. It will probably be a hassle, weeding through automated menus, and telling your story To several people, but you'll get the best info and answers. Good luck!
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Post by twoboyzmom on Jul 18, 2016 16:27:27 GMT
This is new insurance thru my job since my last one. I'm on the phone now and they are telling me that I need to pay up front and then file the claim for reimbursement. Yet if it's in office it is 100% covered. Then they are telling me to transfer records from my exam, but not all places will let me do that.
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Post by freecharlie on Jul 18, 2016 16:29:33 GMT
This is new insurance thru my job since my last one. I'm on the phone now and they are telling me that I need to pay up front and then file the claim for reimbursement. Yet if it's in office it is 100% covered. Then they are telling me to transfer records from my exam, but not all places will let me do that. maybe find one that does? What about your pcp? Mine will do it, I just choose to go to an obgyn. |
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Post by twoboyzmom on Jul 18, 2016 16:32:24 GMT
They want me to come in for a first appt, then go back for insertion. I am trying to find somewhere who will let me transfer the records from my exam 2 weeks ago, and just make an appointment to go in and have it done.
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Post by twoboyzmom on Jul 18, 2016 17:29:16 GMT
Ahh problem solved, insurance Co called places for me and found one to do it, and I can have records from exam faxed! Thanks for all replies!
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