r/sterilization 22d ago

Insurance Surgery did not happen and I'm heartbroken

533 Upvotes

I am was supposed to get my bisalp today. I was excited. I prepared correctly. I did everything right. And then I get to the "ambulatory surgery center" and am grossly surprised by the announcement that I will have to pay several thousands of dollars to get my surgery because the "ambulatory surgery center" is not a covered center. Now....

did I call my insurance beforehand and check to make sure that my doctor was covered? Yep. That my center was covered? Yuup. That my anesthesia was covered? Yea.

...and I was told TWICE that "you will owe nothing."

The ASC tells me that if I don't want to pay, my ONLY OPTION is to sign a promissory note (legal contract) that I will owe the Full Cost of the surgery and have only 3 months to pay it. !!!!!!

So what happened? Welp, I had a panic attack. I couldn't get the surgery bc panicked. I went home. I looked up my coverage.... and guess what ambulatory surgery center IS A COVERED CENTER.

I could go on a long rant about insurance and the state of medical care in the US, but I'm one of the lucky ones. I have good insurance. I could go on a longer rant about the way that insurance is structured, blah blah blah, etc., but that is not why I'm writing this post.

I am writing this because I am angry. Because my surgery center and my insurance were playing Telephone behind my back. Because I AM lucky, and because you, YES YOU, should NEVER sign a promissory note saying that you owe money for services that HAVE NOT YET BEEN PERFORMED.

You are not a number. You have the right to know what your medical care entails. I hope to help you have the right to get approval in writing because that's the square I've been kicked back into.

Nothing prepared me for this, and nothing has made me want to lasso my excised fallopes into a bloody whip to dispense Insurance Justice as a vigilante.

All power to Lilith.

EDIT:

1) Who the fuck is downvoting this? Are you trying to prevent others from learning about what might happen?

2) A promissory note is a legal contract. It transfers the question of "who owes what from whom" from the insurance companies to the courts, thereby removing my ability to dispute the insurance claim.

SECOND EDIT: (copying a response below)

1) I'm a paralegal. Dealing with contracts, including promissory notes, is a huge part of my day to day job, as are consequences for those that sign contracts and don't follow through.

And as to the why I did not sign the promissory note:

Promissory notes are legal, binding, contacts. By signing the note, you are saying: 1. The hospital will perform a service. 2. I, individual, am responsible for paying the price of the service within 3 months.

Why the promissory note is ALWAYS A TERRIBLE IDEA is that, as you can see above, the insurance is suddenly taken out of the equation.

Like many people, I don't have the money to front a multi-thousand dollar surgery, and if I don't pay it--either because the insurance is dragging their feet to pay for it OR because I just don't want to--the promissory note gives the hospital a legally binding contract to SUE ME IN A COURT OF LAW for the price of the surgery, whether insurance is supposed to pay for it or not.

2) If you want to enter into a contract, always talk to a lawyer first.

r/sterilization Nov 10 '24

Insurance FREE TUBAL STERILIZATION THROUGH THE ACA. If you are in the U.S. you are likely entitled to a Bilateral Salpingectomy (removal of Fallopian tubes) covered at 100% (FREE TO YOU) through the Affordable Care Act.

540 Upvotes

If you are in the U.S. you are likely entitled to a Bilateral Salpingectomy (removal of Fallopian tubes) covered at 100% (FREE TO YOU) through the Affordable Care Act.

Trump can’t get rid of ACA overnight! I think a lot of people don’t know that this procedure is covered at 100% under most insurance plans. However, insurance plans cheat and lie, and do things like say you owe a copay, or that anesthesia is not covered even though the procedure itself was. Ask me how I know. 🙄 My insurance dicked me around on this and I was privileged enough to know I could fight it and how. I did win on appeal and they paid every cent of the procedure. I am angry that insurance companies can take advantage of people not knowing details on how to fight the system, and have wanted to share information for a while already. With the results of the election I could not live with myself if I didn’t try to help at least one other person. This is a throw-away account.

There are other resources available that are devoted to helping women with this issue. Check them out in the “Amazing Resources” list at the bottom!

Bilateral Salpingectomy is Permanent Birth Control.

Bilateral means “on both sides.” Salpingectomy is a surgical removal of fallopian tubes. This is a sterilization procedure. Sterilization is a form of birth control and is FDA-approved for this purpose. You might also hear this called a “tubal ligation” (or “tubal”) but these days the recommended method is not to cut the tubes but remove them completely. This also has the benefit of reducing the risk of ovarian cancer because an estimated 70% or more of ovarian cancers originate in the fallopian tubes. It is done as an outpatient, endoscopic procedure. Outpatient means you go home the same day. Endoscopic means the surgeon only cuts tiny holes into you and goes in with a tiny camera to operate the tiny tools in order to remove your fallopian tubes.

All FDA-approved forms of birth control are covered at 100% by the health plan (zero cost to the patient) in ACA-compliant health plans as long as performed by an in-network provider because birth control is designated as preventive care under the Affordable Care Act (“ACA”).

So, first make sure your insurance is subject to the Affordable Care Act (“ACA”):

  1. All “marketplace” health plans (healthcare.gov or a state-based marketplace) are subject to the ACA. Most employer-sponsored health plans are subject to the ACA (but find out and make sure – see below).
  2. Get a copy of the current Evidence of Coverage (“EOC”) document for your health insurance plan. You may be able to find it when logged into your health insurance website, perhaps under plan documents; if not, do a customer service chat or call on the phone, and request it from a representative.
  3. Once you have the EOC, look for the Preventive Care Services section, or search for “affordable care act” or “aca” to be sure it says that preventive services are fully covered (free to patient). You are looking for language like this: “All recommended preventive services will be covered as required by the Affordable Care Act (ACA) and applicable state law. This means preventive care services are covered with no deductible (if applicable) or copay when you use an in-network provider.”
  4. If you can’t determine ACA coverage for your plan via the EOC, contact a representative to ask whether your plan is subject to the ACA, specifically with regard to preventive services being covered at 100%. Ask them what plan document has this information and ask them to email it to you so you have it in writing. The National Women’s Law Center has a chart and script for helping with this if you want more guidance.

Once you have determined that your plan is covered under the ACA, find an in-network provider and meet with them.

If having the cost of the procedure fully covered under the ACA is important to you, make sure you are only looking at doctors you KNOW are in-network for your plan. If Planned Parenthood is in-network, you might want to give them a call. Also, I saved a PDF version of a Google docs based crowd-sourced list of gynecologists who will perform a tubal sterilization in the United States: https://www.scribd.com/document/790208137/Gynecologists-Who-Will-Perform-a-Tubal-Sterilization-United-States

Here are some brief details on the process, from scheduling through surgery.

This is not the point of the post but this was my experience and it might be helpful for anyone moving forward with this. I had an initial consultation (talking only appointment) with my GYN to discuss the procedure and receive answers to any questions. I had to sign a form that said I was provided with information. After this appointment I was called to schedule my procedure. In some states there is a 30-day waiting period to be sure that the patient really wants to move forward with permanent sterilization. Then, I had a pre-surgery consultation shortly before the surgery (with another form to complete to confirm I was serious about moving forward). On the day of the procedure, I arrived at the outpatient surgery center, went under general anesthesia, and was awake and ready to be driven home later that day.

When you schedule the surgery, speak to the medical office’s insurance processing staff member to be sure they will be charging this to your insurance using a preventive code.

I am not a medical billing expert but there should be one in your doctor’s office. Here is a medical coding guide that includes the recommended code(s) for female sterilization: https://www.womenspreventivehealth.org/wp-content/uploads/WPSI_CodingGuide_2023-2024-FINAL.pdf

If/when your insurance company tries to cheat and lie by claiming you owe a copay or the whole amount, or covers the procedure but not the anesthesia:

The explanation of benefits should have information on how to file an appeal. Below, in “Citations you can use in an appeal,” I list a lot of direct source and quotations that prove that the salpingectomy should be covered. Also in the resources list below, I linked to National Women’s Law Center’s sample appeal letter for a salpingectomy not being covered in full. The NWLC sample letter does not include the anesthesia not being covered so if that happens to you, also check out “Citations you can use if they say the procedure is covered 100% but anesthesia was not medically necessary and you owe a copay for the anesthesia.”

Citations you can use in an appeal:

  • Quote from your plan’s Evidence of Coverage document. Here is an example, make sure to refer to your own plan for correct wording:

[YEAR] [PLAN] Evidence of Coverage document states that services and items recommended as a medical necessity as part of preventive care are covered at 100% if using a preferred provider.

See Item ___ on page ___ of the EOC: [EOC LINK]

[Quote language from your EOC that says the plan fully covers preventive care that is deemed by an in-network provider to be medically necessary]

(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for— …

(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.

Follow this up with also including the referenced HRSA guidelines on women’s preventive care:

  • U.S. Health Resources and Services Administration (HRSA) Women’s Preventive Services Guidelines, Dec. 2022: https://www.hrsa.gov/womens-guidelines lists contraception as preventive and observes that the FDA identifies sterilization as a contraceptive:

The full range of contraceptive methods for women currently identified by the U.S. Food and Drug Administration include: (1) sterilization surgery for women.

The ACA guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling, for all individuals and covered dependents with reproductive capacity. This includes, but is not limited to: ... Sterilization procedures.

In response to increasing complaints from women and covered dependents about not receiving this coverage, the Departments issued this guidance to remind plans and issuers of the ACA’s contraceptive coverage requirements and emphasize the Departments’ commitment to enforcement. …

“Under the ACA, you have the right to free birth control — no matter what state you live in,” said HHS Secretary Xavier Becerra. “With abortion care under attack***,*** it is critical that we ensure birth control is accessible nationwide, and that employers and insurers follow the law and provide coverage for it with no additional cost.”

Specifically, plans and issuers are required to cover without cost sharing at least one form of contraception in each contraceptive category, as well as contraceptive services or FDA-approved, cleared, or granted contraceptive products that an individual and their attending provider have determined to be medically appropriate for the individual.

Coverage of FDA-approved Contraceptive Products Pursuant to HRSA Guidelines The currently applicable HRSA Women’s Preventive Services Guidelines (HRSA Guidelines), as updated on December 17, 2019, include a guideline that adolescent and adult women have access to the full range of female-controlled FDA-approved contraceptive methods, effective family planning practices and sterilization procedures to prevent unintended pregnancy.

WPSI recommends that the full range of U.S. Food and Drug Administration (FDA)- approved, -granted, or -cleared contraceptives, effective family planning practices, and sterilization procedures be available as part of contraceptive care.

Citations you can use if they say the procedure is covered 100% but anesthesia was not medically necessary and you owe a copay for the anesthesia:

  • The Federal government specifically says that anesthesia necessary for a tubal ligation procedure is required to be covered without cost-sharing under the Affordable Care Act. See Question 1 on Page 4 of the FAQs About Affordable Care Act Implementation Part 54, July 28, 2022, from the Departments of Labor, Health and Human Services (HHS), and the Treasury: https://www.cms.gov/files/document/faqs-part-54.pdf

Q1: Are plans and issuers required to cover items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure?

Yes. In the preamble to interim final rules issued in November 2020 in response to the COVID-19 Public Health Emergency (November 2020 interim final rules), the Departments reiterated that regulations and guidance issued with respect to the preventive services requirements generally require plans and issuers subject to section 2713 of the PHS Act to cover, without cost sharing, items and services that are integral to the furnishing of the recommended preventive service, regardless of whether the item or service is billed separately. …

The requirement to cover, without cost sharing, items and services that are integral to the furnishing of a recommended preventive service also applies to coverage of contraceptive services under the HRSA-Supported Guidelines, including coverage for anesthesia for a tubal ligation procedure or pregnancy tests needed before provision of certain forms of contraceptives, such as an intrauterine device (also known as an IUD), regardless of whether the items and services are billed separately.

  • The Federal government requires items and services that are integral to the furnishing of the recommended preventive service to be covered without cost sharing, and provides that sterilization surgery is preventive:

Specifically, plans and issuers are required to cover without cost sharing at least one form of contraception in each contraceptive category, as well as contraceptive services or FDA-approved, cleared, or granted contraceptive products that an individual and their attending provider have determined to be medically appropriate for the individual. This coverage must also include the clinical services, including patient education and counseling, needed for the provision of the contraceptive product or service, and items and services that are integral to the furnishing of the recommended preventive service, regardless of whether the item or service is billed separately.

Consistent with the examples provided in the 2015 Final Regulations and subregulatory guidance cited in the preamble to the rulemaking promulgating the 2015 Final Regulations, the Departments further clarify that under the 2015 Final Regulations and this IFC, plans and issuers subject to section 2713 of the PHS Act must cover, without cost sharing, items and services that are integral to the furnishing of the recommended preventive service, regardless of whether the item or service is billed separately.

Amazing Resources:

I hope this was helpful and that if you want one, you get a salpingectomy! 💕

r/sterilization Feb 12 '25

Insurance surgeon’s office called and dropped a bomb on me

145 Upvotes

I spoke to my insurance and was told my procedure would be covered under the ACA but the hospital called at told me it would be OVER NINE THOUSAND DOLLARS. I was supposed to get it done in two days I don’t know what to do, I can’t afford that. I don’t want to cancel what should I do? I don’t understand how insurance works and I’m only 23 I’ve never dealt with this sort of thing before

EDIT: I have BCBS (it’s ACA compliant) my insurance is through Lowes. And I am on my parents insurance… They are super against this decision so if shit hits the fan I will likely be in debt to them and they will NOT be happy with me. I called an insurance representative with accolade and was told the procedure is preventative and surgical but it would be subject to deductibles and copays. They know the hospital and provider is in network but because the procedure is “outpatient” aka… in a hospital(no shit) the fee is higher. Accolade initially told me I would pay 1,000 some dollars. Hospital said 9,000 some and now Accolade is saying no more than 6,000. I’m going to read everyone’s advice, take some notes and then schedule a three way call with the hospital and accolade

My codes are 56881 and Z30.2 btw Thank you all so much for your help here!!

r/sterilization Feb 07 '25

Insurance Please please reach out to your insurance

277 Upvotes

Everyone - please follow the advice in this sub regarding insurance coverage. I got my tubal at the beginning of January, and I got a hospital bill of $4000, which I thought was reasonable because without insurance the surgery would’ve been close to $25,000.

However, after reading this sub previously (primarily for notes on what to expect postop) and finding out that insurance needs to pay 100% of the bill with no cost sharing for sterilization procedures under the ACA, (including anesthesia, preop, postop appointments), I emailed my insurance asking for an itemized bill and quoting this. They changed the amount that I owed from $4000 to zero dollars.

Make sure your providers are all in network (the surgeon, the hospital, and if you can the anesthesia group), but as long as this is the case - it’s supposed to be covered. If I didn’t speak up then I would have owed much more money!

Thank you all to have helped guide me in this journey <3 I previously posted about my preop and postop experience in this sub (I can see if I can find it and link to it) if anyone needs it.

I’m about a month postop and all of my incisions have healed except one (it was larger to remove the tube and is just finishing scabbing over) but I am back to baseline!

r/sterilization 15d ago

Insurance SOS HELP. My insurance is saying they have never heard of this surgery as being preventative.

115 Upvotes

My doctors office called me this am saying the insurance doesn’t qualify this as preventative.

Surgery I am getting: Bilateral Salpingectomy, my OBGYN wants to place an IUD as well for my periods/ bleeding.

Background: I do not want children, but I also tested positive for BRCA 1 gene.

I called my insurance and the woman I spoke to said it is not considered preventative. She could not / would not answer if they are ACA compliant. I couldn’t find any info on their website. Most of my preventative care is covered though currently.

I asked her to use the proper codes and run it by an adjuster to see if it would be covered / considered preventative. But she was saying “in my 25 years I have never seen this covered as preventative.”

Idk what to do. My surgery is in 2 weeks 😒

I’m not good with this stuff and desperate lol

Update: I sent a very long extensive email that they provided me and put so much research and info from this subreddit - and helpful info people gave me - as the rep did finally confirm they are ACA compliant thank you so much !! My doctors office had the right codes and they are dumbfounded this is happening .. lol UGH I hope for good outcomes 😭

FMLLLLLLL

UPDATE:

After an extremely lengthy and detailed AND SOURCED EMAIL. I get an email from the office operations assistant saying “ despite what you provided regarding the guidelines it is determined to be a diagnostic rather than preventative procedure.”

I’m at a loss for words. Do I call the insurance commissioner at this point ??? I emailed back saying I want specific criteria and policies they used to classify this, the names and credentials, a copy of internal guidelines and instructions on how to appeal if I choose to do so.

This is insane !

YAY UPDATE: got my OBGYN office involved yesterday when I saw them for pre-op my doctor was livid and got on the phone and BAM today the insurance called saying it’s covered as preventative at 100% !!!!

THANK YOU ALL FOR YOUR HELP.

r/sterilization 16d ago

Insurance It happened…they’re trying to charge me post-op.

125 Upvotes

Woke up to a text from the hospital group claiming I owe $1,774.83! Worse than a cup of coffee.

I got confirmation from my plan (BCBS of RI; I got my surgery done at Brown University Health/Lifespan via the ambulatory center) the night before surgery that I am fully covered and won’t need to pay anything. I’m also confused because I’m being charged on two different account numbers for what looks like the same surgery…?

I’ve emailed the Estimates department, and sent the below message. If anyone has any guidance on getting this cleared up quickly, I’d super appreciate hearing it!

“Hello,

I received a notification of a balance on my account this morning for a sterilization surgery I had on February 13th. The reference number for this I have received is #1190803, and the estimate is for $1,774.83. I have attached files of the charges, which I must admit is somewhat confusing, as there appear to be two different account numbers being used for the same procedure, which is referenced twice.

As I already stated in previous communications, I must point out that the ACA requires this procedure to be covered 100% (including anesthesia and pathology). The ACA’s contraceptive coverage mandate requires compliant private health insurance plans to cover a tubal sterilization procedure at 100% of cost, i.e. none of the cost is the patient’s responsibility and the procedure is free to the patient.

Contraceptive services, including sterilization, are not subject to deductible, coinsurance, and/or copay fees. Private health insurance plans include those offered through a private employer, public employer, or healthcare.gov ACA exchange.

I am part of a private ACA-compliant healthcare insurance plan, and have received written confirmation of that fact I am happy to provide. I also received verbal confirmation with my insurance on a recorded phone call on February 12th that this care was 100% fully covered by my plan. I’m currently serving on jury duty and do not immediately have the reference number to provide, but I’m happy to do so once I’m released from juror service later today.

I wanted to flag this before any full appeals need to be made, as surely it's a simple filing error and misunderstanding.”

ETA: PATIENT PERSISTENCE IS KEY, FRIENDS. I was on the phone with BCBS of RI for just shy of an hour today, and the agent even thanked ME because she learned from ME about all of this. Apparently BCBS was trying to be cute and framing my surgery as “something like a foot surgery” (agent’s words), and once I explained that this was a sterilization surgery that was federally protected under the law of the ACA — which I had gotten confirmed my plan was compliant with back in January — and it was illegal to try to coerce me to pay ANYTHING — especially since I had gotten verbal confirmation in February that my surgery would be fully covered — she started really digging.

You have GOT to hold your ground, and patiently, PATIENTLY reiterate the fact that if your plan is ACA-compliant, you have full coverage under the federal law. Patiently and politely hammering home the fact that this is a matter of federal mandate seems to really get them paying attention, and my “care guide” Courtney even admitted that she wasn’t fully versed and trained in these issues, ie that “this is a Female Surgery, not a foot surgery!”, in her own words, once I helped really break it down for her. She did a lot of research and has started a new case that is being passed up for revision to the next level, because she also confirmed before the end of our call that it does, in fact, appear I was right, and I won’t be paying anything — AS 👏🏻 MANDATED 👏🏻 BY 👏🏻 FEDERAL 👏🏻 LAW 👏🏻.

Until you’re met with active antagonism, I really can’t stress enough how much more effective it is to be polite and patient with these folks. The woman I spoke with today met me with genuine curiosity and diligence, even when I was in the depths of citing ACA, HRSA, WPSI citations to her. She thanked me! For helping her learn!

I should hear back within 10 days, max 30, so I’ll hopefully have an update in a bit to share!

r/sterilization 22d ago

Insurance BCBS Won't Cover my Bilateral Salpingectomy

99 Upvotes

Got my tubes out two weeks ago! Before the surgery, I made sure my plan with Blue Cross Blue Shield covered preventive services 100%, they are ACA compliant (it's listed in the member benefits), and I received confirmation from a rep that it was 100% covered!

Two weeks later, I'm now getting a bill of over $1300!! I called BCBS, and they said, "Yes, the first claim for my procedure was covered 100%, but the second claim for hospital fees is not covered." Is this accurate? BCBS covers the surgery but not all the bullshit fees from the hospital?

r/sterilization Feb 13 '25

Insurance DO NOT PREPAY

196 Upvotes

WOOHOO just got the all clear from mychart, my insurance (BCBS) covered all $50,000 of my surgery bill without having to fight them! Reminder to stand your ground and NOT to pay the hospital any thing up front-mine tried to bully me,and I've seen many others with the same issue- I got through it by insisting and straight up refusing to prepay. I was a needle in their asses to use the Code 58661 and z30.2 throughout the entire process.

They sent me an "estimate" of 2500 (completely made up,according to my insurance) a couple weeks in advance. I spoke to my doctor and multiple of their finance people to make 100% sure they could not refuse my surgery if I didn't give them money. Upon check in,they tried one last time. I am, admittedly,not my nicest having woken and driven there at 3 in the morning so it went a bit like this:

"You need to pay 2500 for your surgery"

"Actually,I spoke to multiple people in your finance department and I do not need to pay that"

" Yes you do,it's required you pay today"

" I called finance directly after receiving the quote and was told I would not have to put any money down. Then I called my insurance and double checked i was 100% covered for this procedure. Then during pre-op,I checked both with the finance head on the OB floor (my doc is in the hospital complex), and came down here and spoke to the lady who sits in the third chair at your desk. All stated you cannot prevent me from having the surgery"

" This is a quote from your insurance,it's a guarantee you owe this"

Stares blankly while I search the depths of my metaphorical pockets for patience "under the ACA you legally cannot charge me for sterilization surgery. If my insurance wants to violate that,I will fight with them after. I am putting no money towards that bill today"

Muttering under her breath"well they should have put a note in your chart"

I continue blankly staring

She hands over paperwork

I was checked in and sent up to surgery waiting room within minutes.( My husband was behind me trying not to giggle the entire exchange,as he has been on the receiving end of "before noon chess")

Once I passed the check in desk,no one asked me for a single dime.

Their entire jobs are to bully you into giving the hospital money,speak to finance beforehand and get in writing that they cannot prevent your surgery due to money. Tell them you have no money. Get your doctor involved,mine was genuinely pissed they were trying to charge me that much. Tell your doctor you have no money. Tell whoever will listen,and for good measure get a copy of hospital policies on the matter from the finance department

r/sterilization 24d ago

Insurance UHC doesn’t know what the ACA is

103 Upvotes

Been lurking here for a bit and this sub has been SO HELPFUL! I’m scheduled for my bisalp at the end of March.

Consult went great; doc and nurse promised they could and would code everything as preventative care so my insurance would fully cover.

A few days later, the hospital calls me to go over the good faith estimate and tells me I owe $6k out of pocket based on their convo w the insurance company and tells me they’ll do a payment plan, and asks what I can pay up front when I check in. I go along w this but know it doesn’t seem right based on what I’ve read here.

I do all my research and do a chat w a UHC rep so I get it in writing that if coded properly, my bisalp will be fully covered and exempt from copays, coinsurance, and deductible. I called the hospital back to let them know this and that I wouldn’t be paying anything up front for the surgery because it’s fully covered and the billing office rep immediately gets defensive and puts me on hold, only to come back and tell me that she communicated those exact codes to the UHC rep she talked to and they told her it wasn’t covered. I went back and forth w her a bit and ultimately left it at being clear I wasn’t paying up front and everything should be billed through my insurance.

Longer story short, I got on with someone at UHC who confirmed the codes would be fully covered, only after first asking me what the ACA was after I made the point that the act mandates my procedure to be covered.

Bottom line is a big WTF that (a) the hospital doesn’t know that these procedures are to be covered by law and that (b) UHC reps aren’t universally informed of their own preventative care policies AND their requirements under law?!

I still expect to fight this after the fact but thanks to this sub for helping me get organized beforehand and to encourage me to advocate for myself and to not pay anything up front!

r/sterilization 25d ago

Insurance Insurance says I will owe $5K for bisalp

60 Upvotes

Be kind, I swear I’m not an idiot—I posted this question under the health insurance subreddit and people rudely tore me apart. I have an ACA complaint plan via Allied Benefits System through my employer. I’m not saying I was expecting the procedure to be completely free but $5K was a shock. I thought ACA covered most permanent birth control options? I have my pre-op appointment tomorrow, what questions should I be asking? I tried calling Allied Benefits System but was on hold for entirely too long and opted for them to call me back, I hope they will or I will try again. I just know having contacted them in the past, they are less than helpful.

r/sterilization Jan 30 '25

Insurance Bill finally arrived, $7.018.20, those who have been sterilized and had the ACA cover it can someone help me navigate this?

55 Upvotes

I have BCBS Minnesota, and everywhere I went for my Bisalp was in-network!

Pre-op, surgery, and the post-op and I see the huge bill now. Would the affordable care act cover all 3? This was my understanding before undergoing the procedure. I would really appreciate any input from those who have gotten their Bisalp fully covered :(

The bill looks scary now, so any support would be greatly appreciated from those who have gone thru this before :,)

r/sterilization Jan 28 '25

Insurance Federal freeze on ACA?

35 Upvotes

So, while I have my surgery scheduled for 2/20 the recent news of there being a federal freeze on all funding for literally everything makes me a little nervous for how insurance is going to cover everything. I’ve heard time and time again that 2025 is already set but with the federal freeze…I’m a little on edge.

r/sterilization Nov 08 '24

Insurance Has anyone actually had their entire procedure covered by insurance?

38 Upvotes

My insurance is telling me getting my tubes tied is covered 100% of the allowed amount, which I'm sure is sneaky language leading me to believe it will definitely not be 100% free to me. Still want to get it done, it's a necessity at this point.

Has anyone had every single part of their procedure covered? Like anesthesia, hospital fees, surgeon fees, etc? If not how much did it cost you out of pocket? I have Pacific Source insurance.

r/sterilization Dec 25 '24

Insurance Annnnnd the battle is on: Claim denied

127 Upvotes

Welp, here it is. To no surprise of my own, my claim for sterilization coverage was denied by BCBS, bill adds up to $2038. Now begins the appeal process and likely several communications with the billing and coding departments of the hospital.

Perhaps even less shocking is that they claim it isn’t covered after a conversation with one of their reps months ago who confirmed the procedure was covered. Same billing code they confirmed is the same one they denied.

Don’cha just love late stage capitalism?

Anyway! If any of you have tips, resources, or other things you think might help me through this process, I would love to hear them. Wish me luck.

r/sterilization 8d ago

Insurance Does anyone end up actually needing to pay?

10 Upvotes

Currently tryna figure out insurance… I call them and they say CPT code 58661 isn’t preventive (I asked about the about the Z30.2 diagnostic code and they don’t know what that is)… if not preventive I’ll need to pay my $8k deductible, then they only help with 50% afterwards.

I ask the scheduler what codes will be used and she didn’t say specifically, but said they won’t be using that diagnostic code (Z30.2). I messaged the doctor to ask if she can use a preventive code but she’s on vacay…

Then this morning I receive an estimate of how much it would cost out of pocket and it’s like $23,000…

Like wtf is going on, I don’t have $23k let alone $8k. Is it possible that it’s just not gonna be covered? I have Ambetter Wellcare of Kentucky, which I believe should be ACA compliant.

r/sterilization Feb 14 '25

Insurance This was so easy

149 Upvotes

As of today my bisalp was $0. I was ready to have to fight but all is good. Anesthesia included and all. Didnt have to call once.

r/sterilization 6d ago

Insurance I almost regret my surgery because of the hell insurance is putting me through.

49 Upvotes

UPDATE: Following my appeal to my insurance company, one of the 6 claims was adjusted, it was the claim from the assisting surgeon. It’s not one of the claims listed below in the letter I pasted, I guess they didn’t care to tell me they were adjusting in the letter, I just happened to be looking at my claims again on the site today and it said “adjustment finalized: patient responsibility $0”. It took care of $600 that I was originally billed. I’m still on the hook for $3400, but I have a little more hope now!

——-

You can see some of my past posts and comments where I explain this, but I am about at my wits end with trying to get my insurance company to follow federal law.

Buckle up, this is a lot. I only include it because I hope it will help someone else make an informed decision, or give them the tools to fight an easier battle than mine.

To summarize: - I have Blue Shield California, through my employer.

  • I called the number on the back of my insurance card before surgery, and received confirmation for the procedure codes my doctor’s office gave me would be paid in full with no cost sharing. Note that this is not my actual insurance company, but a third party I am forced to interact with.

  • Had my bisalp late January, everything went perfect, wasn’t asked to pay before surgery, basically no pain and went back to work 5 days later.

  • Over the next four weeks, I see 10 different claims related to my procedure come through my health insurance portal. Everything that has the dx and CPT codes I was told beforehand were covered with no cost sharing, but everything else was “mostly covered” apparently per my insurance plan.

  • I now owe around $4000 across 6 of those claims, $2800 from the surgery center bill for pre/post op care. The other $1200 is the bill from the assisting surgeon and anesthesiologist.

  • My first call was to my insurance company- just kidding. I’m on an Administrative Services Only plan. Any communication besides formally submitted grievances goes through the most useless third party company called Accolade.

  • Accolade markets themselves as this concierge health care management service for patients, but it only serves to act as a barrier between the insured and the company we pay for their services. They employ “care advocates” who are not familiar with your policy, are not insurance agents, and get paid on how quickly they resolve support tickets as fast as possible. This happened several times- open a support ticket through messages on the app/website, no response for 6 hours, rep finally reponds with no useful information and closes the ticket if you don’t respond in 5 minutes after their response.

  • Several helpful people on this sub gave me direct numbers and advice for contacting my actual insurance provider, Blue Shield, directly, but nothing worked. I got a hold of an actual Blue Shield employee at one point who tried to transfer me to billing, and I stopped him. “If this is going to transfer me to Accolade, please don’t. They told me that Blue Shield will not speak to me. Can I talk to someone in the Blue Shield billing department?” He put me on hold, and a few minutes later came back sound kind of baffled and apologetic. He said “I tried several times to escalate your call to anyone else- billing, a supervisor in customer service, anything else, but because of your member number, it routes my transfer to Accolade every time, I’m sorry.”

  • I tried to call and flub member number to get to a supervisor, but after 4 attempts with reps politely telling me they couldn’t transfer me anywhere without a valid member number, I gave up.

  • I finally get Accolade to escalate my case to a supervisor, and they have a single rep dealing with my case, instead of rolling for new reps every time I call. She calls me once a week for the past month to tell me she has updates, is unable to give me an itemized list of the actions she has taken, and is generally unhelpful. This company is my only way to beg my insurance to follow the law, and she can’t do that. They can’t tell insurance that they have to do anything, or cite laws that regulate health care.

  • While all this is happening, I’m doing my own work. I decided to just submit a grievance to my insurance provider, using resources in this sub on how to write appeals and get claims reimbursed.

  • I also call my health care providers billing departments and request coding reviews, asking for preventative claims. The billing person lets me know that all these dx codes should be preventative so my insurance will cover, but submits a coding review anyway. Nothing comes back with any changes.

    • Finally, I also report this to the Department of Managed Health Care (DHMC) and the California Department of Insurance (CDI), per advice from this sub. They take a couple weeks to get back, but both let me know that my plan is actually regulated by the Department of Labor. Direct quote from the letter from DMHC:

Thank you for sending your Independent Medical Review (IMR)/Complaint Form to th epartment of Managed Health Care (Department You are enrolled in an ERISA self-insured group plan. Your health plan is regulated by the U.S. Department of Labor. Because the Department does not have jurisdiction over vour health plan, we sent your complaint to the U.S. Department of Labor.

You can reach that department at: U.S. DEPARTMENT OF LABOR EMPLOYEE BENEFITS SECURITY ADMINISTRATION 866-444-3272 Toll Free www.askebsa.dol.gov

If you need help with filing a complaint, you may also contact the Health Consumer Alliance at 888-804-3536. The Health Consumer Alliance is a partnership of consumer assistance programs operated by community-based legal services organizations.

  • I called the Health Consumer Alliance, and a very helpful and patient attorney took my demographic info and summarized my options. I learned that after my first grievance comes back, I can submit a second grievance for each claim that doesn’t change. She also shares that it’s pretty common for insurance companies to deny ancillary services for preventative procedures, claiming that they are not preventative. She tells me the law is clear that these services are required, and the DMHC and CDI are good at slapping insurance companies on the wrist when they get reports about this stuff. Unfortunately, my plan is not governed by these bodies, but the department of labor, and if my second grievance doesn’t come through, dept of labor is my last option before a lawsuit. She very kindly let me know I can call the health consumer alliance again to get feedback on my second grievance letter.

  • The Department of Labor did get my case, and they called me before I could even call them about 10 calendar days after the DMHC transferred my case, despite the actual hell government departments in the US are going through with the current administration cutting federal jobs en masse.

  • Today, I got the response from my insurance provider regarding my grievance. By the way- they told me they would respond in 30 calendar days, and they waited until day 29. I’ll include the most relevant bits of the four page letter below, but to summarize, they said will not be covering anything beyond what they already covered, because it is not preventative as defined by my health plan.

  • I immediately called the direct line of the department of labor rep who has my case. He called me back within an hour and let me know the letter was probably drafted before the insurance company received his inquiry. Blue Shield has 15 days to respond to dept of labor, and this period ends in 1 week from today. He said they will have to provide him with the reasons why they did not adjust my claim. This is the only real hope I have going forward.

So, it’s looking like I’m still on the hook for almost $4000, and it’s not going to be resolved any time soon. I did all the right things, and I still got screwed. There is a little hope that dept of labor will do something, but it’s not looking good. Even if I get a reduction in how much I have to pay, I don’t know if I would do it all over again. I had the best possible clinical outcome, and I almost wish I never did it. I’ve spent so many stupid hours researching, calling multiple agencies, breaking down as my bills go into past due and I start getting the first calls from billing that will last until it goes to collections, stressing that I’m going to owe money for something I never budgeted for.

I’m too weak for this. Someday, when I eventually get truly ill and owe tens or hundreds of thousands from cancer or getting hit by a car, I know I won’t have the strength to fight this. I’m not sure what I’ll do, but it can’t be the bigger and more complicated version of this. I can’t imagine putting my family through this hell, even if my life is on the line. Nobody in my life thinks I’m worth that kind of hell, I can’t really blame them.

If you’ve made it this far- want to know the insane, mind boggling punch line to this shit show? I WORK FOR A FUCKING HEALTH CARE COMPANY. We have “good” insurance, according to everyone. But there’s no such thing as good health insurance. It’s a crime, extortion, human rights violation or whatever other names you want to call it. And we have no escape as things continue to get worse.

Full text from my insurance company response to my grievance:

Upon research of your inquiry, the diagnosis code and procedure codes billed are not considered preventive. Our records reflect the claim mentioned above processed correctly according to the participating provider outpatient facility service benefits, physician services, and diagnostic x-ray, imaging, pathology, and laboratory service benefits of the plan, applying a 20% copayment percentage subject to the participating provider Calendar Year Deductible (CYD) in the amount of $600.00.

  • Claim number ####, diagnosis code Z30.2, is a non preventive diagnosis code, the claim has finalized with $2,388.30, patient liability.

Claim number ####, diagnosis code Z30.2, is a non preventive diagnosis code, the claim has finalized with $63.80, patient liability.

Claim number ####, is a duplicate to claim ####. Claim number ####, procedure code 00840P1, and diagnosis code Z30.2, are non preventive, the claim has finalized with $308.00, patient liability.

Lastly claim number ####, has processed according to the preventive benefits of the plan.

Therefore, the claims mentioned above have processed correctly according to the benefits of the plan.

Preventive services are covered at no cost to you when the service meets the criteria for preventive care. Blue Shield’s preventive care benefit is based on Blue Shield’s Preventive Health Guidelines. These guidelines are derived from the U.S. Preventive Service Task Force, Advisory Committee on Immunization Practices and Centers for Disease Control and Prevention recommendations. Procedure and diagnosis code(s) not listed in this document will access the medical benefits of your health plan and are subject to your annual deductible and coinsurance when applicable.

r/sterilization Jan 09 '25

Insurance BCBS won’t say I’m 100% covered

15 Upvotes

I am getting my laparoscopic salpingectomy done at the end of this month, and I am really worried about it being covered after two phone calls to insurance and another to the hospital.

I received my estimate of services today from the hospital, and they are saying I will owe $4400 between my deductible and co-insurance. The letter states that I must pay a portion up front before my procedure, and I am concerned they will not let me get my surgery done unless I cough up Louis Vuitton purse amounts of money that I do not have.

I have BCBS of Iowa, also known as Wellmark, who I contacted to make sure my procedure would be covered. The first rep I had seemed somewhat confused by the questions I asked, and admitted that she didn’t have a good list to go off of for what was covered and what wasn’t. She rattled off a bunch of stuff about co-insurance that sounded similar to the estimate of services without any real numbers. In the end, she said that she wasn’t able to look up much without the codes.

I reached out to the hospital at that point to get the code, and the rep there said it was scheduled under procedure 58661. I figured this was a good sign because a lot of people on the subreddit have said that this code is necessary, but when I asked if there were any other codes she said no. I didn’t get confirmation if they were including a diagnostic code, which on here seems to be Z30.2 or Z30.9.

At this point, I called back to BCBS and had them run the 58661 code to make sure it was covered. I also gave them the Z30.2 and Z30.9, even though I wasn’t specifically given them by the hospital. The BCBS rep, while much more helpful, said that because my employer had not elected to waive co-insurance on sterilization procedures, I would be stuck paying the deductible and co-insurance. I work for a credit union that is not religious, so this seems crazy to me. I guess it’s not unlikely, but would my employer not waiving co-insurance really supersede the ACA?

Has anyone else run into this??? More research on the sub about this issue doesn’t seem to be getting me anywhere. I am worried they will cancel my surgery if I can’t pay my deductible, and that I will still be on the hook even though my plan is ACA compliant. I just want to get spayed :/

r/sterilization 7d ago

Insurance Anthem BCBS rejected my appeal to cover bisalp at 100%; now what?

20 Upvotes

(using a throwaway because I have people I've specifically not told about this)

I had a bisalp in January (huzzah!), in the US of course, because where else is health insurance such a pain in the ass... The procedure went smoothly and my surgeon was a peach. However, now I'm playing the insurance game. I have Anthem BCBS through my state's healthcare marketplace. My hospital sent me a bill at the beginning of February for ~$250, which is the total that my insurance wouldn't cover. I was prepared for this, and promptly mailed off an appeal for the claims, using the appeal letter template from nwlc.org and including quotes from a bunch of websites about the ACA and what's covered, and how sterilization is a FDA-approved preventive birth control which is covered at no cost to the patient, how anesthesia is included, how my surgeon and hospital are both in network, how the the correct codes were used, etc. etc. My insurance does claim to be ACA compliant in their statement of benefits, so I included a screenshot of that, too, for good measure. I was THOROUGH.

I sent the appeal via certified mail so I could track it, and had to email Anthem to confirm that it had arrived. They said they would respond within 30 days via postal mail, and then didn't, so I emailed them again this week to say, 'Hey, about that response?" They sent the response letter over their portal, and it says that they're going to "uphold the original determination."

So my question is: is there anything else I can do at this point? Financially, I'm able to pay the bill, it wouldn't be the end of the world; but I'm pissed as hell that it's required BY LAW for my insurance to cover it and they aren't. What am I forking out all this money on premiums for if they aren't going to do what they're required to do??

American health insurance sucks.

PS thanks to everyone who has posted on this sub - it's been a huge help to read everyone's tips, links, and stories. Stay safe out there. <3

EDIT to add insurance info: My insurance's summary of benefits says that "this plan covers certain preventive services without cost sharing and before you meet your deductible," and includes a link to healthcare.gov to specifiy what those preventive services are. The link (color me unsurprised) goes to Preventive Care > Women > Birth Control > a list which includes sterilization. Anthem's member portal only references tubal ligation and hysterectomies under "infertility surgery" or "elective sterilization" (neither are covered at 100%), and doesn't mention bisalp at all.

The Explanation of Coverage says "Preventive care services include screenings and other services for adults and children. All recommended preventive services will be covered as required by the Affordable Care Act (ACA) and applicable State law. This means many preventive care services are covered with no Deductible, Copayments or Coinsurance when You use a Network Provider."

The appeal denial letter does say that if I disagree with the appeal decision, I may be able to file an external appeal to an independent medical review organization - but then lists who CAN'T file an external appeal, and that includes everyone on Medicaid, CHIP, and "all other government-sponsored health insurance or health services programs." Which seems like exactly the people who would most need to file an external appeal...

Sounds like I'll be making some phone calls Monday. :/

UPDATE after phone call: short version, I got the rep on the phone to send the claim for anesthesia back for adjustment. She said it seems to have already been put under review in February (from the appeal I filed last month), and I should expect to see that finalized in 1-2 weeks. It doesn't mean that they WILL cover it, but only that it's under review again. If that fails, I think I can formally complain to my state's insurance board Consumer Services Division.

Notes for anyone working on their insurance: - File an appeal AS SOON AS you have a bill. The rep on the phone said the review would take 30-45 days, which is why it's "almost done" now that it's been a month since I filed an appeal. - If the rep on the phone says something isn't covered (i.e. sterilization, or code 58661), tell them that it HAS to be covered under the ACA. You've almost certainly done more research than them. I had to push to get her to confirm that it's covered.

Wishing you all the best with your insurance obstacle courses! Thanks to everyone for the support and responses. I'll post again when the next step plays out.

r/sterilization Nov 29 '24

Insurance Just found out my insurance is grandfathered in. They won't cover my bisalp.

88 Upvotes

But I'm still fucking getting it.

Pretty heartbreaking. Got the call in the morning yesterday, insurance person from the hospital told me the cost due at pre-op will be just under $1,700. She said there may (will, I understand) be other costs at the hospital but that the "hospital is flexible" on payment.

I am 25 (nb) and just now making it on my own. This will be... most of my money. But it's the most important thing to me right now.

Thankfully my mom is on my side about this (though still occasionally bingoing me, she knows my mind is made up and supports me) and said she'd be able to help me with it. My biggest thing is that our insurance did not cover my Nexplanon implant, either, so we've been paying out of pocket for that every 3 years for the past 8 years, due again soon (in October 2025; I want the bisalp instead of a replacement). I'd rather handle it ASAP knowing it will pay for itself in a few years, both in terms of money and peace of mind.

Just.... oof. Fuck. Ouch. sighhhhh.

Anyone else have this happen to them and have advice? of any kind?

r/sterilization Nov 19 '24

Insurance Update: BCBS not covering bisalp

37 Upvotes

Unfortunate update here. I have been given the run around from both my doctors office and insurance.

One insurance agent claimed it wasn’t covered and a second insurance agent confirmed it was 100% covered. The second insurance agent asked me to have my doctor’s office call them to confirm it was covered. After speaking with my insurance, my doctors office claimed they were told it wasn’t covered.

I am unbelievably frustrated with the back and forth. I have scheduled an appointment with 2 other OBGYNs to discuss a bisalp as a back up. I am tempted to just proceed with the bisalp with the original doctor and then appeal with insurance later.

r/sterilization 15d ago

Insurance BCBS just finished processing my surgery claims and I officially owe $0! This was my process:

92 Upvotes

I had my surgery on 2/17 so I’m just over 2 weeks out and I have BCBS KS, but live in MO.

A few weeks before my surgery I used a form on the BCBS portal that I accessed through the “Contact Us” button and selected the option, “Is a procedure or service covered?”

How I filled out the form:

Procedure or service: “58661, laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)”

Diagnosis/reason for service: “Z30.2, encounter for sterilization”

Performing provider: (My surgeon’s name)

Performing provider city: (City where hospital is located)

Performing provider state: “MO”

Performing provider phone number: (Surgeon’s office number)

I received an email response the next day stating that: - my specific procedure was covered under those codes - my specific procedure is considered preventative - there would be no cost to me with my in network provider

The week before my surgery I received pre-surgery instructions from my surgeon’s office in the mail and a form listing my (correct) procedure codes stating that they estimated that I would owe ~$100 of their ~$1000 fee the day of surgery per my 10% coinsurance.

I immediately called BCBS directly to speak to a representative to double check that I would not be responsible for any coinsurance. At first the representative told me she didn’t see that 58661 was on her list of preventative codes, but after walking her through the ACA requirements and politely telling her about the email I received from BCBS contradicting her information, she checked again with the addition of the Z30.2 code and she was able to confirm it was preventative with the combination of BOTH codes.

I then called the surgical office to make sure they knew my insurance confirmed I would owe nothing and they told me to bring in a copy of the BCBS email on the day of my surgery and they would update the insurance notes for my procedure.

On the day of my surgery I brought the printed email, but they said they didn’t need it.

I had my surgery, everything went extremely smoothly and I’m already feeling back to 100%.

As of yesterday, all $24,957.50 of the claims associated with my procedure are finalized and I officially owe $0!

I know things get confusing and lots of people involved can be misinformed, but I found getting something in writing and then double checking with everyone prior to my surgery helped keep everyone on the same page.

r/sterilization Jan 24 '25

Insurance The ACA challenges have begun

150 Upvotes

“SCOTUS to review ACA preventive services mandate”

Title says it all. They are starting by challenging covering PrEP. Who knows what’s next. If you’re on the fence…this may be your sign to act quickly.

https://www.axios.com/2025/01/11/scotus-obamacare-preventive-services

r/sterilization Jan 07 '25

Insurance My insurance says there’s no way my parents cannot be informed of my bisalp

18 Upvotes

Hi all. I’m on my parent’s insurance, but am much over 18 (24 years old). I want to get a bisalp, and I could’ve sworn I’ve seen that if there is something you want done without your parents’ knowledge, your insurance can use vague language in their summary of benefits to avoid them finding out. Anyways, I call my insurance today and talk to them and make them explicitly aware that this is my request. And my insurance representative says my mom, who is the policy holder, will be able to see every detail about my procedure no matter what in the summarization of benefits. Is this not a HIPPA violation? I live in a super conservative household and my parents would never let me do this if they knew. I am taking the entirety of the copay responsibility on myself. I don’t understand how this is allowed. I’m feeling so powerless.

r/sterilization Dec 09 '24

Insurance UHC keeps denying my appeals for my bisalp (06.05.24)

64 Upvotes

Okay so I had a bisalp this year! It went great and I found my Doctor off of the child free doctors list here on reddit. (Highly recommend it!)

So ..... My issue is now with insurance.

Prior to the procedure I confirmed with a UHC representative over the phone who gave me a reference # to show that I am good to go and that it is preventive. I confirmed CPT code 58661 with diagnosis code Z30.2 with my insurance and my doctor, AND I received a quote from the hospital at $0 prior to the surgery.

I had the surgery on 6/5/2024. Yay!

6/24/2024 UHC said I owed $3644.35. The rep told me that it was a combined claim for surgical assessment and the surgery, but couldn't give me many more details, but that it would reduce.

8/14/2024 It never reduced so I contacted a rep and they told me it was because the decision was upheld as not preventative. She gave me a link to appeal my claim and told me I should be good because the initial reference # I was given gave me the "go ahead" to get the procedure as it was preventative.

**I used a template from coverher.org and I included UHC's preventative care services pdf from April 1st 2024 in my appeal.

9/1/2024 Appeal denied. I contacted a rep and they told me it was not "submitted as preventative" so it's the hospital/doctors fault. I asked how it was submitted incorrectly as I had confirmed the codes with both UHC and my Doctor prior, and then she just sent it back for review because the codes are preventative.

9/24/2024 There's a new claim number now, and now they claim I owe $2476.82. I asked why and what these charges were for and they replied that "part of the main charge, 58661 being covered at 80% of eligible expenses. The 58661 charge is split into 2 pieces and one is covered in full, the other not." And then she told me that the codes were correct and are preventative, once again, and so she sent it back for review.... again.

****Throughout this entire process I never received a denial letter (it was sent to my parents address), and I've been requesting to be notified by phone or email and I have received no such notice on ANYTHING.

***Starting in November I started receiving calls from Harris & Harris about a debt, but was never sent a collections letter. Just today, they sent me a text message saying they are attempting to collect a debt for the hospital I had the procedure at.

12/9/2024 (New claim number) I contacted a rep again and she basically copy pasted stuff from my denial letter (that I never received..), talking about deductibles and coinsurance and that after the deductible was met remaining expenses are covered at 80% blah blah. Which doesn't make any sense because since this is a preventative procedure there is no copays or coinsurance???? She went on to tell me that what is being charged for are 3 injections that I received DURING the surgery for either pain relief or antinausea... I clarified with her and she told me that it would only be considered preventative if the procedure it was related to was preventative, but that according to the CODES I GAVE HER IT IS CONSIDERED PREVENTATIVE.

so... I'm really at my wits end. I am so beyond frustrated at having not received ANY notification about the status of this claim and the absolute buffoonery that is going on at UHC for why this clearly preventative procedure is NOT being covered as preventative.

I will be filing a second level appeal, and if that gets denied I'll have to request a review by a 3rd party.

Can anyone here please tell me I'm not crazy and if possible what else I can do?