Reddit was tremendously useful when I was going through my lengthy & anxious claim adventure. Sharing my experience here to pay it forward to other ladies.
Tl;dr – UnitedHealthcare didn’t cover my IUD Mirena replacement and charged me a $6xx bill. Got UHC to cover the procedure and the clinic visit after digging deeper.
Insurance info – UnitedHealthcare HDHP with HSA through my employer. Based in California.
Itemized bill from the provider and what UHC covered initially back in Sep 2020:
- 99203 – office visit (not covered)
- 76857 – radiology (ultrasound / not covered)
- J7298 – Mirena (covered)
- 58300 – IUD insertion (covered)
- 58301 – IUD removal (covered)
- 81025 – Urine pregnancy test (not covered)
At the clinic, it sounded like the urine pregnancy test was mandatory before IUD insertion. I also had a lot of pain during the insertion so the doctor did an ultrasound to make sure it’s placed correctly. None of these sounded like a la carte services that one could decline at the moment. Naturally, I was surprised that they weren’t covered as part of the IUD prodcedure when I received the EOB. The first Mirena wasn’t that expensive either under another insurance plan (this was five years ago, vaguely remember around $100-ish). I paid out of pocket immediately since I was moving to a different city and I didn’t want to incur any billing problems. However, I felt that something’s off after reading and researching further.
I sent a message via MyUHC, and the canned response I received was: The coverage will be based on whether or not it’s is being used for medical reasons or preventive birth control. The diagnosis the provider bills will tell us if is preventive or diagnostic. It’s most common to be covered under preventive.
Unsatisfied, I reached out to CoverHer Hotline after learning about it from one of the subs and also reached out to my company’s benefits team to see if I can get a real response through work instead.
CoverHer Hotline got back to me with their phone script. When I reached out to MyUHC again asking if my plan was grandfathered, the MyUHC rep replied with a link to their Preventive Care Services Guideline. On page 3, FAQ #5 says related services are covered. Well… would you look at that?
I forwarded the CoverHer article, a screenshot of FAQ#5, itemized bill from the clinic, and EOB from UHC to my Benefits team. Ten days later, the Benefits team rep informed me that UHC has reprocessed the related services under the preventive benefit. I got a refund for all the out-of-pocket!
Hope the links above will help you in your appeal process. I’ve also donated $100 to NWLC afterward because CoverHer Hotline was a godsend <3
submitted by /u/half-not-empty
[link] [comments]
Reddit was tremendously useful when I was going through my lengthy & anxious claim adventure. Sharing my experience here to pay it forward to other ladies. Tl;dr – UnitedHealthcare didn’t cover my IUD Mirena replacement and charged me a $6xx bill. Got UHC to cover the procedure and the clinic visit after digging deeper. Insurance info – UnitedHealthcare HDHP with HSA through my employer. Based in California. Itemized bill from the provider and what UHC covered initially back in Sep 2020:
99203 – office visit (not covered) 76857 – radiology (ultrasound / not covered) J7298 – Mirena (covered) 58300 – IUD insertion (covered) 58301 – IUD removal (covered) 81025 – Urine pregnancy test (not covered)
At the clinic, it sounded like the urine pregnancy test was mandatory before IUD insertion. I also had a lot of pain during the insertion so the doctor did an ultrasound to make sure it’s placed correctly. None of these sounded like a la carte services that one could decline at the moment. Naturally, I was surprised that they weren’t covered as part of the IUD prodcedure when I received the EOB. The first Mirena wasn’t that expensive either under another insurance plan (this was five years ago, vaguely remember around $100-ish). I paid out of pocket immediately since I was moving to a different city and I didn’t want to incur any billing problems. However, I felt that something’s off after reading and researching further. I sent a message via MyUHC, and the canned response I received was: The coverage will be based on whether or not it’s is being used for medical reasons or preventive birth control. The diagnosis the provider bills will tell us if is preventive or diagnostic. It’s most common to be covered under preventive. Unsatisfied, I reached out to CoverHer Hotline after learning about it from one of the subs and also reached out to my company’s benefits team to see if I can get a real response through work instead. CoverHer Hotline got back to me with their phone script. When I reached out to MyUHC again asking if my plan was grandfathered, the MyUHC rep replied with a link to their Preventive Care Services Guideline. On page 3, FAQ #5 says related services are covered. Well… would you look at that? I forwarded the CoverHer article, a screenshot of FAQ#5, itemized bill from the clinic, and EOB from UHC to my Benefits team. Ten days later, the Benefits team rep informed me that UHC has reprocessed the related services under the preventive benefit. I got a refund for all the out-of-pocket! Hope the links above will help you in your appeal process. I’ve also donated $100 to NWLC afterward because CoverHer Hotline was a godsend <3
submitted by /u/half-not-empty [link] [comments]Read Morer/HealthInsurance