I have spent the morning making calls. What United has claimed is that they don’t pay for services until after they are rendered. However, in all my research and talking with insurance companies and such in the past, for IVF services are always paid for up front, before services start. It’s basically an industry standard, at least in this large geographical area, that fertility facilities collect full payment up front, whether from the patient(s) or the insurance company, and then begin. So I called United again and told them that this is how it goes by industry standard, that the services are pre-paid, and by them saying they won’t pay, but that I can submit a claim and try to get it reimbursed afterward, is in contradiction to the $1,500-OOP max in our contract with them as it’s an additional $8,000 out of pocket we’d have to pay up front, and that if pre-paying is industry standard, then it is their responsibility to know this and have a policy in place to cover it beforehand rather than to tell clients to pay for it and try to get the money later. Since this isn’t cash most people have available, they’re basically turning it into a benefit you can only get if you can afford it to begin with, and that people pick insurance plans based at least partly on what they can afford out of pocket. I emphasized how the contracted agreement we have with them is $1,500-OOP, NOT $8,000+-and-try-to-get-some-back-later, and if this is industry standard, then they’re responsible for not forcing us to pay more out of pocket when there are NO alternatives available. If the only options they will give us that they might reimburse for are places that require payment up front and they won’t pay it up front, it’s basically become a worthless benefit because we just don’t have, and can’t get, $8,000 in cash. I told him truthfully that even Kaiser was only going to have us pay $6,000 and they were going to cover the rest up front, and that we left Kaiser to join United because the benefit from United was presented as greater, that we’d rather pay $6,000 out of pocket we don’t get back to a company that was up front with us than to pay $8,000 more than the $1,500 we agreed on and hope to get it back later. At this point, he repeated a couple time, “Kaiser was going to pay? They were going to pay up front?” and I told him yes, because they knew services are paid up front and what those services for a fairly standard procedure are going to be and how much they cost.
I asked him if there was a local representative I could speak with in person and possibly have my attorney present because what they’re doing is very misleading, and it’s misleading on one of the things most important to most people.
I think that became a ramble, but I think it gets my point across. I nearly cried on the phone talking to him and told him how I’m 27 and have been dealing with this for four years already and finally thought I saw a light at the end of the tunnel as we were going to start IVF in two weeks, only to have it taken away by a misleading policy, and that we’re talking about having children here. At that point, I was trying to strike a cord in his heart, hoping he had kids himself that he loved and would think about what if he wasn’t able to have them.
He said he’d look into this some more and get back to me by tomorrow morning, and I let him know I had an appointment for today at 1:50 and another tomorrow at 2 that we went ahead and canceled since there was no point if United wasn’t going to pay.
There was nothing in any of the contracts we have for them that mentions anything about payment only after services are rendered. If there was, we’d have stayed with Kaiser. Having to come up with $6,000 we wouldn’t get back is a lot better to us than having to come up with $8,000 and hope we can get some of it back later.
Needless to say, I am so deflated of hope I am looking into what therapy is covered. I am so emotionally battered right now I can’t keep food down, so incredible ashamed for having believed something good was going to happen for me, embarrassed that I thought myself worthy of something good for once. We had our hearts set on this. I tore apart the baby afghan I started in frustration. Do I have to accept not having a baby all over again when I never even accepted it fully from the first time?