Negotiated rate after insurance benefits run out?

[Anonymous]

I’m a Shady Grove IVF patient. My insurance covers 3 IVF attempts per live birth. I’ve used these up (a freeze all cycle counted as one, then 2 failed FETs). So my next FET will be out of pocket. Does anyone know if I will have to pay the $4600 cash fee, or if I would still get the benefit of the negotiated rate that they would normally receive from my insurance company?

I’ve asked my financial counselor and I don’t even think she understands what I’m asking. She says she can’t tell me anything until she runs it through my insurance and I need to decide on my FSA before then. Working with the financial people has been the most challenging thing for me!

[Anonymous]

SGF's financial people are the worst! They're like the folks at the DMV

[Anonymous]

I would assume the full rate. The negotiated rate is the only amount insurance is willing to pay so SG doesn’t have any other choice. Unfortunately they can charge you whatever they want.

[Anonymous]

OP which insurance do you have? If it's Aetna, they honor the negotiated rate but I'm assuming b/c you asked that you don't have Aetna or else SG wouldn't be vague.

[Anonymous]

Anonymous wrote:SGF's financial people are the worst! They're like the folks at the DMV

So true. I don't know where they hire them from. I haven't studied finance or accounting but I could do a better job than them.

[Anonymous]

My financial counselor at SGF has always been pleasant, patient, and responsive quickly.

[Anonymous]

NP. I have the same question - my insurance covered my last FET and always covers all bloodwork/ultrasound appointments. So I know for my next FET, which isn't covered by insurance, insurance will still cover my 2 monitoring appointments and pay out for those. So I just wish Shady Grove would consider lowering the fee that I have to pay at least by the amount my insurance company will pay out! FETs seems unreasonably expensive - $4600 for 2 appointments and an embryo transfer? Almost no labwork or anything needs to be done except thawing the embryo. I don't get it!

[Anonymous]

Anonymous wrote:NP. I have the same question - my insurance covered my last FET and always covers all bloodwork/ultrasound appointments. So I know for my next FET, which isn't covered by insurance, insurance will still cover my 2 monitoring appointments and pay out for those. So I just wish Shady Grove would consider lowering the fee that I have to pay at least by the amount my insurance company will pay out! FETs seems unreasonably expensive - $4600 for 2 appointments and an embryo transfer? Almost no labwork or anything needs to be done except thawing the embryo. I don't get it!

I wonder about this too. Does FET include the follow up appointments; beta, ultrasound if pregnancy is confirmed, until 12 weeks of gestation?

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP. I have the same question - my insurance covered my last FET and always covers all bloodwork/ultrasound appointments. So I know for my next FET, which isn't covered by insurance, insurance will still cover my 2 monitoring appointments and pay out for those. So I just wish Shady Grove would consider lowering the fee that I have to pay at least by the amount my insurance company will pay out! FETs seems unreasonably expensive - $4600 for 2 appointments and an embryo transfer? Almost no labwork or anything needs to be done except thawing the embryo. I don't get it!

I wonder about this too. Does FET include the follow up appointments; beta, ultrasound if pregnancy is confirmed, until 12 weeks of gestation?

Yes, it should if you fall pregnant on the last attempt FET because those things are all part of the same cycle.

[Anonymous]

Anonymous wrote:NP. I have the same question - my insurance covered my last FET and always covers all bloodwork/ultrasound appointments. So I know for my next FET, which isn't covered by insurance, insurance will still cover my 2 monitoring appointments and pay out for those. So I just wish Shady Grove would consider lowering the fee that I have to pay at least by the amount my insurance company will pay out! FETs seems unreasonably expensive - $4600 for 2 appointments and an embryo transfer? Almost no labwork or anything needs to be done except thawing the embryo. I don't get it!

All policies are different, but it surprises me that your insurance would cover monitoring for a new cycle after you exhausted your attempts. I am also very doubtful about SG offering you a negotiated rate. Once you’re OOP you’re just OOP, I would think.

[Anonymous]

Anonymous wrote:I’m a Shady Grove IVF patient. My insurance covers 3 IVF attempts per live birth. I’ve used these up (a freeze all cycle counted as one, then 2 failed FETs). So my next FET will be out of pocket. Does anyone know if I will have to pay the $4600 cash fee, or if I would still get the benefit of the negotiated rate that they would normally receive from my insurance company?

I’ve asked my financial counselor and I don’t even think she understands what I’m asking. She says she can’t tell me anything until she runs it through my insurance and I need to decide on my FSA before then. Working with the financial people has been the most challenging thing for me!

Most of the time the negotiated rate is typically higher than the self pay/private pay price. the Clinics usually bill a substantial higher amount and the health plan (insurances) negotiate a rate between the clinics. They essentially have contracts and as such may not be able to balance bill the pt for any balances (hence the negotiated rates). To really know what the insurance paid you would have to request a claim copy from the clinic ( if they are willing to provide) or the health plan. Also note that most people have a deductible or copay. If you have met your deductible & maximum out of packet expense ( averages 3K depending on health plan) for the year then subsequent services are covered at 100% depending on your health plans. I literally had my IVF paid for at 100% since I did it close to end of year and I had multiple clomid/IUI cycles during first half of year so I was able to meet my maximum out of pocket expense for the year.

[Anonymous]

^That's often not how it works PP given that for many IVF is not a covered procedure so your out of pocket max doesn't apply or help you here if your policy excludes IVF coverage. My plan excludes IVF and I've met my out of pocket max (no deductible) so I don't pay for doctors/medications/procedures anymore till January 1st of next year. But I'll pay in full for IVF/medication needed for that since it's not a covered expense.

To get to the original question OP if you have Aetna SG will honor the negotiated rate. If not you're likely to pay the full rate.

[Anonymous]

Anonymous wrote:^That's often not how it works PP given that for many IVF is not a covered procedure so your out of pocket max doesn't apply or help you here if your policy excludes IVF coverage. My plan excludes IVF and I've met my out of pocket max (no deductible) so I don't pay for doctors/medications/procedures anymore till January 1st of next year. But I'll pay in full for IVF/medication needed for that since it's not a covered expense.

To get to the original question OP if you have Aetna SG will honor the negotiated rate. If not you're likely to pay the full rate.

PP you are absolutely correct! This only applies to health plans that cover IVF (sorry for not clarifying that piece). If no IVF coverage then you have to pay out of pocket as the maximum copay does not apply in this case.