kaiser coverage/costs

[Anonymous]

I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

[Anonymous]

If kaiser did the bloodwork, infectious disease aand hormone levels should all be covered like you're regular lab work. If SG did it, then you have to pay per the infertility coverage. My lab work says it is covered 100% aand I didn't even pay for my amh draw, which at the time was a rare test for kaiser and they had to send it out externally. It is worth appealing imo.

If you're doctor hasn't gotten back to you, email and see if she can send the referral now. It took a few weeks or a month to get the approval.

Some gratuitous advice: check and see if infertility is excluded from your out of pocket max. With my first it was excluded. With my second the list changed and it was not listed as excluded. But benefits kept ignoring that. I appealed and won every time. (Also note, it is worth appealing because after hours on the phone with even the plan managers, it was clear that the only people who really knew anything were in the appeals department).

[Anonymous]

Anonymous wrote:I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

Once you've done all of Kaiser's fertility work-up (the bloodwork, HSG, saline ultrasound), they will put the referral through to SG. And yes, anything that has to do with infertility (at KP) is billed to you at 50% of the actual cost (at least with my plan). All of these OOP costs counted towards my $3,500 OOP yearly deductible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

Once you've done all of Kaiser's fertility work-up (the bloodwork, HSG, saline ultrasound), they will put the referral through to SG. And yes, anything that has to do with infertility (at KP) is billed to you at 50% of the actual cost (at least with my plan). All of these OOP costs counted towards my $3,500 OOP yearly deductible.

I also found that any tests done related to infertility testing, including infectious disease testing, was charged to us at the 50% rate, although we only paid maybe $200 total for all of the infertility bloodwork prior to the referral to SG. Consistent with our evidence of coverage, this payment did not count towards our out of pocket maximum.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

Once you've done all of Kaiser's fertility work-up (the bloodwork, HSG, saline ultrasound), they will put the referral through to SG. And yes, anything that has to do with infertility (at KP) is billed to you at 50% of the actual cost (at least with my plan). All of these OOP costs counted towards my $3,500 OOP yearly deductible.

I also found that any tests done related to infertility testing, including infectious disease testing, was charged to us at the 50% rate, although we only paid maybe $200 total for all of the infertility bloodwork prior to the referral to SG. Consistent with our evidence of coverage, this payment did not count towards our out of pocket maximum.

Did you only pay $2500 copay after that? or, did you incur more costs? I know freezing and storage is not covered, but now about monitoring appointments is there a separate charge for that?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

Once you've done all of Kaiser's fertility work-up (the bloodwork, HSG, saline ultrasound), they will put the referral through to SG. And yes, anything that has to do with infertility (at KP) is billed to you at 50% of the actual cost (at least with my plan). All of these OOP costs counted towards my $3,500 OOP yearly deductible.

I also found that any tests done related to infertility testing, including infectious disease testing, was charged to us at the 50% rate, although we only paid maybe $200 total for all of the infertility bloodwork prior to the referral to SG. Consistent with our evidence of coverage, this payment did not count towards our out of pocket maximum.

Did you only pay $2500 copay after that? or, did you incur more costs? I know freezing and storage is not covered, but now about monitoring appointments is there a separate charge for that?

I was very lucky as I never did IVF (2nd IUI was successful). SG did give me a rate sheet for Kaiser that includes IUI and IVF. Basically it says if we did IVF we'd need to pay a $2,750 deposit that I understood to include the Lupron evaluation (no idea what that means) monitoring, retrieval and transfer as well as 5 monitoring appointments. It lists additional costs for ICSI, assisted hatching, freezing and storage and PGD. I believe PGS would also be an additional cost if we used that. And obviously medications are not included.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have Kaiser and asked for referral to SG. My ob/gym asked to do some infectious disease blood work, which I did, and now have a $500 bill which is about 50% of the actual bill. question: since I do not have a referral yet, I am just asking for referral to be placed, should they be charging the 50% copay? Has this happened to anyone?

Once you've done all of Kaiser's fertility work-up (the bloodwork, HSG, saline ultrasound), they will put the referral through to SG. And yes, anything that has to do with infertility (at KP) is billed to you at 50% of the actual cost (at least with my plan). All of these OOP costs counted towards my $3,500 OOP yearly deductible.

I also found that any tests done related to infertility testing, including infectious disease testing, was charged to us at the 50% rate, although we only paid maybe $200 total for all of the infertility bloodwork prior to the referral to SG. Consistent with our evidence of coverage, this payment did not count towards our out of pocket maximum.

Did you only pay $2500 copay after that? or, did you incur more costs? I know freezing and storage is not covered, but now about monitoring appointments is there a separate charge for that?

I paid 50% of the cost each time I went in to SG for monitoring/bloodwork appointments. After a few IUI's and meds, and some other unrelated medical expenses, I met my $3,500 deductible (or OOP max) in August. I ended up doing Shared-Risk IVF though, which I had to pay for entirely OOP b/c anything to do with IVF (excluding meds) was excluded from my plan with KP. The good news was that I got 90% of my IVF meds free b/c I had met my OOP max. With respect to incurring more costs w/ SG after I already met my OOP yearly-max with KP, I'm not yet sure. I've been back to SG for a few ultrasounds and bloodwork after my FET, and because it was considered OBGYN care, they told me they would bill me after they submitted the claim to KP. So the bottom line is I won't know if I owe anything to SG (and thus in excess of my $3.5k OOP max) until I get my bill.