Reply to BCBS FEP $40 copay no longer $40 with IVF?

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[quote=Anonymous]I have BCBS Federal Employee Plan and up until now have always paid only $40 for monitoring appointments, even during IVF cycles.  I've done this at Shady Grove and CFA for a long time.

CFA just sent a claim in from an FET cycle and my insurance has determined I now owe more than the standard $40 copay because some services (standard monitoring bloodwork) were provided in conjunction with services they don't cover (IVF).  When I called, BCBS told me that they requested a "medical review" and after receiving my records from the provider, they are deciding not to cover.  I'm really nervous about back-review of claims that were already covered now coming back to haunt me.  This actually did happen to me with another provider after the BCBS "medical review" and now I owe $$$$.

What's going on here?  Why now?  Is this a new thing?  Does "medical review" happen when you've been a heavy user of the system or are they starting to do this routinely more?  Has this happened to anyone else?[/quote]

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