Polycystic Ovary Syndrome (PCOS)

Insurance question..

Question:

Hi everyone.. I am 21, live with my parents, am still under my father’s health plan and am the one who hasnt told my mom yet about my PCOS… anyway, my dad’s plan switched to Healthlink and they will not cover my birth control pills even with my letter of necessity (they say because it is a brand name drug that they wont cover it– I am taking Mircette).. and then we got a letter in the mail today and they are not going to cover my last office visit which was only a 6 month check up and that is when he did the glucose/insulin ratio test.. the bill was $75 and the letter said that they would cover nothing and that they do not cover such conditions/services and to check our handbook for details… has anyone had similar problems as this??  My last insurance company covered all of this and I am getting so upset.. now i will have to tell my mom everything, especially if she is gonna call the insurance company and complain to them, and she doesnt even understand what is wrong with me… any suggestions?? similar situations with a remedy???    thanks for any help…. Becky

Response:

Hopefully it is just a matter of your doctor putting in a wrong diagnosis code or something equivalent.  If your insulin came back high or your bloodsugar high.  You may be able to claim it as insulin resistance.  Not PCOS.  Which can sometimes look like your treating fertility.  Maybe if your doctor puts in a letter to your insurance that the birth control isn’t used for fertility issues, that is used to treat a medical condition instead.  If I am not mistaken you make have to file some sort of grievance letter to the insurance. ( ladies please help me out with this one). Best of luck to you. Donna "Beckers123" <beckers…@aol.com> wrote in message

news:20010328233223.19763.00001318@ng-cb1.aol.com… – Hide quoted text — Show quoted text -> Hi everyone.. I am 21, live with my parents, am still under my father’s health > plan and am the one who hasnt told my mom yet about my PCOS… anyway, my dad’s > plan switched to Healthlink and they will not cover my birth control pills even > with my letter of necessity (they say because it is a brand name drug that they > wont cover it– I am taking Mircette).. and then we got a letter in the mail > today and they are not going to cover my last office visit which was only a 6 > month check up and that is when he did the glucose/insulin ratio test.. the > bill was $75 and the letter said that they would cover nothing and that they do > not cover such conditions/services and to check our handbook for details… > has anyone had similar problems as this??  My last insurance company covered > all of this and I am getting so upset.. now i will have to tell my mom > everything, especially if she is gonna call the insurance company and complain > to them, and she doesnt even understand what is wrong with me… any > suggestions?? similar situations with a remedy???    thanks for any help…. > Becky

Response:

Thank you for your response.. we have sent a letter to the insurance company about the birth control and my last insurance provider covered them, but this one will not, even after 2 letters being sent to them..  and i was diagnosed with insulin resistance..  but i am not sure what he used as a code or whatever.. i guess i will have to give the doc’s office a call.. the doc in online right now, but i would hate to bother him…  thanks and any other input would be greatly appreciated..   ) Becky

Response:

The easiest thing for you to do is to switch to a generic birth control pill. If your insurance company doesn’t cover brand name BCPS they won’t make an exception for you, unless perhaps you’ve tried all of their covered generic brands and had side effects.  There are numerous very good generic birth control pills on the market do not hesitate to change. As for getting your insurance company to cover your visit, you’ll need to read the information they sent you to see if they cover preventative service and/or problem visits.  That will be the major issue. Your doctor’s office can contact the insurance company.  They can also resubmit your bill if they made a mistake in coding.   Contacting your doc online won’t help you. You need to talk to his insurance billing person!   Good luck!! Insurance companies can be such a pain. Susan – Hide quoted text — Show quoted text ->Thank you for your response.. we have sent a letter to the insurance company >about the birth control and my last insurance provider covered them, but this >one will not, even after 2 letters being sent to them..  and i was diagnosed >with insulin resistance..  but i am not sure what he used as a code or >whatever.. i guess i will have to give the doc’s office a call.. the doc in >online right now, but i would hate to bother him…  thanks and any other >input >would be greatly appreciated..   ) Becky

Response:

Filed under: PCOS Fertility

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