One time is an accident but two times… it cannot be a coincidence. WARNING: Rant Time. Here I am fretting as Cycle Three is a day or two away and we have no financials confirmed. Feels like a repeat for B’s TESE procedure, information and expectations to pay last minute. I’ll be honest, my least favorite part of this journey to date has been dealing with financial counselors/ finances. That says a lot as I HATE needles or well actually watching needles puncture my skin.

I try to be proactive and I do think sometimes my experiences working in healthcare keep me from being so naive and going with the flow. This is technically an advantage though it does not feel like it in this moment. With our fertility clinic I had not run into major financial issues until now. I had not had to request authorizations be sent to insurance or anything of the matter in the past. I would just get financial estimates in our portal and then I would ask to review them for clarification on what we are agreeing to. When I paid for our last cycle I did go ahead and request this authorization for this cycle to be worked on.

Cycle Two came to an end and I realized I had not received any financial information so I followed up the April 8th, the Monday immediately after my retrieval. I had not heard anything in a week and I do understand authorizations take time. I decided to call up our medical insurance provider on April 15th, to even inquire if a new authorization was sent. It was confirmed a new authorization was sent over on April 10th with three CPT codes. During that interaction, I did confirm with the insurance representative that the previous 17 CPT codes were still authorized for the year. Our insurance confirmed yes. At that point, I felt confident to follow up with the clinic and inquire about the delay as the majority of the codes have already been approved. (For additional context, the financial estimate has to be signed and paid before baseline/ monitoring appointments can begin for a cycle.)

The financial counselor responds with we only have an authorization for one cycle for an egg freezing package. Now, again, working in healthcare, I document everything. I check my records and I know I paid for two cycles and had two authorizations, one for an embryo freezing package and one for an egg banking package in total 17 CPT codes approved. I express all the CPT codes already approved are good to go and it’s the same package that we are utilizing again so why would anything change? The financial counselor notes a pre-authorization is needed for each service. At that point, I feel like I am talking to the wall and request to speak via the phone as I know written messages are not always the best route.

Today, we had our phone call which the financial counselor repeats there is nothing they can do until the insurance authorization comes back. They note only one authorization is good at a time and only one authorization can be sent out per cycle. I reiterate that would not make sense as three CPT codes do not cover all the services required for this cycle and no insurance would keep approving the same codes over and over if an approval is already on file. I inquired how do we proceed forward if this information is not on file. The counselor noted we will have to private pay the whole cycle and request insurance reimbursement. Again, that doesn’t make sense if the whole cycle which was previously approved in January 2024 minus those three codes. I realized I was getting nowhere and requested if they could request insurance to expedite the authorization. The counselor told me they sent the request to pre-authorization. So from my gathering is the financial counselor does not handle this process at all so how can you truly speak to the issue at hand.

I called our health insurance immediately after the call ended. I had a lovely representative today who did validate I am correct that all the 17 CPT codes are approved and only three are pending. The insurance representative noted someone from the clinic called the other day and denied wanting to receive the authorizations on file as they will wait for the last one to process. The representative did offer to call the clinic to see if they could smooth it over with them. I said it would be greatly appreciated.

Once that call ended, I tried calling the clinic back to see if I could speak to someone in finance, billing or even the clinic manager. I ended up leave two voicemails. With the day coming to an end I messaged my care team noting I have concerns and I am unsure how to resolve them. My nurse noted she reviewed the financial information and is requesting the practice director to get involved.

I know I am not the only person this has happened to. I believe there should be some kind of flexibility so you are not wasting time and money for minor issues. I understand the clinic wants to get paid, trust me I want to pay them my portion so we can continue, though if we drag this out another cycle because of this I will be extremely upset and have a bad taste in my mouth. We are almost to the finish line and remember time is of the essence. So I am left without a resolution at this time, stuck in limbo for now.

-A