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Thread: Diagnostic vs. Treatment

  1. #1
    Webbski26 Guest

    Default Diagnostic vs. Treatment

    My husband and I were told that all diagnostic testing for infertility would be covered by our insurance, however, since the diagnostic code used on the bills sent to insurance contain the word infertility, they are not covering anything. we have not yet even been told if we are going to be needing treatment, and already have bills totaling approximately $5,000 that insurance is not covering. I asked them to show me in my policy where this is stated, and it only states that Infertility Treatment is not covered. Any guidance on how i can handle this? Diagnostic codes cannot be altered.

    Thank you.

  2. #2
    Join Date
    Jul 2009


    I had the same problem, my plan only covered diagnostic claims, no treatment, but if the code that was used for testing had "infertility" in it, it was declined. My doctor's office resubmitted the claims with a different code that was still applicable to my situation, I think they used a code for abnormal menses? With my husband's tests it was more complicated. We had to appeal the claim and the doctor had to write a letter and send our records in to get testing covered. It took a long time and was very aggravating. Hopefully your doctor's office will be helpful and work with you to get the claims paid!

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