Insurance: To Cover or Not To Cover

So Friday I had the following email exchange with my RE’s office regarding our upcoming laparoscopy to look for endometriosis:

RE’s office:    

I just wanted to give you a heads up that as of right now, (Insurance Co) is denying your surgery. A negative Beta  Integrin  test  is not justification for laparoscopy.  [We will] review your history to  determine if there  are other signs/symptoms to support a laparoscopy. I will keep you posted on Monday after we are able to review your chart.

Me:                  

Out of curiosity, with so many women asymptomatic (as I am), how does the surgery usually get justified? Or is this often a problem?

RE’s office:    

It is a problem …. Beta Integrin testing (that’s the gross biopsy I had a few weeks ago and will likely repeat) is not recommended/approved by ASRM. That’s why insurance does not cover the test and you had to pay for it out of pocket.  It is a controversial subject in the field. It is kind of one of those theories that has  not been 100% proven or backed by the RE community and studies.

Me:                

Oh I get that – but what about ladies who don’t have symptoms (a 1/3 of women with endo don’t have symptoms) but it becomes necessary to check to see if endometriosis is present….that it’s the culprit for fertility problems? Do you have to go through this every time?

RE’s office:  

If patients are asymptomatic there is usually no need to check for endo.  The only reason we typically do a diagnostic laparoscopy is because someone has symptoms and we have a hunch that those symptoms are due to endo so we go in a look to confirm if our theory is correct.

So…..hopefully they’ll be able to make the case, because it would be nice to know what’s going on in there…and if there’s something going on in there, do something to fix it. We will not do the lap if it’s out-of-pocket. It would be thousands and thousands (and thousands) of dollars, and since it’s only to “look and see” we’d rather save those thousands and thousands (and thousands) of dollars to put into our adoption fund if IVF4 doesn’t pay off. (Speaking of, we had a great meeting with an adoption agency a week ago – I really need o write about that soon).

I have a pre-op phone consult tomorrow to discuss the surgery….hopefully I’ll know soon if I’m actually going to have it.

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