How I Got $1,200 Back for an Out-of-Network Fertility Visit

Part One: Asking for Help‍

Last fall, I sat on the edge of a paper-lined exam table, blinking back tears while a doctor gently told me what I already knew: “We can try again.” It wasn’t the first failed fertility attempt. And it probably wouldn’t be the last. I’m 37, living in New York City, working a demanding job I actually love. I’ve built a full, beautiful life, but I’ve also spent the last year trying to carve out space in that life to become a mom. That’s not an easy task when the healthcare system seems designed to make it harder, especially for people like me with pre-existing conditions. In my case, it’s my thyroid. An autoimmune disorder I’ve managed for years, but one that quietly complicates fertility and what insurance will cover.

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The (Financial) Breaking Point

The visit in question wasn’t anything groundbreaking: a consultation and diagnostic ultrasound with a highly recommended reproductive endocrinologist. Out-of-network, of course. (In-network clinics were booked out for months, and I didn't have time to wait.)

The bill we received came to $2,760.

My insurance covered nothing. I was angry, sad, confused, and frankly, exhausted. The idea of calling my health insurance company to fight the bill or even get a clear answer on our next options would send me into immediate depression. 

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The Upload That Changed Everything

A friend going through her fertility journey mentioned Sheer Health. I downloaded the app and uploaded my bill to Sheer Health. and found several instances where my benefits had been applied incorrectly. They got to work fixing everything, including the most urgent, my denied fertility visit.

I didn’t have to rehash my story over the phone to a stranger. No hold music. Just connected my insurance and uploaded the information I had. 

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What Sheer Health Found

“This claim was denied due to a missing provider authorization. We’re on it.”

‍Sheer Health flagged that the insurance company had incorrectly denied the claim. They had overlooked that an approved prior authorization was on file. So Sheer gathered the documentation and filed the corrected claim, and had it reprocessed on my behalf.

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1. They double-checked the facts.
   Sheer reviewed the denial and found the issue right away: fine print, vague codes, something filed under the wrong date. Sheer Health knows what to look for, and what shouldn't be ignored.
   
   
2. They pulled together everything needed.
   Instead of asking me to chase down paperwork, Sheer handled it. They retrieved the provider authorization, gathered medical records, and packaged everything into a clean, corrected claim.
   
   
3. They resubmitted with notes.
   The claim went back to the insurance company with clear annotations pointing out the exact authorization that had been overlooked.
   
   
4. They kept watch.
   While the claim made its way through the system, Sheer monitored it every step of the way, sending updates and translating confusing insurance terms plainly so that I could understand.

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The Win

Approved. Reimbursed. $1,200. 

I sat on my couch in disbelief, rereading the message like it might vanish. It didn’t fix everything. I’m still on the path, still facing decisions, injections, and unknowns. But that moment, of someone else fighting for me, felt like a turning point. This was a reminder: I’m not doing this alone.

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What I’ve Learned

Here’s what I wish every woman knew when navigating fertility care:

• Always keep your documentation. Denial letters, visit summaries, diagnosis codes, save it all. You might have to upload these documents to Sheer Health if errors in billing come up or coverage gets denied, and Sheer Health has to step in to reverse things.
  
• Never assume a denial is final. 80% of medical bills contain errors. Seriously.
  
• Ask questions. Sheer Health exists for a reason — and they know how to spot what’s missing, what’s wrong, and what’s worth appealing. If anything, and I mean anything, seems off, open the app and ask. You’ll get an answer.

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