Insurance & IF

SassFrass

So, I just went through DH's insurance plan through his employment... and my heart sunk a bit... I found the section that discusses infertility, and in the state of NM, in his policy paperwork, it clearly states that IF testing dx and treatments are not covered. I feel like that just put a dead end to all of this. We are currently paying out of pocket for my labs and Clomid, but anything beyond that, I just don't see how we can afford it... not on our salary, I am pushing it considering we have been paying for blood work, which I have done 3 times this month alone and each time is about $150 for the lab not including the office visit... I mean to me it is worth it to see if everything is going right, but in the long run, how can we do this month after month... and with no help from insurance... I feel so lost.

Does your insurance cover your IF?

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SassFrass

JimBobCooter said:

Our IF is 100% out of pocket.  It's why we skipped all other treatments and went right to donor eggs. We can only afford to do this once.  Have you looking into medical financing?  It's not preferable but it you can afford the monthly payment it's an option.  It sucks that so many people's hands are tied by the financial piece.

Where in NM are you?  I'm originally from Albuquerque and DH moved here from Santa Fe when we got engaged. I miss it so much.

THIS! and we are in Melrose, 30 mins from Clovis... We have shitty doctors and shitty insurance I am not very happy right now

pettycrocker

Yes. I live in one of I believe three(? maybe two) states that have mandatory IF coverage. Sometimes, it's cheaper to relocate than it is to pay for it all OOP. 

Last year my IF coverage paid out 20k, that was with 1 IUI and 1 IVF. This year will be much more. I have a crazy deductible now though, last year my total OOP was $500, this year is $4k, plus all the copays for meds and visits, so it adds up quickly even with the coverage. 

freakyfast

100% Out of Pocket 

SassFrass

I think it is just CRAZY! I mean this is a REAL issue that millions of women deal with and then to be like "Screw you, don't care about your IF probs" is a real dick move for Insurances I think

Momarazzi007

100% OOP...
Did your husband finally get tested? This could mean the world of 5k for a cycle or up to 25k+! Just hadn't seen if you posted results yet- or maybe if he was still dragging his feet this might motivate him?

SassFrass

Momarazzi007 said:

100% OOP... Did your husband finally get tested? This could mean the world of 5k for a cycle or up to 25k+! Just hadn't seen if you posted results yet- or maybe if he was still dragging his feet this might motivate him?

this, but I also haven't been able to get in touch with my dr... She has been out of office and the nurse taking messages has been pretty snooty... I should get a call about my 7DPO labs today or tomorrow, and if it is my regular nurse, I will ask her if we can schedule one.. and  just make him go.

Momarazzi007

I hope it is your regular nurse then!!! Good luck w results!!!

MrsLaurenandDan

I'm in NM too. We are lucky that lab insurance covers testing, but not treatment. FYI I looked up your town, and your closest RE (in Nm you look pretty close to TX though) will be in Albuquerque. There are only 2 in the state, there and las cruses. The RE in ABQ does do payment plans, FYI. That's what we will probably have to do.

SassFrass

Where in NM!!!??

MrsLaurenandDan

I'm in LA. So we just did the 2 hr drive to the RE for my HSG and HYst. We're hoping to have a plan today. So wish me luck!

SassFrass

YES GL!!! FX!!!!!

Jodee37

My insurance pays 100% of everything leading up to the dx of IF but anything beyond that is 100% OOP. i have to get pre-auth for everything under the sun though, and they have kicked back a bunch of RPL labs saying they are "experimental." i call bullshit. i wish i lived in the 2 states that pay for IF treatments. maybe i'll move to israel. either way this country sucks as far as providing coverage to IF couples. It's a medical problem just like everything else, what in the fuck. sorry. it pisses me off.

ConstanceGoodspeed

Yes. DH took a pay cut for a job in a coverage mandated state. He hates his job and it is a long commute, but IF coverage is like a $30k+ "bonus."

GraceyandTroy

Which states are IF mandatory coverage?  

My insurance covers testing, but not treatments.  We were able to get one round of clomid monitoring covered because the RE's office submitted it under testing codes, but they wouldn't approve it the second time, so I paid OOP the second time.  I ended up doing weekly acupuncture for 9 months that we paid for ourselves before getting pregnant with DS.  It ended up costing well over $2k, which could have paid for two IUI's at my old RE's office.  Now that I'm a SAHM, we don't have the extra income.

This is part of the reason why I really like working with a midwife and learning and practicing traditional Chinese medicine.  It's much more subtle and takes longer to get in balance, but it's a lot cheaper! 

CeCe8579

100% OOP here....it's not uncommon. Did you not ask or wonder why your Clomid wasn't covered?

pettycrocker

GraceyandTroy said:

Which states are IF mandatory coverage?  

My insurance covers testing, but not treatments.  We were able to get one round of clomid monitoring covered because the RE's office submitted it under testing codes, but they wouldn't approve it the second time, so I paid OOP the second time.  I ended up doing weekly acupuncture for 9 months that we paid for ourselves before getting pregnant with DS.  It ended up costing well over $2k, which could have paid for two IUI's at my old RE's office.  Now that I'm a SAHM, we don't have the extra income.

This is part of the reason why I really like working with a midwife and learning and practicing traditional Chinese medicine.  It's much more subtle and takes longer to get in balance, but it's a lot cheaper! 

I just googled, it says CT, MA, RI, NJ so basically only NE. It does say CA, and TX offer it but it's not mandated yet. 

GraceyandTroy

Thanks for the legwork, @MrsCastillo (how do I tag you?)  I'm in CA but I have non (  Annoying!

HawaiianSunset09

Our insurance is through Illinois, and we have IF coverage(this JUST happened in January). We actually downsized and sold our first home to try and save money for fertility treatments. We went through IF for almost 3yrs with our son, and ended up about 20k in debt because of it. 

sailorgal

We're 100% out of pocket. What bites is that DH had a contract position previously with a kick ass insurance plan. He got a full time job recently and the insurance benefits exclude fertility treatments entirely, meds and all. Being in Canada, thankfully some blood tests, ultrasounds etc. are covered. 

Recently government announced that in 2015 they plan to cover one IVF cycle for a single embryo transfer in an effort to reduce health costs long term from multiples etc. But who knows if that will go through or when. Would be nice if it did. Currently IVF is completely off the table for us.