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Navigating health insurance

boymamacoboymamaco member
in TTC after 35
"Fertility enhancement" isn't covered by my health insurance - not even any tests. I made an appt to see an RE instead of going to my OB first b/c of my age and knowing that the RE office will require me to redo any testing by their own labs.

Now I'm wondering if I should go to the OB first and have them at least order the mammogram since that would be covered if it was "routine screening". Pretty sure my insurance company won't approve anything ordered by a fertility clinic even if coded for screening.

Then again it's only one test that I'd be "gaming" the system on so maybe not worth the extra headache.

Thoughts? How did you all try to best manage expenses?
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Re: Navigating health insurance

  • meredithcarolemeredithcarole member
    That's a tough one. I would talk to the clinic and see what they hope to gain in knowledge from that particular test and if they would accept results from your OB. Explain the situation. I am sure you are not the first one to be in that position.
    TTCAL January Siggy Challenge: Animals in the Snow

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    About Me: 

    AMA 35 :  DH 33
    BFP#1 1/26/14 (EDD: 10/7/14).  MMC 3/10/14 D&C 3/14/14
    RE Consult 11/3/14 - AMH 2.25 "great" . FSH 7.10 . Low Vitamin D
    Myomectomy 12/17/14.  Benched until March.

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    My Ovulation Chart
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  • shannonm97shannonm97 member
    Most REs are also OB/GYNs so can code things as routine.  I have fertility coverage for testing only no treatment, surgery, etc.  All my bloodwork and u/s have been covered as well as a lap since they were coded as gynecological. Talk to your RE's office about how it is coded.  It all boils down to the code. 
    Me 38 DH 40
    TTC since Dec 2010.
    Diagnosed anovulatory, HSG clear. Slight MFI- borderline count, but excellent motility and morphology 
    Nov. 12- Feb.13 Gonal F + Ovidrel + IUI = BFN
    Lap April 13. Found blocked tube and bridged fimbria. Opened tube and cut fimbria. All clear 
    June 13  Gonal F+ Pregnyl +IUI = BFN Stopped treatment with RE due to side effects from drugs and told we needed IVF.
    Oct. 13 started Accupuncture and Chinese herbs- being monitored by RE. Getting better response- e2 and follie size. 
    Now RE says TI till March, then IUI. Fingers crossed, 

    All welcome
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  • boymamacoboymamaco member
    Excellent, thank you @shannonm97

    @meredithcarole that is a hilarious book cover! 
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