Insurance Coverage...the newest hurdle!!

MsJazzy73

"The following services are not covered by (my insurance):

  • Medications, hormones, lab work, and ovulation stimulation [is this trigger shots?] used in conjunction with any of the following artificial conception techniques:

  • Artificial insemination including intrauterine insemination and any costs related to donors and semen banks. 

• IVF, GIFT, zygote intrafallopian transfer, tubal embryo transfer, all other noncoital reproductive procedures, and any related services or supplies." 

Am I having a foggy moment, or is this basically saying that I shouldn't even plan on keeping my appt with the RE in February? Looks like nothing they do will be covered under my insurance anyway. Having a pessimistic TTC day anyway, so this is not surprising. Only on 10dpo, but I've already had red spotting today...and it totally feels like AF will be here within a day. Really starting to wonder if we should just call it quits now, before it puts too much stress on our marriage. But it breaks my heart to think he'll never have a child of his own. Ok, that's my pity party for the month! Thanks for reading.

Nikolie93

I can't be sure what the insurance stuff says, I just wanted to say I'm sorry for your frustrations

My insurance says they pay for everything up to an infertility diagnosis. I'm thinking mine won't pay for any of the stuff you listed as well.

I am still going to keep my RE appointment because if I don't I will always wonder.

You're probably feeling extra crappy because you feel AF is coming. You may feel differently soon so I wouldn't cancel your appointment.

I'm so sorry *hug*

wannabmama23

I'm so sorry. The finances of all of this is an extra unfair twist of the knife, isn't it? I don't really understand it all, so I'm not much help but I do wonder if you could call the RE and ask the office to look up your insurance and see if there's anything they can tell you to help you make sure you know what you're dealing with.
I hope you feel better in general, too.

MsJazzy73

Thanks @Nikolie93‌! I think you're right! im definitely bummed about upcoming AF! Was hoping I'd be one of those lucky TR patients that got pregnant right away. Nope! Then hoping I'd be one of those lucky people that get pregnant on the honeymoon (like my coworker did). Nope! Lastly, I was hoping I'd be one of those 1st round Clomid BFPs. NOPE! PMS Blows!!!

Nikolie93

I hope what I said made sense, I kind of rambled and it made sense in my head lol

You're definitely just feeling disappointed and frustrated right now. I think you will feel a bit better about it soon.

Jenniferk08

Be sure to check with flex spending. Often you can use that for non covered medical expenses. You are still paying it all but its money taken out pre tax.

MsJazzy73

Yes it made sense! lol

I will surely go, and we will se from there. The good thing is, my TR doc will do free IUIs as part of his aftercare services, if need be!

CML11

@MsJazzy73‌ how does your DH feel about not having children of his own? Is it something you are more concerned about than he is? Is he close with your children to become more involved with their lives?

A lot of what's listed there is IVF related, but you could try IUI first if your RE recommends that you are a candidate for that route. It's much cheaper than the IVF. Your RE would probably want you to have an HSG (dye test to check to make sure your tubes are open)
Blood work and ultrasounds
DH to have an SA (semen analysis)
There's not many medications for an IUI just initial meds through the first few days then a trigger shot.
Prices will vary, but an IUI is a fraction of the cost of IVF.

Hugs to you with whatever you choose.

[Deleted User]

The user and all related content has been deleted.

MySallyGirl

I'm sorry your insurance is covering what you hoped.  I would still keep the first appointment just to see what the doctor might offer you.

MsJazzy73

@CML11‌ .... Thank you for asking that question! :-)

He is getting more and more disenchanted with the idea, the harder this becomes. Having dealt with infertility in his first marriage for 13 years (her PCOS and even failed IVF) and now here we are with this after my reversal almost 3 years ago! His SA was finally normal again after discovering and then healing from varicocele surgery in January this year. 

That's why we talked about it a month or two ago, and agreed to call it quits (on TTCing) if I wasn't pregnant by our birthdays in November next year. I think after so long and so much disappointment, he's just accepted that it's not gonna happen for him. Which makes me want it even more. :-(

I will definitely go to the appointment and see what other options we have. I would be willing to pay for a few rounds of IUI, but after that, no more. I'd rather just move on to the next phase in our life together, and I know he feels the same. We would be ecstatic if it happens, don't get me wrong. But, I think we are both starting to accept the inevitable. It's a trait of his that I think is rubbing off on me! "Expect the worse and be pleasantly surprised" )

Teenie16

I'm so sorry. PMS sucks! I know there have been a few months that I've felt that it was never going to happen for us too... Don't get too down just yet. The RE may help give you some positive answers. 

I've learned a lot since we started see one. Your insurance sounds like mine, nothing is covered when it comes to TTC. But was hoping I read it wrong and called the RE office and had them check. They confirmed what I thought and nothing is covered so we're 100% OOP. They're great with letting me know how much everything costs before we do it. Office visits, US, blood work, IUI, IVF etc. I think they're used to people like us. So we're proceeding accordingly. 

You have to do a bunch of leg work but it can work out if you want/can spend the time and money. (He sent me for a HSG. I called several different hospitals for price comparison. They ranged from $2500 to $350. I had to drive an hour but saved a lot of money.) I know this isn't something you want pinch pennies on but it was still a reputable hospital and I got a CD of the images. Fancy! ;-)

Hopefully you won't need all of that.... Fingers crossed for you and hope you feel better soon. 

MsJazzy73

Thanks for all the kind words and helpful advice! I had my HSG done last year and tubes are clear! Got the CD too! It's pretty neat!

@Teenie16, I can't wait to see hopefully good news from your IUI! FXd for you!!

suziq1978

MsJazzy73 said:

"The following services are not covered by (my insurance):

  • Medications, hormones, lab work, and ovulation stimulation [is this trigger shots?] used in conjunction with any of the following artificial conception techniques:

  • Artificial insemination including intrauterine insemination and any costs related to donors and semen banks. 

• IVF, GIFT, zygote intrafallopian transfer, tubal embryo transfer, all other noncoital reproductive procedures, and any related services or supplies." 

Am I having a foggy moment, or is this basically saying that I shouldn't even plan on keeping my appt with the RE in February? Looks like nothing they do will be covered under my insurance anyway. Having a pessimistic TTC day anyway, so this is not surprising. Only on 10dpo, but I've already had red spotting today...and it totally feels like AF will be here within a day. Really starting to wonder if we should just call it quits now, before it puts too much stress on our marriage. But it breaks my heart to think he'll never have a child of his own. Ok, that's my pity party for the month! Thanks for reading.

I work in benefits and while I don't know your plan, this sounds to me like anything that is provided in relation to IUI or IVF will not be covered.

Plan documents can be hard to read and understand.  I would suggest that you contact either your HR department (if your insurance is through your employer) and have them explain or contact the insurance carrier directly and ask them what is covered in regards to fertility/infertility.

I hope this all works out in your favor!

kelley72

I am so sorry, your insurance sounds like mine, nothing is covered.  I couldn't even get my bloodwork paid for...

I wish you well!