Insurance Coverage

ErinJoshua2011

Was wondering about cost...my insurance (like most, I'm sure) doesn't cover any infertility.  I met with my RE for the first time on Wednesday and he's recommending taking Provera followed by 150mg Clomid CD3-7, he wants me to call on my first bleed day and schedule an HSG and an US.  Our deductible for the year is met...I just wasn't sure if any of this would be covered?  Does anyone have any experience with this?  If not covered, can anyone give me an estimate on the cost of their procedures?  He also said that once the follicles appear to be ready, he would give me a trigger shot...he said that wouldn't be covered and would be around $150.  Thanks for your help!

ceclarlinetlo

I think price is going to vary a lot by office. And there is usually a difference between what is billed to insurance vs what you would have to pay out of pocket if your insurance denies you. Also my insurance covers diagnostic tests and treatments for underlying medical conditions but not things like IVF. so the HSG and ultrasound might be covered a bit for you since its being done to diagnose you with something.

I remember from looking at my explanation of benefits that they billed my insurance $400-500 for a regular ultrasound and that my saline ultrasound which is an alternative procedure to an HSG was around $1400.

BrightenMySky

Ditto @ceclarlinetlo that you may have coverage for diagnostics (like the HSG) but not all treatments.  I have 0 infertility coverage through my work insurance, but it covered the HSG.  Then I moved over to DH's insurance which has some coverage.  The trigger shot (Ovidrel) is not covered, though, and I pay $99 for it at a fertility pharmacy in my city that my clinic recommended as the cheapest option in the area.  

ShallowSeas

It depends on your insurance. Some or all may be covered.  Have you talked to your insurance company?  I have Aetna and once my deductible is met, all my testing is covered.  The only thing I have to pay out of pocket is the copay for the office visits and the treatment...however my insurance does cover some prescription drugs.

ErinJoshua2011

I haven't talked to my insurance company yet...I was thinking the same thing about it being covered because he's using it to diagnose something.  He wants me to come to his office to have it done which is 2 hours away, I guess I should call them because he's in-network but not a "preferred provider."  Or I'll just get it all done and figure it out when I get the bills!

Thanks, ladies!  I just love this board...it's helped me so much!  Best of luck to all of you @severmilli12 @BrightenMySky @ceclarlinetlo

guzmancw

I think it depends on your insurance. Ours covered diagnostic testing at a %. Our HSG exam was $150 out of pocket with insurance however we asked for the cash price just incase it didn't cover and it was $375. I have found that the metformin, and provera are relatively inexpensive. I get both of those from our rite aide pharmacy and it comes to less than $20 for the both of them. We have been on a tight budget so I have been keeping a close eye on the costs. The Clomid was $12.99 for the off brand (100mgx5days) while the Femara that I took was less than that. Our RE charges for the procedures done. For example if we go in for an ultrasound, I only pay for the ultrasound. If we have a consultation, we pay the office visit, when I went Friday for the IUI, there was one price $335 for the whole procedure even DH's donation and wash. The trigger shots can be called into lots of different pharmacies. My RE's office is great about directing us to the cheapest. We have ordered from Freedom Pharmacy and also Integrity RX, (both will Fed Ex the prescription to you). This cycle we order from Integrity the pregnyl shot and it was just under $100. I was also told that Costco offers the cheapest Clomid pills in my area, maybe check with your local Costco? I hope that this helps!! Best of luck!!!

starlitfae

My personal I don't think will help you, but I will stick it up in case it will help someone else...  I have military insurance (Tricare), which does not cover fertility at all outside of what is done at military facilities.  So the RE, and the IUI itself is all done at the military hospital, and I do not have to pay out of pocket.  DH's SA(s) were considered medical testing, so they were also covered although they were done by civilians, but the wash was not covered and paid for by us when it was done.

For you @ErinJoshua2011 I would for sure say call your insurance. I would write down all the questions beforehand, because I would get myself confused and miss something.  It's better to make sure you have all.  You can also call the doctors and ask them how they work with your insurance..  Ive had the experience that the insurance companies themselves don't always know what they cover.

LGW2015

@ErinJoshua2011 I just scheduled my HSG for next week. I'm not sure if this will help but I spoke with the financial woman at the hospital and she said that my insurance will "cover" it but it falls under my deductible. She gave me the estimate as follows: $188.30 toward the deductible and $20 copay. Because my deductible is $300, I will have to pay for it out of pocket and continue to do so until I hit my $300 limit.

bumpuser10794054

We have diagnostic coverage only.  My HSG was covered as well as my Lap surgery.  Although my insurance isn't supposed to cover treatments, I have found that we have coverage for a handful of medications. 

yellingbanana

Just remember that each visit, blood draw, procedure will cost something. Our ins was supposed to cover a good chunk, but we've had to call and fix many a bill. Still, each month going to the RE has cost about $600-$900. Each month also involved a procedure (HSG, SHG, clomid challenge, semen analysis- can't believe they called that a procedure, and 2 ultrasounds a month, 2 blood draws or more a month).
Just make sure to go over the cost of each visit. That's my best advice. And good luck

Hogwartsmom

Our insurance covers infertility except for IVF. Before I got any procedures done, I called the billing department at my REs office and got them to find out exactly what would be done and the exact trigger shot name. Then I got the ICD9 codes which are the codes they send to insurance to tell insurance what they did or gave to you.

Once I had the codes I called insurance and verified that it was covered and whether or not I needed to get pre authorization.

The weird thing is, when I finally went in for my IUI, billing came out to the waiting room to talk to DH and I about insurance. She said that it wasn't covered but I knew for a fact that it was. So I called my insurance in the waiting room and had the representative tell the lady from billing that it is covered. I just kept thinking that if I hadn't checked for myself, I might have not been so sure. It also made me wonder how many women out there are told by their RE's "insurance verification person" that things aren't covered when in fact they very well might be.

turtle148

My insurance only covers diagnostic testing. However, it does add in discount coverage through Optum ParentSteps if I go to a specific RE. If I go to any of the clinics in my area that are on the list I can save between 12% - 33% on treatment. Since we are preparing to be sent back to the RE I decided to check into it. While it's not my insurance coverage it does help with some of those costs.