Insurance/ Clomid Question

km-wed

Hi ladies!

I lurk here occasionally, mainly because I am not sure that I fall in to TTTC  yet as we haven't been trying for a full year, but I have learned a lot and I thank you all for that.

I have noticed that quite a few of the ladies on here have taken or are taking Clomid. My question is does your insurance cover clomid and the testing that goes along with taking it? If not what kind of costs can I expect?

I have been dx with PCOS and my doctor said that my next step is clomid. I have been looking into my insurance and found out that it won't cover any infertility treatment or testing, so I am afraid that once I am put on clomid they will stop covering my doctor's visits, any blood work, lab costs or other testing, which I am sure will add up quickly.

Thank you for any advice that you feel comfortable giving!

OCW2010

I'm 100% oop (even for testing/diagnostics and meds).

For 100mg of Clomid, it was $36 at CVS.  But bc it was a new perscription, I got a free $25 gift card.

These are my out of pocket diagnostic testing costs:250 - consult
125 - H's SA
104 - H's infectious disease
602- HSG 78 - FSH and E2 bloodwork
116 - CD4 baseline ultrasound
36 - 5 days of worth of 100mg Clomid (aka crazy pills - I hate them)
136 - TSH and prolactin tests

200 - my infectious disease tests

 =**$1500 approximately

tarabehr

My Insurance covered the first Rx then made me pay OOP for the second. I went to wallmart for my third round and it was like 10 dollars. I don't remember exaclty how much but it was a lot less then the other Pharmacy. Going to Wallmart you would be paying OOP which doesn't go towards insurance which means your insurance company wouldn't even be notified.  To be positive you don't have to give them your insurance card.

Hope that helped!

apaige25

I guess it really depends on what type of insurance you have and how the doctors offices sends in the coding to the insurance company.  Here were my costs.

HSG - covered under ins only cause I already met my $300 deductible.  w/out ins it would have been $850 ish.

SA - covered, only paid like $13 after ins, around $150-200 w/out ins.

Clomid - $28 for 50 mg for 5 days, no ins

u/s - covered by ins as preventative $13, if w/out ins would be $350.

All b/w has been covered by insurance.  I can't remember what is is with insurance.

So basically for me all doc visits, u/s, b/w, and tests are covered.  Not covered is medicine and IUI or IVF procedures.

 Hope this helps.  Good luck with the clomid!!!  It does work for some people.

 

 

futuremrso'

Hi there. I have pcos too. My insurance would not cover anything until 12 months, however they billed all the testing and the clomid challenge test as medical along w/ the pcos. Then my dr was able to submit the medical history along with a letter to get insurance to cover everything. good luck!

jesselayne8

I am out of pocket for "IF" but insurance has been covering a lot more than I ever thought it would.  They have covered all b/w and SA at 100%.  I had to pay $250 for HSG.  Clomid was about $30/cycle.  I pay about $110 for u/s.

MBfromBMC

My insurance covered all of the testing for IF and three cycles of Clomid/IUI.  My plan is fairly basic - just one level above an HMO - and I was actually quite surprised that it covered the Clomid and IUI.  I did have to pay OOP for the Ovidrel injection, however, which was around $90, but I heard from my nurse that it is much more (up to $120) at CVS and other pharmacies.  If you are OOP, I would shop around a bit or ask your RE or nurse where the meds are a little cheaper. 

Sara*n*Ryan

I got my Clomid at Kroger (not sure if you have Kroger where you are), it's on their $9 out of pocket script list, which was very nice. My Ovidrel shot was $250 out of pocket, but I called Walmart and they sell it for $75 and Kroger price matched it for me! I had two u/s to check follies and I asked my Dr. to bill them as routine visits. She did, insurance still declined them, but $60 is much better than $250 for a u/s.

HTH.

SweetieD21

Go somewhere with a generic prescription drug program, like Walmart, Walgreens, or Giant Eagle.  I got mine at Giant Eagle for $9 for 50mg.  My monitoring appts were covered under my insurance since my RE coded them as diagnostic, and I had diagnostic testing coverage under my insurance.  My insurance didn't cover any fertility treatments but diagnostic testing was covered...look in to diagnostic.

km-wed

Thank you all so much for the information!! You all have given me so much to think about and talk to my doctor about at the appt. tomorrow!

I will definitely be checking out the Walmart pharmacy as well as talking to my doctor about whether or not the visits can be billed as routine visits. We have had DH's SA done and that was not covered, but at least it is already done and came back normal. 

This may be a silly question but I am assuming an HSG only needs to be done once, to make sure my tubes are clear. Is this correct?

 

mabst196

My insurance covers diagnostic testing and has covered clomid and progesterone amazingly. They will not cover actual treatment like injectables, IUI, IVF so I was suprised when they covered the clomid.

2HopefulMoms

Sounds like your insurance is just like mine: no coverage for IF treatments at all. I get my Clomid through Walgreens pharmacy and it's $8.99 for 5 pills (a normal prescription) through their generic prescription plan. I have also heard Walmart is very cheap as well. GL to you!