Because nothing can be simple...

Mrs.McIrish

What would you do with this scenario:

It looks like DH's insurance will cover me for IVF at 100% as long as my FSH is under 15. Sounds fabulous, right? I can't  get on his insurance until July 1 and you have to be pre-approved before doing the procedure. So I would likely be doing injectibles until mid July/August.  I can live with that.

The ringer:  my current RE is at a new practice (she and 3 other docs left a center to start their own a few months ago). DH's insurance has not given them a contract for IVF!!!  They are only approved for IUI.  They are going through the approval process but it will take months."Maybe" it would be this summer. 

Question: Would you go to a new doctor for IVF if it was covered 100%? What if that meant going back to the original RE I didn't like?

ETA: I realize 100% coverage is unheard of so please don't take this as complaining. I fully realize how fortunate this coverage is. I'm just debating where to go next.

jb2rn

Yes, I would. Only because sadly, time it not on our side at this age.

100% coverage for IVF is something I have never heard of, honestly (and I wouldn't have qualified with my FSH number). Go for it!

I am sorry it is never simple.

Although, I really, really, hope you don't ever need IVF.

Mrs.McIrish

jb2rn:

Yes, I would. Only because sadly, time it not on our side at this age.

100% coverage for IVF is something I have never heard of, honestly (and I wouldn't have qualified with my FSH number). Go for it!

I am sorry it is never simple.

Although, I really, really, hope you don't ever need IVF.

Jen- Massachusetts apparently rocks in IF coverage. It's totally crazy but they cover 100%!! All I would pay is $250 deductible apparently. There are rules of course but it's 100%.  I just hate the idea of a new doctor again. But it probably isn't worth me paying 20% to stay where I am... I just don't know whether to go somewhere else in MA versus back to the doc I didn't care for who is close to home.

irishgirl0525

I would too. Is the RE you didn't like the only option to go to? I wouldn't want to go to someone I didn't like if I could help it (I don't know the background of why you didn't like him), but if you are covered at 100% and you could do it sooner rather than later, I personally feel those two reasons alone are worth switching doctor, but that is just me.

And I also really hope that you don't need to do IVF, but how fortunate you are that it is covered!

IVF on my husband's insurance is $1500 out of pocket which I am grateful for, but we get a lifetime limit of 3 tries, so really need to be prudent about it.

Mrs.McIrish

irishgirl0525:

I would too. Is the RE you didn't like the only option to go to? I wouldn't want to go to someone I didn't like if I could help it (I don't know the background of why you didn't like him), but if you are covered at 100% and you could do it sooner rather than later, I personally feel those two reasons alone are worth switching doctor, but that is just me.

And I also really hope that you don't need to do IVF, but how fortunate you are that it is covered!

IVF on my husband's insurance is $1500 out of pocket which I am grateful for, but we get a lifetime limit of 3 tries, so really need to be prudent about it.

I have to wait until July 1 for the insurance coverage no matter what. If I did it earlier, it would be on my insurance and I'd have to pay 20%.  It's really only 1 month past what I was going to do originally.

The original RE seemed to be treating me as if I was 28 and had normal FSH. She just wasn't aggressive and didn't want to tell me anything. I'm type A and I "need" to know!  There are other RE options for me to go to but they would be further away. I am in RI and would have to go to Boston or surrounding areas.The monitoring would be tough as it takes 2 hrs to get into Boston in rush hour from my house (I'm an attorney and that's how long it takes me from my house when I go to court in Boston).

DH's insurance will cover 5 IVF cycles (a cancelled cycle counts though).

ForTheLoveOf Pink

hmmm, the RE always seems to be the thing that makes you relaxed and feeling at ease with the whole process. However, IVF 100% coverage.....there is no question for me I'd see anyone with a decent track record!!!!! You have seen a fair amount of Doc's to know and to be able to question if the "new" RE is doing something out of the ordinary. Hopefully the new place will be able to just pick up where the current has left off...meaning not having to do any additional testing or procedures.

I'm in Canada and not covered for IUI or IVF (some companies do cover but not my DH's). With that said our Provincial coverage covers office visits, blood work, u/s. So for an IUI we pay drugs, and the insemination. I feel fortunate to have minimal things covered, but feel sad that IVF may be financially out of reach.

BostonGayGal

Have you talked with the insurance lady at the new place?  She might have more targeted timing info in terms of approval.

Otherwise, find a new doc.  Not the old one.  If I couldn't stay at our practice, I would look for a doc at the Brigham because I have heard wonderful things about their fertility practice. 

happywifemomofone

I would look for a different RE at the clinic that you used to go to.  We had to switch RE when we switched to an HMO and I hated switching.  However, I've found that it's good to have more that one perspective, despite being comfortable where you are.  You can always switch back if your current RE picks up a contract with DH insurance plan.  Would watch term 100% coverage, we had same, but were out 25% copay for first IVF cycle (this was >$1500, and we didn't find out until we NEEDED the meds)   Good luck with whatever you choose to do!

Mrs.McIrish

BostonGayGal:

Have you talked with the insurance lady at the new place?  She might have more targeted timing info in terms of approval.

Otherwise, find a new doc.  Not the old one.  If I couldn't stay at our practice, I would look for a doc at the Brigham because I have heard wonderful things about their fertility practice. 

Yes! I spoke to Jennifer and she said the contract could take months. It's the one insurance they don't have the contract for yet. She said she would keep me posted since I'd be waiting until July for DH's insurance to kick in anyway.

Good luck with your transfer this weekend!!

MelleTX

I would totally wait the month and go for 100% coverage. Do another injectibles cycle and maybe you won't even need it.

Scratch that... you definitely won't need it because of course this cycle will work for you.

However, if you do have to go back to your old RE, what about making an appointment to talk to her about your feelings and what you need from her as a patient. I know my RE tries not to overload me with medical information. I basically had to tell him how I want to be treated. He responded very well and now gives me exactly what I need.

lhcooper

I pretty much second what everyone else says.  For me, if I had the option of 100% IVF coverage, I think I'd even go back to the clinic I didn't like.  Sadly, where I live we have 0% fertility coverage of any kind.

cmyrck

I think the only thing you can really do is calculate up the 20% and figure out if the RE you like is worth that surcharge, and even if she is, can you afford it.  You could also look around for a third option; some other new RE that is covered at 100% if there is a third option nearby that is decent.  I'm not sure I'd go back to an RE that I wasn't comfortable with and whose approach didn't seem right for my circumstances if I had the funds to go to the one I did like - but it all hinges on the money. And even if the RE wasn't 100% covered, would the meds be covered the same way at either place?  Can the labs be in network?  If you can get the labs and the meds covered the same either place, the actual OOP cost of the RE might not be that bad, depending on your protocol.  It takes a lot of legwork and negotiation to pull that off, however, so it depends how much that will stress you out as well.  Hope that helps -

irishgirl0525

I agree with cmyrck about calculating the cost of the 20% and determining affordability and if it's worth it to you to pay that. I really hope you don't have to go that far and that your IUI works this cycle. 

Worrying about insurance and planning ahead for timing and all of these issues really doesn't help keep the level down during a cycle that you are hoping works so that you don't have to go to all of this extra trouble.  It's so ridiculous that the second you finish your insemination that you have to start thinking about what you are able to do if the current cycle is a failure, but heaven forbid the insurance companies don't get enough notice about what you are doing.

 

mtlaurel

I agree with cmyrck and irishgirl. You seemed to like the RE you're with now, so I think you need to figure out if the 20% is worth her relative proximity (vs. Boston), her familiarity with you, and the ability to start IVF (if needed) more quickly.

I hate that anyone is trying to make these kinds of decisions while still waiting on IUI results... Good luck.

boymamaco

You could always look around and do a couple of consults with other RE's in your area. Even if you have to drive a ways to get to them, 5 covered IVF cycles is amazing. Can I borrow your DH?  Sorry that you have to wait a couple of extra months, I'm sure that is equally as frustrating!