Good and Bad insurance news

Country Girl in the City

I looked into my insurance coverage for IF.  If it is related to endo (which I have been diagnosed with in the past) all IUIs and IVFs will be covered except for a $200 co-pay.  If it is undiagnosed feritlity then they pay 50%.  All IF drugs are covered.  The only down side is that I have to wait until we have been trying for a year before we are covered.

This try has only been 7 months so I have to wait for a bit before I can go to the RE.  I think that I should still go back to the OBGYN in June because I had another annovulatory cycle.  Do you ladies think that is the best idea or should I wait it out until October when I can go straight to the RE?

Mrs.McIrish

Insurance coverage is great. What state are you in? I'm just curious. Did you specifically ask about the age factor?  MA only makes you wait 6 months if you are over 35 for coverage.

lmydogally

That is extremely excellent coverage, even at 50%.  We have 50% coverage and it made a huge difference. 

Country Girl in the City

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Country Girl in the City

Do you mind if I ask how much you had to pay out of pocket at 50%?

Mrs.McIrish

Country Girl in the City:

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Oh well. I'm not sure what my advice is on waiting until October. Obviously you have to wait for coverage. But if you are annovulatory and get into the gyn to give you clomid (and monitor you), that might be worth it and not too expensive out of pocket. Do you usually ovulate or was this month just a whacko cycle where you didn't?

Mrs.McIrish

Country Girl in the City:

Do you mind if I ask how much you had to pay out of pocket at 50%?

I know this isn't directed to me but I was told by my first RE that IVF was $11K plus about $5K meds. The price of meds is variable as you don't know how much you will need and for how many days. So it could be more or could be less.  Anyway, 50% of that total is $8000 per cycle.  If you do ICSI and anything else, it is more of course.

lmydogally

Country Girl in the City:

Do you mind if I ask how much you had to pay out of pocket at 50%?

6,000 for the IVF and we have 20% OOP for meds and I paid about $1,000.

Country Girl in the City

Mrs.McIrish:

Country Girl in the City:

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Oh well. I'm not sure what my advice is on waiting until October. Obviously you have to wait for coverage. But if you are annovulatory and get into the gyn to give you clomid (and monitor you), that might be worth it and not too expensive out of pocket. Do you usually ovulate or was this month just a whacko cycle where you didn't?

According to FF I have only ovulated one cycle out of 7.  Last cycle I had highs on the the CBEFM but no peak.  This cycle I had no high and no peak.  My insurance specifically says that it will cover clomid at any time so I am good with that.  Even if they did not cover it I would not mind paying out of pocket.  I am just worried that they would not pay for the monitoring.  I don't know if my OBGYN would give me the clomid whithout going to the RE.  Our last conversation was to try for two more cycles and then she would send me to the fertility doctor.

If I had ovulated on my own but just had not gotten pregnant yet, I would be more comfortable waiting a year for any more treatment.  The annovulatory cycles are what has me concerned and feeling like it is the time to get more aggressive.

Country Girl in the City

lmydogally:

Country Girl in the City:

Do you mind if I ask how much you had to pay out of pocket at 50%?

6,000 for the IVF and we have 20% OOP for meds and I paid about $1,000.

Thanks, it looks like this could get expensive very fast.

Mrs.McIrish

Country Girl in the City:

Mrs.McIrish:

Country Girl in the City:

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Oh well. I'm not sure what my advice is on waiting until October. Obviously you have to wait for coverage. But if you are annovulatory and get into the gyn to give you clomid (and monitor you), that might be worth it and not too expensive out of pocket. Do you usually ovulate or was this month just a whacko cycle where you didn't?

According to FF I have only ovulated one cycle out of 7.  Last cycle I had highs on the the CBEFM but no peak.  This cycle I had no high and no peak.  My insurance specifically says that it will cover clomid at any time so I am good with that.  Even if they did not cover it I would not mind paying out of pocket.  I am just worried that they would not pay for the monitoring.  I don't know if my OBGYN would give me the clomid whithout going to the RE.  Our last conversation was to try for two more cycles and then she would send me to the fertility doctor.

If I had ovulated on my own but just had not gotten pregnant yet, I would be more comfortable waiting a year for any more treatment.  The annovulatory cycles are what has me concerned and feeling like it is the time to get more aggressive.

That was be extremely frustrating trying on your own when you know you aren't ovulating. It can't hurt to call the gyn to see what she says. Clomid is VERY cheap if you have to pay OOP. I would say the u/s would be a few hundred(it depends on how fast you stimulate and how many u/s you would need). You can do TI and save money on the actual IUI. It sounds like you just need eggs to come out! Good luck!

Country Girl in the City

Mrs.McIrish:

Country Girl in the City:

Mrs.McIrish:

Country Girl in the City:

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Oh well. I'm not sure what my advice is on waiting until October. Obviously you have to wait for coverage. But if you are annovulatory and get into the gyn to give you clomid (and monitor you), that might be worth it and not too expensive out of pocket. Do you usually ovulate or was this month just a whacko cycle where you didn't?

According to FF I have only ovulated one cycle out of 7.  Last cycle I had highs on the the CBEFM but no peak.  This cycle I had no high and no peak.  My insurance specifically says that it will cover clomid at any time so I am good with that.  Even if they did not cover it I would not mind paying out of pocket.  I am just worried that they would not pay for the monitoring.  I don't know if my OBGYN would give me the clomid whithout going to the RE.  Our last conversation was to try for two more cycles and then she would send me to the fertility doctor.

If I had ovulated on my own but just had not gotten pregnant yet, I would be more comfortable waiting a year for any more treatment.  The annovulatory cycles are what has me concerned and feeling like it is the time to get more aggressive.

That was be extremely frustrating trying on your own when you know you aren't ovulating. It can't hurt to call the gyn to see what she says. Clomid is VERY cheap if you have to pay OOP. I would say the u/s would be a few hundred(it depends on how fast you stimulate and how many u/s you would need). You can do TI and save money on the actual IUI. It sounds like you just need eggs to come out! Good luck!

You have such good advice.  I will keep the appointment for June.  I won't have to pay OOP for Clomid because my insurnance will cover that at any time.  However, I will have to pay for the ultrasounds but that should not be so bad.

Do you know how often you have to have ultrasounds while on clomid.  Also, what is TI?

Mrs.McIrish

Country Girl in the City:

Mrs.McIrish:

Country Girl in the City:

Mrs.McIrish:

Country Girl in the City:

I am in DC and work for the federal government.  We get to pick which insurance we want out of about 20 plans with high and low options.  The one year if for all ages.  There is nothing special for us old ladies.

Oh well. I'm not sure what my advice is on waiting until October. Obviously you have to wait for coverage. But if you are annovulatory and get into the gyn to give you clomid (and monitor you), that might be worth it and not too expensive out of pocket. Do you usually ovulate or was this month just a whacko cycle where you didn't?

According to FF I have only ovulated one cycle out of 7.  Last cycle I had highs on the the CBEFM but no peak.  This cycle I had no high and no peak.  My insurance specifically says that it will cover clomid at any time so I am good with that.  Even if they did not cover it I would not mind paying out of pocket.  I am just worried that they would not pay for the monitoring.  I don't know if my OBGYN would give me the clomid whithout going to the RE.  Our last conversation was to try for two more cycles and then she would send me to the fertility doctor.

If I had ovulated on my own but just had not gotten pregnant yet, I would be more comfortable waiting a year for any more treatment.  The annovulatory cycles are what has me concerned and feeling like it is the time to get more aggressive.

That was be extremely frustrating trying on your own when you know you aren't ovulating. It can't hurt to call the gyn to see what she says. Clomid is VERY cheap if you have to pay OOP. I would say the u/s would be a few hundred(it depends on how fast you stimulate and how many u/s you would need). You can do TI and save money on the actual IUI. It sounds like you just need eggs to come out! Good luck!

You have such good advice.  I will keep the appointment for June.  I won't have to pay OOP for Clomid because my insurnance will cover that at any time.  However, I will have to pay for the ultrasounds but that should not be so bad.

Do you know how often you have to have ultrasounds while on clomid.  Also, what is TI?

Glad you like the advice. It's nice to know that all this crap I've learned in the past 6 months can help someone out!  

TI= timed intercourse

I did one clomid cycle. I had the baseline u/s on day 3 and only one more on day 10. My b/w showed I was about to ovulate on my own so the IUI was done on Day 11.  Most people probably ovulate later than that so you'd need more u/s depending on how fast you respond to the drug.

MelleTX

Just a note - don't even bother with your insurance for Clomid. It's on the $10 list at Wal-Mart!!!