Had to get infertility audit from Insurance co?

dhreczuck

Uggg, so I feel like an Ass&*^!.. for being ms sunshine about insurance the other day. I've spent two days on the phone w/ my insurance and am still no closer to finding out how much an injectable iui cycle will cost me.

My RE office billing coordinator told me I have a 10K lifetime max on fertility treatments and that I have to request an audit to see how close I am to that max.  As you all know, that does not go very far at ALL! I started seeing an RE in July after my first m/c and had tons of blood work and at least 4 or 5 ultrasounds since then so I could already be close to that 10K max. The billing coord said alot of the times its hard to know what would have been coded as infertility treatment so i can only hope my appts up to this point have been coded as routine care. The only hopeful thing she said is that alot of the time prescriptions do not get added to that lifetime max. If we do an injectable cycle that will be the burden of the cost. 

I got sooo depressed today, with the why us wtf.. why did we have a cvs test done, i probably wouldn't be going through this if we hadn't  

DH and I had a good conversation tonight of were we can cut our budget to save more money. We have enough to pay OOP for about 3 Injectable cycles i think with a little left over but we don't think it's worth putting more time and $ into that, if we have to move onto total OOP for IVF than we're looking at early 2013 and even then probably only one cycle.

I'm trying to stay positive that bfp is in our future, but I think going to an RE and listening to stupid statistics really makes you panic! 

 

chicagobride_07

Hang in there- I know it is hard!  I can't get anywhere with figuring out what my benefits cover.  I know IVF is not covered- it's hard to tell on other things.  Keep getting different stories.  So far they've paid for the initial consultation, some monitoring and meds.  We will submit everything to insurance and pay what is rejected with our FSAs and savings.

hmontty

Eh, we had to pay everything out of pocket when we saw a RE a few years ago. We paid probably $10K out of pocket for a handful of IUIs, not including meds. No insurance coverage for infertility at all.

However, once we were pregnant (naturally, as it turns out), our entire pregnancy and delivery cost us a total $30 out of pocket. Go figure.

I guess what I'm saying is, feel fortunate you have any coverage at all!

Reilly626

Sorry! Put the rest of your 10k towards IVF, the IUIs are a waste o time. GL

dhreczuck

I don't have any coverage for IVF, so it won't count towards the $10k max, as it stands we'll probably only do 2 IUI's, from what I understand it's worth it so your RE can see how you react to the injectables, I don't want my first IVF to be a "test" cycle.

Country Girl in the City

Hang in there.  Dealing with United Healthcare can be exhausting.  They have made me cry many times.  However, once you get it all figured out, it will be worth it.  Good luck!