Insurance

Lenox1975

I have my annual visit with my ob/gyn next week and since I'm getting closer to the 6 month mark, I plan to ask some questions about seeing an RE, etc.

In preparation, I am planning to call my insurance company and ask about costs and coverage for IUI, IVF, etc. For those who have gone through this - can you tell me what I need to ask? I usually get nervous on the spot so want to write it all down so I don't forget.

Total related side note - I work for a big company and my husband works for a start up/small company.  Overall, my insurance is better so we're both on mine.  However, my DH's (very inappropriate) head of HR has been grilling him on when we will try.  She was 40 when she had her son and went through IVF.  She had so many challenges TTC that she made a decision to have all Infertility treatments covered by the company insurance so no one else would have to suffer!!!  I guess I can look into switching to his mid-year but I'm not sure that's possible....

Country Girl in the City

When I talked to my insurance company, I never got the same answer twice.  Look on your insurance card and see if there is a website.  It should spell out for you exactly what is covered in different circumstances.  For instance, with my insurance fertility testing and treatment is not covered until you have been trying for one year.  The exception to that is if you are diagnosed with certain conditions such as endo.

It was really hard for me to get my insurance company to initially cover my IF.  I really wanted to just go OOP because it was so hard.  I am glad that I listed to the advice that I got here.  I kept pushing until the agreed to cover what my policy said they would cover.  My IVF meds would have been around $7000 OOP.  With my insurance, I paid just under $300.

Good luck to you.

dhreczuck

Wow, I wish someone at my company would make that decision!

Some of the ladies here may remember I posted back when I first joined the board before calling my insurance company, I thought it would be easy to get all this info but typically it's not at all. Since you haven't been to the RE yet I would just ask if they cover diagnostics tests ie HSG, ultrasounds, sperm analysis and bloodwork for infertility. That's usually a good starting point. I don't want to scare you but expect the worst and maybe you'll be pleasantly surprised. They usually give you the run around.  Set aside plenty of time for the conversation because it will likely involve getting put on hold or transferrred and repeating your question multiple times. My insurance still hasn't given me a straight answer on what is and isn't covered and I've asked a million different ways and spoken to dozens of people there. I hope you have better luck!

happywifemomofone

I would get started just asking about seeing a RE and the coverage for diagnostics.  See what treatment RE is suggesting, then call back and ask about individual treatments.  I always tell other to make sure you ask about drug copays.  We switched to an HMO to get coverage for our IVFs.  However, learned one week before starting stims that we had a $2500 copay on Class IV drugs (which is what all the stimulation meds are).  We almost had to cancel our cycle because we were completely unprepared for this expense.

chicagobride_07

I've called my insurance several times (as has my RE's office) and always gotten a different answer about my coverage.  I found the best way to sort of get an inkling was to have the physician's office call with the specific diagnostic/procedure codes.

I do have coverage for IUI, but even with that, I've been paying about $1K-$1,500/cycle.  I have 80/20 coverage for the office visits and procedure- but no coverage for injectible fertility meds.  The meds really add up. I also have no coverage for IVF.

It sounds simple but it actually took me just incurring the costs and submitting the claims for a cycle to figure this out.  I got so much information from my insurance company (BCBS PPO) customer service and it was not spelled out at all in the plan documents.

mtlaurel

As PPs suggested, I'd start with asking about diagnostic testing coverage, and would ask if you have to have been TTC for a certain length of time.

Once you have a diagnostic code, it's easier to get information out of insurance. Also, I tended to trust what my RE's financial coordinator told me insurance would and would not over, more than the insurance company's customer service folks, just because she had been through it so many times.

Good luck, and here's hoping it doesn't come to that for you.