insurance question r/t TTTC

JessicaLeeRiley

I know everyone has different insurance companies and plan options but just curious what have everyones experiences being with what insurance covers. Ex procedures, meds.  

Recently diagnosed with PCOS and this is my first time really having to deal with medical insurance (besides routine yearly visits) and don't fully understand everything with insurance.. Thanks in advance!

RmJohns92

Hi, welcome, these ladies are amazing and a wonderful support system

Our insurance covers just the basic testing other wise we are OOP (out of pocket) for everything including meds.

Good Luck!

Laylarue

My covers all testing up until a diagnoses.  Once a diagnoses is determined, I am 100% OOP.

KdgTeacher

I had all IF DX testing covered as well as all b/w and u/s covered.  98% of meds and 100% of procedures were OOP. 

mkwgymnast

I am so incredibly grateful that I have infertility coverage. With that being said I did find out that my follistim isn't covered but everything else has been; not sure why. Good luck!!!

KdgTeacher

baconface:

 

It is bizarre to me that some of the PPs mentioned that companies will pay until a diagnosis, but not for treatment!! It's like, "ohhh you have cancer. Ok, well now you know. You're on your own. Good luck!"

Uhh yeah, except cancer is life threatening.....IF not so much.

JessicaLeeRiley

My insurance has a infertility benefit that covers up $7,000 medical/procedure and $3,000 in perceptions.  Those are both lifetime benefits and not yearly limits.  The person that I talked to on the phone said as long as the Dx is infertility when the MD does the billing it is covered up to those amounts.  

Has anyone had to do pre-approvals for medication or procedures?? Don't fully understand that either.  I've just been bombarded with information in the past few days I feel like my head is going to explode.

MrsSJE2011

katyj25:

Ours covers testing and meds, as long as we are doing TI. Anything past that is OOP. So even if we do IUI, my RE just submits my meds as TI and we make sure to not submit the IUI claim to insurance.

 You really need to call your insurance company though. Some companies cover the basics, while some cover IUI/IVF and others cover absolutely nothing.

It varies immensely!  We are SOOOO lucky to have 100% coverage.  We just pay a copay for when we actually see the RE and for meds.  Have a lifetime maximum of 6 IVF cycles and there are all kinds of stipulations (ie 3 IUIs before IVF, once you have IVF you cannot go back to IUI unless you have given birth since your IVF etc, etc)

ETA: clarity

hlke

Your RE's financial department should be able to help you a lot with this - they are used to dealing with all the insurance companies.  My insurance covers everything up to a Dx, DW's has a lifetime limit like yours does.  We don't know yet if meds are in that lifetime limit or covered under her pharmacy benefit or not covered at all.

futurehuber

We just have 50% coverage on visits, blood work, ultrasounds, etc.  IUI and IVF are 100% OOP. =( So envious of those who have coverage!  You are so lucky!  My old company gives $15K lifetime towards IF...I kinda want to go back, haha! 

Twinkie0612

I have no IF coverage at all, so all of my testing and treatment has been OOP.  

I am currently going round and round with my insurance company and doctor's office, trying to get my TSH blood work covered since I was due to have it done anyway because of family history of thyroid disease.  It's not much compared to the amount we have spent on the rest of the testing and treatment, but any little bit I can save helps.

htn1763

I am 100% covered for all diagnosis procedures, and then 100% for treatment with a 10k lifetime max.I didn't think the 10k would last long, but the price that the insurance actually pays for each IUI is so much less than the actual cost. Medication is also fully covered. I have a $30 copay each time. 

cdale86

Only testing was covered for us.  No procedures or medications. Everything IVF related is 100% OOP.  I would just talk to the insurance company to make sure you understand the coverage and stipulations.

vpine

SA was not covered by insurance, paid $110 for that. HSG, blood tests and IUI: paid the $35 copay each visit and one bill for $22 for the lab to do blood test.  Trigger shot (Ovidrel) was not covered so we paid out of pocket. Bravelle injections were 80% covered. Insurance will pay up to $10,000 in a lifetime for IVF, that's our last resort, probably after 2 more IUI attempts.

sundowner85

Each insurance is different.

My insurance does not cover anything and we are OOP even for testing.

We are expecting to pay $426 for DH's SA and I was charged $90 just to TALK to my OB for 5 minutes about what she thinks I should do at my annual exam. I am being charged $245 for my annual exam that would normally be free because my OB's office coded my visit under infertility. I have been fighting this bill for the past month and have gotten nowhere. I hate my insurance, and it has totally ruined my chances at having any hope that we will be able to use medical intervention to conceive.