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Infertility
intheplanningstage
member
Make sure you question any insurance denials!!
intheplanningstage
member
in Infertility
I have 50% coverage for IVF, after we meet our deductible. That's just for the actual procedure though. When I look online it says 0% coverage for fertility medications administered at home, purchased through a pharmacy. I called carefirst to confirm, and they said that was correct. Only 'in office' fertility drugs would be covered 50%. Ok, I'll be grateful for the other 50% coverage and suffer the cost of the medications.
I ordered my medications, gave them my insurance info, and they said only 2 things were covered (the antiobiotic and something else not necessarily fertility related). I wasn't surprised, placed the order, and paid the $3000 bill.
This week I looked on my insurance and didn't see the claim for the medicine. I called the pharmacy to ask, and they said it wasn't covered. I said that I understood that but it still should have been sent to insurance so it gets applied to my out-of-pocket/deductible. After many phone calls of people who couldn't understand what I was saying, I got my RE involved. Good thing I did, because the financial counselor told me that I SHOULD have coverage, and she'd work with the pharmacy to fix it. Long story short, a week later, we're getting abotu $1500 back!!!! It was so frustrating but a blessing in disguise that the pharmacy messed up, because I truly thought we had no coverage.
Moral of the story-keep asking questions. Clearly insurance reps don't always know what they are talking about! My Re financial counselor told me that even though the drugs are taken at home, the fact that the dr gives me instructions makes it 'in office'. I hope that helps someone else!
Our Novel of TTC:
*Male Factor (low count and low motility), High Prolactin, and Polycystic Ovaries (March 2013)
*Recurrent Miscarriage testing also revealed high anti-phospholipids & single MTHFR mutation. (Feb 2014)
*IVF (07/2013): BFP-Natural Miscarriage @ 5 weeks*
Madison Riley
*FET #1 (10/2013): BFN
*FET #2 (12/2013)- BFP-Missed Miscarriage at 8 weeks Kyle Andrew
*Chromosomes and Karotyping tests were both normal.We lost a healthy baby boy
*FET #3 (04/2014) was cancelled after finding Chronic Endometritis
*IVF (07/2013): BFP-Natural Miscarriage @ 5 weeks*
Madison Riley *FET #1 (10/2013): BFN
*FET #2 (12/2013)- BFP-Missed Miscarriage at 8 weeks
Kyle Andrew *Chromosomes and Karotyping tests were both normal.We lost a healthy baby boy
*FET #3 (04/2014) was cancelled after finding Chronic Endometritis
*Miraculous BFP July 2014!! (I was taking baby aspirin and Cabergoline to stay regulated while "taking a break from TTC" and waiting to consult with a reproductive immunologist!!!)
Our healthy baby girl was born 03/10/15 thanks to daily Lovenox injections and baby aspirin. There are no words for how grateful I am for our rainbow baby.
This discussion has been closed.
Re: Make sure you question any insurance denials!!
Me & DH (33), 3 Furbabies, TTC since October 2011
Day 3 #’s (Dec 2012) FSH 9, AMH .77, LH 2.4, E2 31, AFC 9
DX: Me-DOR + No Tubes, DH-Fine
Ectopic 2007; lost tube/2nd tube removed Dec 2011 (hydro)
April 2012=IVF#1- EPP Antag+ICSI, 2R,0F (BFN), Now dx’d with DOR.
June-July 2012=IVF#2- MDL+ICSI&AH, 8R,4M,3F (BFP 9dp3dt) Beta#1 at 11dp3dt=36, Beta#2 at 15dp3dt=156, Beta#3 at 19dp3dt=671, dx'd with SCH, no growth-m/c at 7wks/Lap Dec 2012 to remove small fibroid.
Feb 2013=IVF#3-MDL, 2/1=baseline, started 10 units mdl, AFC-7, 2/3 start gonal f, self cxld cycle b/c of low e2.
April 2013=IVF#3.5-(with new RE)AG/ANT Conv + ICSI. 4/10-4/23 bcp's, 4/20-4/27 lupron, 4/28-ganirelix until end of stimming, 5/2-600 gonal f, 5/4-add 1/2 vial menopur, 5/13-ER (9R,1M,1F), 5/17-ET, 1 beautiful 8 cell (please be my sticky baby!!!!) 5/28-BFFN.
Oct 2013=IVF#4-LLP+ICSI &AH, 10/14 (6R, 2M, 2F), 10/17-ET, 1 seven cell & a six cell, BFP at 9dp3dt, 1st beta=56, 2nd beta=52, CP.
Jan 2014=IVF #5-LLP, Cxld after 6 days of stims due to fast response and lead follicle.
March 2014=IVF 5.5-LLP, Lupron 3/10, BL 3/18, 11 days of stims, Trigger 3/29, ER 3/31. 7R, 2M, 2F. ET 4/3. Txfd one 5 cell & one 9 cell. BFP on hpt from 7dp3dt & on. Praise be to God. Beta #1 at 11dp3dt=106, #2 at 13dp3dt=239. First u/s 4/28, measuring on track & heartbeat seen. 5/5-2nd u/s, measuring on track with strong heartbeat. 5/12- 3rd u/s & released from RE. Grow baby grow, we love you! Baby G&T is a BOY! Born 12/2014 via c/s! 8lbs, 8oz & 21 inches.
*******Ticker Warning**********
"God's Delay is not God's Denial"
| Married since 2008 | DH and I: Both 30 | Me: Endometriosis and Carrier of an X-Linked Dominant Genetic Disorder | DH: Low Morph | Planning IVF with PGD and PGS in 2013 | Freeze-All IVF #1: March 2013 ER 3/26. 29R, 12M, 11F. 4 5AA frozen blasts. Freeze-All IVF#2: May 2013 ER 5/15. 31R, 21M, 20F. 6 5AA frozen blasts. Our PGD probe was completed in late June (total of 20 weeks to develop). PGD and PGS Results came on 6/19: 3 healthy embryos (normal chromosomes and unaffected by my family's genetic disorder). FET #1: July 2013 Natural Cycle - Cancelled due to insufficient lining (only got to 7.5mm). FET #1.2: August 2013 - Medicated Cycle with Lupron & Estrogen Patches to build up lining. Single embryo transfer was 8/23. Beta #1: 240! Beta #2: 578! U/S on 9/19 at 6w4d: We saw the heart beating at 131bpm. Second U/S on 10/4 at 8w5d: We saw the heart beating at 178bpm. EDD 5/11/2014
*IVF (07/2013): BFP-Natural Miscarriage @ 5 weeks*
*FET #1 (10/2013): BFN
*FET #2 (12/2013)- BFP-Missed Miscarriage at 8 weeks
*Chromosomes and Karotyping tests were both normal.We lost a healthy baby boy
*FET #3 (04/2014) was cancelled after finding Chronic Endometritis
Awesome news!!!
Also, even if your insurance doesn't cover anything currently, it's possible that it may be covered later and backdated. I may have heard a rumour about my own insurance, so I'm absolutely putting a claim in anyways, just in case!
***EVERYONE WELCOME***