RE/Insurance Question

brande99 · August 2010

Good evening ladies... I have a quick question for you all.

First some background info: Hubby and I have been trying to conceive for 1.5 yrs. I went to my doctor last month and she started me on Metformin for PCOS. Then, I saw my GYN and she said I should continue the metformin and then start Clomid in a month. She also prescribed me an HSG procedure. I was supposed to take the HSG tomorrow but it was canceled because my insurance won't pay for it.

So I was going to start the Clomid anyways, until I saw your posts about needing to see an RE and how I need to be monitored on Clomid. The GYN didn't say much about being monitored.
I would like to see an RE but my insurance sucks and it looks like most tests won't be covered. Has anyone else run into this issue?

Thanks for your replies!!

Hels · August 2010

Yup. Sure have! For my insurance, once you get the "Infertility" label, nothing is covered. No HSG, no diagnostics, no medications. Nada. It really sucks, but looks like we'll be forking out the cash. It really is important to be monitored on Clomid. IMO, it's not a risk worth taking.

SweetieD21 · August 2010

My insurance doesn't cover infertility procedures, but it covers diagnostic testing and ultrasounds. Maybe this is the case for you too? Definitely don't start the clomid without having an hsg done. Your dr shouldn't have even prescribed clomid for you without having the hsg done first. All the clomid in the world won't help if you have blocked tubes. Remember, OB's aren't fertility specialists, so they don't monitor you as closely as RE's do. As pp said, this is all very expensive, but worth it in the end. I'm sorry that your insurance seems to suck though:(

AmberZ2be · August 2010

I'm sorry you don't have all the coverage. It sucks, I know. BUT, please don't take clomid without the proper monitoring & testing. Best of luck.

Temp935838312504158 · August 2010

Regardless of your insurance, you shouldn't take Clomid without being monitored!

My insurance doesn't cover IF either but it does cover diagnostic tests (US & b/w) so it is something definitely worth checking out!

ams8099 · August 2010

Yeah. I don't have any IF coverage. It's expensive, but its all tests you need in order to get proper treatment

mdluv21 · August 2010

Mine covered diagnostics and has surprisingly covered u/s but not medications or procedures.

I think it is still VERY important to see an RE and be monitored but being OOP for all of it def. sucks.

ermaderma · August 2010

Can you see an endocrinologist for the PCOS? Maybe that way, they can code things as PCOS and not IF. Maybe you should look into it.

Otherwise, I wouldn't go through with the clomid without at least having an HSG and SA for your DH. I'm not sure about the HSG, but I believe the SA isn't that expensive.

camedowncrushing · August 2010

I am normally just a lurker, but I wanted to reply. My husband's insurance would not cover any of the testing I have had done. My obgyn has also offered me clomid, but from lurking here I know how dangerous that can be. I wanted to see an RE, but our insurance was absolutely the worst. I work part time and and am in grad school part time so we sort of bounced around the idea of me going to work full time anywhere just for insurance. We priced out private insurance. Finally my husband decided to take a pay cut and make a move to a different company for the good insurance. He starts next week and as soon as I have that insurance card I am going to see the RE.

morgs8384 · August 2010

My insurance has covered testing, u/s and my lap.. out of about 10k we have only had to pay about $750.. I am sure that will change as we finally enter into a medicated cycle.

brande99 · August 2010

Thanks for all your responses! I'm glad to see I'm not alone with sucky insurance

My DH did have a SA first. I put off calling to schedule the HSG until CD1 and that's when I found out insurance wasn't going to cover it. Well, I called insurance and they said they WOULD cover it as long as it was for diagnosing the IF. However, the 'CPT code' that was sent over, showed it was already diagnosed as Inferitle so it is a matter of semantics. I'm hoping they can correct it for me but we'll see. Either way, if they do cover it, maybe I'll just have them send the results over to an RE? Is that a good route to go if the HSG is finally covered?

Ladybug71109 · August 2010

Unfortunately, most times with insurance it's all about those stupid codes! One the many benefits to seeing an RE, is that most clinics see to have someone that all they do is insurance; basically an insurance coordinator. Their job is to be the liason between the insurance people and you. This comes in really handy with the coding...the ins. liason will know how to "put it through" to be sure it's covered. Your gyno office might have someone similar if you plan to have the HSG done prior to seeing an RE (I did too). Just explain to them the situation.

As the previous ladies said, please don't take Clomid without being monitored (and definitely NOT before an HSG...it really could be pointless). Gynos are great at taking care of you once pregnant, but not so great at getting you pregnant. (Mine actually told me to "relax and it'll happen...". I couldn've kicked her!)

Good luck!

SweetieD21 · August 2010

brande99:

Thanks for all your responses! I'm glad to see I'm not alone with sucky insurance

My DH did have a SA first. I put off calling to schedule the HSG until CD1 and that's when I found out insurance wasn't going to cover it. Well, I called insurance and they said they WOULD cover it as long as it was for diagnosing the IF. However, the 'CPT code' that was sent over, showed it was already diagnosed as Inferitle so it is a matter of semantics. I'm hoping they can correct it for me but we'll see. Either way, if they do cover it, maybe I'll just have them send the results over to an RE? Is that a good route to go if the HSG is finally covered?

That's great that you have diagnostic coverage. Talk to your dr's office about coding the HSG as such. When you decide to move on to an RE, they'll ask for all your prior medical recoreds, so the HSG results will get sent to them.

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