UPDATED - RPL vs infertility testing? and a long update

hungryhippo · July 2012

*UPDATE* - Thank you all for your responses. I did some searching of ICD-9 codes and learned that my insurance carrier does indeed consider RPL and Infertility separate codes. I also got brave enough to call the insurance company and it turns out that diagnostic testing for a medical condition would not normally be coded as "infertility" and would therefore be covered in my plan. So, as long as all of my testing isn't linked to an infertility diagnosis, testing should be covered. Small victories!

Here's my question: Do any of you know whether your insurance considers RPL an "infertility" thing? I am not covered for anything related to infertility. If my doctor can somehow code testing as RPL, do you think I have a shot of having some coverage for testing?

I will call my insurance company and ask, but I'm paranoid that they'll put my question in my file and use it as a reason to deny coverage for anything that looks like it could be infertility related. Anyone know any successful strategies for asking questions without inviting future scrutiny?

Here's my update:

Background: Two months ago I had reached out to my OBGYN to ask about taking some steps in testing and she responded strongly encouraging me to keep trying and wait for that 1 year mark. My OB and everyone at the medical university where I get care is of the belief that RPL = 3 consecutive losses (I've "only" had 2) and that each time you get pregnant your year of trying starts over. (I've been getting frustrated about this recently)

My doctor's coming around!! On Monday I got an email from her out of the blue checking in to ask how I was doing. I told her that I'm nearing the end of cycle #8 (16 overall TTC #1). She suggested I make an appointment in September. Here's her plan:

"Prior to being seen by a fertility specialist, we would want a day 3 blood draw for you for FSH, estradiol and AMH. Your husband should also have a semen analysis. They may also want some further imaging but I usually let them decide about that because then it wouldn't have to be repeated if we don't do the timing on it right."

So, depending on the timing of my cycle, this CD3 b/w could be done in cycle 10, or more likely cycle 11 (again, counting just the TTC cycles after loss #2). In the meantime, I'm planning on attending an open house event at the university fertility consultants. I've avoided going because I work closely with the event people at the university who support this monthly open house, but now I want to go and run several questions by them, so it's worth "outing" myself in front of these coworkers. I think.

Depending on what I learn at the open house and by calling my insurance company, I might just skip the b/w with my OBGYN (who I love) and do all of it with the RE.

In honor of the Olympics (and the freaking olympic journey we've all been on), here are some strategically frosted and arranged donuts:

luvmyducks · July 2012

RPL is for Recurrent Pregnancy Loss so I'm pretty sure it is not considered infertility testing. I had an RPL and my insurance covered it and they also do not cover infertility. I would double check with your RE's office to see how they code it also when they submit to insurance.

[Deleted User] · July 2012

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hungryhippo · July 2012

luvmyducks:
RPL is for Recurrent Pregnancy Loss so I'm pretty sure it is not considered infertility testing. I had an RPL and my insurance covered it and they also do not cover infertility. I would double check with your RE's office to see how they code it also when they submit to insurance.

Thank you for letting me know. I am hoping that might be a possibility for me.

I looked up some of the ICD-9 codes and it is now obvious to me that there are distinct codes. Hopefully when I talk to the fertility folks they can give me some expectations about what codes the would use for me.

hungryhippo · July 2012

stlucia_wife:
Those donuts are awesome!!
As far as your question I have no clue, but wanted to wish you luck at the open house. I hope you get some great info. I am glad to hear you doctor is finally coming around. I too would skip the blood work and just do it with the RE.

Yeah, I know in my head that it's the right thing to do. I do like my OBGYN a lot, but I've lurked all around The Bump enough to know to go straight to the experts.

buckeyebaby814 · July 2012

It really depends on your insurance. RPL is an IF Dx, but you're right, most do not consider it RPL until you've have 3 consecutive losses. Check with Resolve's website. They have a fantastic insurance section that lists by state which are required by law to cover IF claims. Some states (like Ohio) only cover diagnostics- which is still better than nothing.

Best of luck on this new part of your journey!

KGS2003 · July 2012

I'm so glad to see that your OBGYN is finally coming around. I say go with your gut. When I first started trying for #2 I was no where near as knowledgeable as I am now and wasted a lot of precious and valuable time with an OBGYN who didn't help me at all.

hungryhippo · July 2012

Thanks to each an every one of you for replying. All of your responses were very helpful. I think I learned what I need to from my insurance company to know that I can probably proceed with testing without blowing our possible treatment budget. Next stop - chat with RE and staff at their open house on Aug. 9.

UPDATED - RPL vs infertility testing? and a long update

Re: UPDATED - RPL vs infertility testing? and a long update

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