To add insult to injury

Sugartwink · May 2013

Just got off the phone with my insurance company because I just had 3 claims denied. I recently had BW and HSG and a subsequent doctor's visit to discuss the results (PCOS), NONE of which is covered. I mean I knew that fertility treatment usually isn't covered, but how are diagnostic tests not even covered??

As a side note, I think it is just ridiculous that IF is not generally covered by insurance (oh, but ED is covered? sure, that's not discrimination. Last time I checked, ED isn't life-threatening either) but I think it is insane to not even cover BW! Now I have to pay for the full amount, several thousand dollars.

To add insult to injury, I had to sit on the phone listening to my dr's billing office argue with my insurance company about my infertility. The insurance lady was asking the billing office to reclassify as PCOS (rather than just plain-ol' IF) and she wouldn't budge. She is going to "ask the doctor" but I'm not exactly hopeful. This clomid better work, bc I can't afford to do anything else...

krdesi · May 2013

Sorry you're dealing with this!

Twinkie0612 · May 2013

I'm sorry that you don't have any infertility coverage, it really does suck.

None of my IF testing was covered as well, since my insurance specifically says "does not cover testing/treatment for infertility."

I did all of my testing with my OB/GYN and they refused to change any of the billing codes for my tests. I understood that my HSG and most of my blood work pretty much had to be coded as IF (I am mostly unexplained IF) but what really made me mad was that my Thyroid blood work was coded as IF eventhough I was due for a screening (family history of thyroid disease) and had planned on having it done anyway.

What's interesting is that with the way my RE codes blood work, I have had some things covered, including my P4 that was denied when I had it done with my OB/GYN. It sucks to know that I paid $150 for a blood test that now only costs me $20.

katib77 · May 2013

I'm so sorry, because I live in Illinois there is a mandate for *some* IF coverage. And for me originally, it was only testing so I was able to get my HSG and such covered up until they said we were MFI and LPD. Then any treatment cycle and monitoring was OOP.

I know you say all you can afford is this round of clomid, and I'm sorry you feel that now - but there are ways for OOP to help pay. I did have to wait eight months between treatment (two years in a row so over 16 months worth of breaks between spring of 2010 and January of 2013). But if you are not yet in a HSA or FSA with either of your companies - SIGN UP when it comes around again in December (or whenever your insurance companies allow changes). The max is usually $4-$6 thousand. This is how we afforded the last two years of our treatment. Also, if you have a 401K, you can take out a tax free loan against yourself if you want. We have looked at this option for IVF if needed.

Also, if you have an email address for your RE, email him personally about helping to get your codes changed in order to help pay for the testing you've already done.

Good luck moving forward!

EIK2013 · May 2013

I find the financial burden of the IF journey to be the most stressful and frustrating. I'm sorry you dealt with all of this today. Hang in there and lots of hugs!

jjdale288 · May 2013

Sorry your testing isn't getting covered. I think it should be mandatory for every state to cover certain portions of IF. I know help with labs, testing, or meds would help out a lot.
I don't think you should say anything against ED though. My dh is having problems with that due to his testosterone being so low. Yes it isn't life threatening but it's hard to have sex and ttc when your dh is having problems.

Sugartwink · May 2013

jjdale - I didn't mean anything against ED. I just meant that it seems discriminatory that ED is covered on my insurance, while even the simple BW to check thyroid and hormones on a woman are not. I think that all testing and treatment should be covered for both men and women but it seems like only men are taken care of on my current plan. It seems a bit sexist to me, that's all. I'm sorry to hear about you DH's problems. I hope things work out for all of us!

ttuprincess · May 2013

Ugh. So sorry you are dealing with this. Insurance problems just seem to add insult to injury. My Re has been good about coding things as treatment for endo or PCOS so they have paid for some but we are still footing most of the bill. Sending ((HUGS)) your way.

Twinkie0612 · May 2013

katib77:

I'm so sorry, because I live in Illinois there is a mandate for *some* IF coverage. And for me originally, it was only testing so I was able to get my HSG and such covered up until they said we were MFI and LPD. Then any treatment cycle and monitoring was OOP.

I know you say all you can afford is this round of clomid, and I'm sorry you feel that now - but there are ways for OOP to help pay. I did have to wait eight months between treatment (two years in a row so over 16 months worth of breaks between spring of 2010 and January of 2013). But if you are not yet in a HSA or FSA with either of your companies - SIGN UP when it comes around again in December (or whenever your insurance companies allow changes). The max is usually $4-$6 thousand. This is how we afforded the last two years of our treatment. Also, if you have a 401K, you can take out a tax free loan against yourself if you want. We have looked at this option for IVF if needed.

Also, if you have an email address for your RE, email him personally about helping to get your codes changed in order to help pay for the testing you've already done.

Good luck moving forward!

My big word of caution about FSAs is to be careful about how much you put in, because if you don't spend the full amount you lose it at the end of the year. We had to decide in November how much to contribute to for the following year. I ended up only contributing $1000 dollars because I wanted to make sure that it was an amount that we would be able to spend even if we got pregnant on our own before starting treatment. It turns out that we could have easily spent 3 times that amount between DH's dental work, DH's trip to the ER and surgery, and our IF treatments; but I had no way to know this ahead of time.

Sugartwink · May 2013

Thanks for your support and kind words, ladies. I just think it is so unfair

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