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insurance stupidity -- ideas?

tweetyknickstweetyknicks member
in Trouble TTC
I talked to my insurance company today to find out what our coverage would be if we saw an in-network RE for fertility treatment, just in case we have to take a serious look at IVF after another round or two of IUI. (Current RE is out of network.) Looks like 8 cycles of IUI and 4 cycles of IVF for lifetime coverage. Great. Except that we are disqualified from all coverage because DH underwent voluntary sterilization. It doesn't matter that it was successfully reversed or that even if DH's numbers were fine, I'd still be a problem.

Has anyone found a way to get an exemption from something like this?


***siggy warning***

Me: 29; DH: 53
TTC since February 2013 --- mild thin PCOS (or not, depending on which RE you ask), MFI

TI#1: BFN (April 2014; Clomid 50mg x5 days, Estrace x5 days, Clomid 50 mg x4 days)
IUI#1: c/p (May 2014; Letrozole 2.5 mg x5 days, Estrace x5 days, Bravelle 75 IU x10 days)
IUI#2: abandoned... O'd early & DH hormone issues (June 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x2 days)
IUI#2.1: BFN (July 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x4 days)

Moving on to IVF. (Why we're moving on to IVF)

IVF#1 (w/ICSI): BCP 9/9-9/23. Gonal-F, Ganirelix, Low-dose HCG (antagonist protocol). 41R/35M/32F... 2 transferred on 10/14, 14 frosties! On cabergoline to help avoid OHSS. BFN, possibly because of 90% drop in estrogen and progesterone a few days after ET.
FET#1: Transferring 2 on January 8. BFP! beta#1 (1/17): 408, beta#2 (1/20): 1310, first u/s scheduled 2/5

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Re: insurance stupidity -- ideas?

  • tweetyknickstweetyknicks member
    A$$hole insurance company requires a load of medical records to decide if we are eligible for treatment. That alone seems like it's an invasion of privacy. And it is DH's insurance. They already know about his history.

    They did not cover his reversal and they are not covering my current IUIs because my RE does not work with my insurance company. I had my OB ping the insurance company to see if they would cover IUI (since she is in network) and they said no. DH said we can try an appeal/exception, but we have to look at the exact wording of their policy.

    Strangely, they are covering all u/s and labs since I am doing them at an in-network clinic. That makes IUI with low-dose injectables and pills cost about $1000/month OOP. Not *so* bad, but it still hurts.

    I like your "donor" idea, @Rumbera28 :)


    ***siggy warning***

    Me: 29; DH: 53
    TTC since February 2013 --- mild thin PCOS (or not, depending on which RE you ask), MFI

    TI#1: BFN (April 2014; Clomid 50mg x5 days, Estrace x5 days, Clomid 50 mg x4 days)
    IUI#1: c/p (May 2014; Letrozole 2.5 mg x5 days, Estrace x5 days, Bravelle 75 IU x10 days)
    IUI#2: abandoned... O'd early & DH hormone issues (June 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x2 days)
    IUI#2.1: BFN (July 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x4 days)

    Moving on to IVF. (Why we're moving on to IVF)

    IVF#1 (w/ICSI): BCP 9/9-9/23. Gonal-F, Ganirelix, Low-dose HCG (antagonist protocol). 41R/35M/32F... 2 transferred on 10/14, 14 frosties! On cabergoline to help avoid OHSS. BFN, possibly because of 90% drop in estrogen and progesterone a few days after ET.
    FET#1: Transferring 2 on January 8. BFP! beta#1 (1/17): 408, beta#2 (1/20): 1310, first u/s scheduled 2/5

     image 
     image    image
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  • tweetyknickstweetyknicks member
    Thank you for the warning Ketchup. I considered that before I replied to Rumbera. My joy in the idea is mostly of the it'd-be-nice variety, much like my ill wishes for Sallie Mae.

    I'm still hopeful that we won't get to IVF. Just surveying the landscape in case we do. Stupid guidelines piss me off if there is any possibility I may have to deal with them.


    ***siggy warning***

    Me: 29; DH: 53
    TTC since February 2013 --- mild thin PCOS (or not, depending on which RE you ask), MFI

    TI#1: BFN (April 2014; Clomid 50mg x5 days, Estrace x5 days, Clomid 50 mg x4 days)
    IUI#1: c/p (May 2014; Letrozole 2.5 mg x5 days, Estrace x5 days, Bravelle 75 IU x10 days)
    IUI#2: abandoned... O'd early & DH hormone issues (June 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x2 days)
    IUI#2.1: BFN (July 2014; Letrozole 2.5 mg x5 days, Bravelle 75 IU x4 days)

    Moving on to IVF. (Why we're moving on to IVF)

    IVF#1 (w/ICSI): BCP 9/9-9/23. Gonal-F, Ganirelix, Low-dose HCG (antagonist protocol). 41R/35M/32F... 2 transferred on 10/14, 14 frosties! On cabergoline to help avoid OHSS. BFN, possibly because of 90% drop in estrogen and progesterone a few days after ET.
    FET#1: Transferring 2 on January 8. BFP! beta#1 (1/17): 408, beta#2 (1/20): 1310, first u/s scheduled 2/5

     image 
     image    image
    Report Reply
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