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My job getting new insurance, and my RE doesn't take it.

Fredifer1115Fredifer1115 member
in Trouble TTC
Called the new provider and they only have the plan summaries, not the exact details, so cannot tell me if infertility is covered.  My current insurance has a $10000 cap, so I have to figure out how to suck that up before switching.  I have an additional 90 days of coverage under current insurance due to continuity of care for being in treatment.  So annoying.  Like this process isn't enough of a headache.  Something has to give.
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Re: My job getting new insurance, and my RE doesn't take it.

  • lebradfordlebradford member
    A 10k cap...on infertility coverage? I'm not sure about your policy, but I also have IF coverage. There is a limit to the number of IVF cycles, but it specifically says that even if you switch insurance companies, your IVF cycles that were covered by your old policy still count towards the limit on your new policy. You might want to check on that before just randomly using up your current 10k.

    I can't believe they haven't given you the full policy though! I hope you can get it soon. Insurance is such a nightmare.
    **siggy warning**  **everyone welcome**

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    DS- 11.07.02
    DSS- 6.26.04
    Married- 6.29.13
    TTC Again- Sept. 2013
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    Test Results/Diagnosis- HSG & SA totally normal
    DX: 3/2014 Prolactinoma/Hyperprolactinemia- Started cabergoline 2/2014
    5/2014 Possible mild PCOS in addition to hyperprolactinemia??
    7/2014 Adding probable tubal factor to the diagnosis list
    9/2014 And now adding hypothyroid to the list- Started synthroid 9/2014
    Cycles 1-4 - Sept.-March- All Anovulatory 
    IUI #1 March/April-  Clomid 50mg + Clomid 100mg +Trigger + IUI #1 = BFN
     IUI #2 April/May-Clomid 100mg + Clomid 150mg + Trigger + IUI #2 + Endometrin=BFN
    IUI #3- June- Follistim 75iu + Trigger + IUI #3  Benched due to a 40 mm cyst. :-(
    IUI #3- July- Follistim 75iu + Trigger + IUI #3 + Endometrin = BFP! on 7/25/14
    Slowly rising betas - Ectopic suspected on 8/8/14 & confirmed on 8/11/14
    Methotrexate on 8/12/14 -HCG negative on 9/2/14
    IVF #1- November- Antagonist protocol: 11/1: start stims, 200iu of Follistim; 11/12 ER 17R/14M/14F; 11/17 5 day transfer of two blasts, 2 blasts and 2 expanding morulas frozen; 11/22 BFP!! (On FRER at 5dp5dt)
    Betas: 9dp5dt 205, 11dp5dt 497, 14dp5dt 1,709
    u/s at 5w0d- 1 sac; u/s at 6w0d 1 baby with heartbeat, another sac without a heartbeat
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  • Fredifer1115Fredifer1115 member
    You are correct, it is $10000 to IVF, and the new carrier is offering the same coverage, which is great news.  I can do a certain number of IUIs (only medicated, I just learned) that will be approved on case by case basis.  They just denied me doing a natural cycle IUI so I am doing timed intercourse.  So romantic.  

    I am trying to work the system, though, for a few reasons.  I was informed that if I used all of my IVF benefit under my current insurance it would reset with the new insurance, but it would have to be done by policy effective date of October 1st.  I am on CD9 so there is no shot this can happen.  I am also trying to file a grievance with my HR for special circumstances.  The other reason is my RE does not specialize in women with high FSH and he is not optimistic of my chances of success with IVF, so if I was to have to wait to use my benefits I would rather it be with a doctor that has a special protocol for women in my situation.  I just hate feeling like I am on the losing end of this battle all of the time, and I personally feel it is egregious for a company to give such short notice about something as important as health insurance and expect all loose ends to be tied up in just a matter of weeks.   
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