RE coverage with your insurance...did it exist?

LG2793 · August 2014

Hi ladies,

DH and I are coming up on 17 months ttc. I have been told by my ob that I have polycystic ovaries with an AMH level of 21, long-ish cycles (35-55 days), and have had 4 consecutive cycles with short LPs (less than 8 days). I'm at the point where I know we should probably see an RE...DH just is not ready yet.

Anyhoo....for those of you who have seen an RE, what (if any) parts of your diagnosis visit, medicine, or procedures were covered by insurance? I know every plan is different, and I've contacted mine but have not heard back yet. I do know I have the highest plan coverage they offer. I'm just curious as to what your experience was.

Thanks!

hoplesslybeautiful · August 2014

All testing was covered on my insurance but treatment (ex: iui / ivf) was not.

MrsS728 · August 2014

We just started seeing our RE in August. I called my insurance before our consultation. Between mine and my husband's insurance everything is covered including $50K of IVF, but we also knew that mine didn't cover IVF, just IUI, so we picked up my husband's insurance so that I have double coverage for this reason. We are very fortunate that both of our insurances are very good and cover ore or less all infertility, most people aren't so lucky. The great thing about our RE office was that during the consult we met with the doctor and then met with finance who went over our coverage, and OOP expenses.

rockopera · August 2014

My REs office found out and gave me the info. Documents said 'some coverage.' I was planning on calling, but they did it and told me when I got there for the consult.

Testing and treatment through IUI was covered.

jesselayne8 · August 2014

All testing, u/s, and bloodwork was covered. IUIs and medications were completely OOP.

BabyCowbell · August 2014

I found the detailed coverage booklet for my plan on our HR intranet site and it said no coverage. When I made my consultation appointment with the RE they took my insurance info anyway and looked into it. Then they came back and said no coverage too.

I did the consult, CD3 ultrasound, HSG, genetic screening, my husbands sperm analysis, and a shit ton of blood work all OOP and it was $1,700. Prices obviously vary, but this was better than some stories I had heard for OOP costs.

If you don't have coverage but want to go ahead anyway, I would suggest looking into whether you can do an HSA or an FSA with your insurance so that at least you're paying with pretax money.

Good luck!

chaysefaith · August 2014

bibliothecary said:

Not to threadjack, but how do you find out what is covered without attracting their notice? Edit: you know, if down the road you need to get creative with billing codes.

I work for a health insurance company, if someone called to check their coverage for infertility services every single person in the company I work for would just document the call as "family planning" and the overzealous reps would make a note that they went over infertility benefits. But those notes would never be looked at by a claims processor so it wouldn't have an affect on coverage.

blitzy23 · August 2014

I don't have an answer, but so sorry for your frustrations:(

kelley72 · August 2014

I have absolutely zero coverage, no matter it seems the diagnosis code utilized, no bloodwork, ultrasounds, nothing. I couldn't even get coverage for my labwork, etc when dr tried to determine if I have PCOS... basically my insurance sucks! I wish you well!

virginiaorjohn · August 2014

I called my insurance a few weeks ago before I went in for a consult with my OBGYN. FWIW, my insurance said that all testing was covered but "assisted reproduction" (IVF) was not covered.

more importantly, I specifically said that my doctor wanted me to come in to get some testing done because they were concerned about my cycle. I also said I was calling to make sure I understood the requirements as far as which testing came first, which testing came second etc, to make sure every test was covered by insurance. I'm hoping that because of the way it I articulated my questions, my doctor can still code them as creatively as needed to get the most coverage. I guess we shall see...

BabyCowbell · August 2014

linny1012 said:

BabyCowbell said:

I found the detailed coverage booklet for my plan on our HR intranet site and it said no coverage. When I made my consultation appointment with the RE they took my insurance info anyway and looked into it. Then they came back and said no coverage too.

I did the consult, CD3 ultrasound, HSG, genetic screening, my husbands sperm analysis, and a shit ton of blood work all OOP and it was $1,700. Prices obviously vary, but this was better than some stories I had heard for OOP costs.

If you don't have coverage but want to go ahead anyway, I would suggest looking into whether you can do an HSA or an FSA with your insurance so that at least you're paying with pretax money.

Good luck!

Seriously so jealous. Even with insurance, my portion of just my bloodwork and initial appointment was $2,300, so far, the bill have just started to roll in.

-------------------------
That really sucks! I definitely got a cash discount on the HSG and the genetic screening. Not sure if the rest was discounted at all.

virginiaorjohn · August 2014

@GhostMonkey‌ good to know about IUI and IVF. The OB nurse mentioned checking the order of testing, most often applying to having the SA done first before any female testing. but you are right, when I called the insurance they said the order did not matter.next week I am getting blood drawn to test for progesterone, prolactin, and TSH.

ETA my mother has hypothyroidism so that is the concern

virginiaorjohn · August 2014

Yeah, obviously there's a lot I don't know so it's very possible my OB is full of shit. But, with the issues I've been having with short LP, low temps, and my mother's hypothyroidism, I'm very interested in the results of that TSH test.

@lg2793 sorry if I accidentally hijacked your thread, FX that your insurance gives you lots of coverage.

nlscroggins · August 2014

all of our ultrasounds, bloodwork, labs, and office visits were covered. HSG was covered. some meds were covered (clomid, provera, femara, metformin), but others were completely OOP (gonal-f, bravelle, menopur). anything like IUI and IVF were not covered at all.

OhHeyB · August 2014

bibliothecary said:

Not to threadjack, but how do you find out what is covered without attracting their notice? Edit: you know, if down the road you need to get creative with billing codes.

What do you mean by this? Are they watching us?!

I actually just called the RE yesterday to check on costs and my coverage. I have to pay for 50% of all service. So my costs would be: 1st visit - $108, blood tests - anywhere from $20-35, HSG (tube blockage test)- $149, Ultrasound - $139 (I've already had this with my regular GP and I only had to pay by $10 co-pay, so that's just bullshit).

I didn't ask about costs if I would actually need any meds or IVF. I'm only at the 6month mark but I'm very irregular and unsure if I'm even ovulating. I'm thinking of just biting the bullet and spending the $$ just to get a better sense of what's happening in my body. I'm sure it's one of those things where "elective" fertility services make people go broke and viagra is always covered.

OhHeyB · August 2014

MeatandBandP said:

OhHeyB said:

bibliothecary said:

Not to threadjack, but how do you find out what is covered without attracting their notice? Edit: you know, if down the road you need to get creative with billing codes.

What do you mean by this? Are they watching us?!

I actually just called the RE yesterday to check on costs and my coverage. I have to pay for 50% of all service. So my costs would be: 1st visit - $108, blood tests - anywhere from $20-35, HSG (tube blockage test)- $149, Ultrasound - $139 (I've already had this with my regular GP and I only had to pay by $10 co-pay, so that's just bullshit).

I didn't ask about costs if I would actually need any meds or IVF. I'm only at the 6month mark but I'm very irregular and unsure if I'm even ovulating. I'm thinking of just biting the bullet and spending the $$ just to get a better sense of what's happening in my body. I'm sure it's one of those things where "elective" fertility services make people go broke and viagra is always covered.

You are not a special snowflake. Please do not take an appt away from someone who has actually hit the year mark and needs that appt. Start temping to see if you are ovulating, which has been suggested to you before. If you dedicate yourself to temping for a few months and confirm that you are not ovualting, than that is a different story. Right now you have no reason to think you are not ovulating. My cycles were always irregular but I ovulate.

Oh dear.

I actually didn't think that making an appointment might take one away from someone else, so that is something I will consider. I'll be sure to get a sense of how busy the clinic is when the doctor calls to talk about an appointment, talk about my symptoms, and see if this is jumping the gun. I'll trust that they have a handle on scheduling.

The only way I can get an appt with an RE is through referral which was given and recommended by my NP since she was concerned that I've only had 4 periods in the last year since getting my IUD out and looking at my temp charts over a 4 month period, there were no obvious signs of ovulation.

divinemsbee · August 2014

I'm lucky that everything so far (ultrasounds, blood work, SA, meds, HSG, hysteroscopy/lap and all related things) have been covered. If I needed it most other testing procedures (SIS or other) would also be covered. Pretty much anything that can be coded as testing is covered by my insurance no matter what.

The trickier/luckier part is that because of where we live we have a few more covered options. IUI and all meds would be covered, I actually don't think there's any OOP, maybe we would pay $200ish. However, to have that option I would have to be seen at my MTF, so no doctor picking for myself. IVF is also extremely discounted there. It's part of why I'm starting to get very very nervous, because we will probably be leaving here next summer, which gives me a really limited timeline and I don't know if I would be able to come back here just to cycle.

OhHeyB · August 2014

You are not a special snowflake. Please do not take an appt away from someone who has actually hit the year mark and needs that appt. Start temping to see if you are ovulating, which has been suggested to you before. If you dedicate yourself to temping for a few months and confirm that you are not ovualting, than that is a different story. Right now you have no reason to think you are not ovulating. My cycles were always irregular but I ovulate.

Oh dear.
I actually didn't think that making an appointment might take one away from someone else, so that is something I will consider. I'll be sure to get a sense of how busy the clinic is when the doctor calls to talk about an appointment, talk about my symptoms, and see if this is jumping the gun. I'll trust that they have a handle on scheduling.

The only way I can get an appt with an RE is through referral which was given and recommended by my NP since she was concerned that I've only had 4 periods in the last year since getting my IUD out and looking at my temp charts over a 4 month period, there were no obvious signs of ovulation.

You said in a previous post that your cycle lengths have ranged from 33 to 58 days, which means in a year you would have had more than 4 cycles.

Were you temping everyday over that 4 month period? Can you link your charts?

Taking your temp each morning is a lot easier and less work than going through fertility treatments. Oh and cheaper, less emotionally draining, I could go on.

I've really only been tracking CL since March. I didn't have a period for ~5months after my IUD was out. I temped for 4months consistently with maybe 2 or 3 missed days over that timeframe.

I wouldn't want to start any treatments less than a year out and it's a good reminder that the sooner they're started the more emotionally draining it can be. I had talked to my NP about my irregular periods back in March where she did some blood work. She asked me to get back in touch in 6 months if things were still irregular. They are, so I did. And she recommended I see the RE. So this is where I am. I stopped temping for a couple months but will definitely start again.

OhHeyB · August 2014

So someone who is not even a doctor has decided that you need to see a specialist based on 4 months of temping, and your menses last year? It can take your body up to a year to regulate after IUD removal, so it's not surprising that you only had 4 periods since getting your IUD out.

And this, ladies and gentlemen, is why I refuse to go to a medical practice that gives the authority to make prescribing or referral decisions to anyone outside of someone with MD or DO after their name. I have a cable and internet provider. When I go to a doctor's office, I want to see a DOCTOR. Not a Nurse Practitioner, not a Physician's Assistant, a PHYSICIAN.

I completely disagree with this. I find Nurse Practitioners to be excellent care providers and have no hesitation using one for women's health appointments over an MD. Keep in mind that she was not diagnosing, simply referring me to someone who has expertise in reproductive health, which, to me, is exactly what they're supposed to do and the same thing an MD would do. I'm in a care practice where you essentially have to get referred to a special clinic if even one aspect is outside of the scope of a generalist, hence this referral. It very well may be premature and that is what I will try to assess when I speak to someone (who definitely is not a doctor) from the RE clinic.

Belou52579 · August 2014

GhostMonkey said:

I'm laughing that you think the actual RE is going to talk to you.

I've spoken to my RE exactly twice. Once during my consultation with my husband and another time getting my completed testing results. Since starting the drugs and IUIs I've never had one single conversation with him. In fact, I cant even get the same person to call me with my blood results each day. Going into this, I thought you got your RE and stuck with them until the bitter end. Not the case for me at all, different person every blood draw, different person every ultrasound and insemination and different person calling me with my levels.

Anyway, before I started testing and treatment I called my insurance and got the break down for infertility testing and treatment plans. They claimed they'd pay 100% testing and 50% treatment with the exception of IVF which had no coverage at all.

My REs office has done some fancy coding on their end and I've really only paid a fraction of what I may have at 50%. For this, I am thankful.

Clomid is not covered under my RX plan so I pay out of pocket for the five pills each cycle: $22.

LG2793 · August 2014

Thank you ladies for your input. I have searched my insurance plan online and cannot find anything about reproductive medicine/infertility treatments. If they do not call me back this week, I might go ahead and call the RE's office to see what they could find out for me.

LG2793 · August 2014

Ok, so I just did a little chat thing on my insurance website. I was told that the initial visit/consultation and diagnostic testing would be covered, I would just have to pay my co-pay. She said that from that point, my diagnosis would determine whether or not infertility treatments would be covered.

Are some conditions considered more serious than others? Endo, pcos, etc?? Also, are HSG's included in that initial testing?

melissa721 · August 2014

Everything was covered for me EXCEPT PGS for our embryos during IVF. I also have state insurance so...

melissa721 · August 2014

GhostMonkey said:

melissa721 said:

Everything was covered for me EXCEPT PGS for our embryos during IVF. I also have state insurance so...

I have federal insurance. Still didn't cover ART.

I'm surprised. It's generally looked at as "better" insurance.

melissa721 · August 2014

GhostMonkey said:

melissa721 said:

GhostMonkey said:

melissa721 said:

Everything was covered for me EXCEPT PGS for our embryos during IVF. I also have state insurance so...

I have federal insurance. Still didn't cover ART.

I'm surprised. It's generally looked at as "better" insurance.

It is for a lot of other things, just not that. And ours has the better coverage of the options we had.

My work has BCBS. It would have covered up to $15k for IF treatments, but sucks for other things.

Trade offs. Blah.

Just curious...did you have to pay anything after you gave birth?

LG2793 · August 2014

GhostMonkey said:

melissa721 said:

GhostMonkey said:

melissa721 said:

Everything was covered for me EXCEPT PGS for our embryos during IVF. I also have state insurance so...

I have federal insurance. Still didn't cover ART.

I'm surprised. It's generally looked at as "better" insurance.

It is for a lot of other things, just not that. And ours has the better coverage of the options we had.

My work has BCBS. It would have covered up to $15k for IF treatments, but sucks for other things.

Trade offs. Blah.

I have BCBS....is that $15K dependent on a specific diagnosis? I'm sure the plans differ from state to state, but that's good to know..

melissa721 · August 2014

melissa721 said:

GhostMonkey said:

melissa721 said:

GhostMonkey said:

melissa721 said:

Everything was covered for me EXCEPT PGS for our embryos during IVF. I also have state insurance so...

I have federal insurance. Still didn't cover ART.

I'm surprised. It's generally looked at as "better" insurance.

It is for a lot of other things, just not that. And ours has the better coverage of the options we had.

My work has BCBS. It would have covered up to $15k for IF treatments, but sucks for other things.

Trade offs. Blah.

Just curious...did you have to pay anything after you gave birth?

Nope.

Well, his NICU stay, but that's not considered maternity.

Yeah me neither. And I had a c section. I was shocked. I didn't know he was in the nicu. I was thinking of adding the nicu coverage through my Aflac bc we were going to transfer two embryos with IVF and your never know I guess. But now we will ride out this surprise and see what happen although neither of us are hopeful just yet. If this doesn't work out we will go back to IVF and I think I'm gonna do the nicu coverage.

melissa721 · August 2014

Mobile bumping sucks.

Twinkie0612 · August 2014

spragglefrock said:

twinkbrite said:

Your doctor should be able to find out for you. At my office (dental) we can get a detailed list easier than the patient can. We also have software that we can put a proposed treatment in and it will give an estimate of what insurance will pay towards it. I'm sure it's a lot like dental in that some tests use the same code no matter the diagnosis or major treatment so insurance will end up covering more than you think. Blood work and ultrasounds I would think would be like this. My insurance allows me to go online at any point and view what's covered in detail. Since the interwebs is all popular now I'm guessing a lot of them do this. It gives me codes too though none of them mean anything to me but the dental ones.
I work for health insurance and I process claims. You're right that the procedure code (CPT) wouldn't change but the diagnosis (dx) would so blood work and ultrasounds may or may not be covered depending on the dx billed. Sadly, my insurance excludes coverage from any diagnosis, testing, or treatment of IF. That's why we are putting off going to an RE; to hopefully save up some money. Count yourselves lucky if you have any coverage at all!

Ah... ok. They should just all cover infertility no matter what but since I don't get to make those decisions I'll just say they suck. I hope I don't get to that point because I'm pretty sure my insurance doesn't cover anything at all. They are amazing with everything else though.

Remember who "they" are. Your insurance provides coverage for the plan your employer (if you get your insurance through your employer) picks out. So really it's your employer who has decided that infertility coverage will not be included in your plan, not the insurance company.

Twinkie0612 · August 2014

My insurance has no coverage for infertility, not even diagnostic. Occasionally I'll have some lab work or med covered, but other than that I'm 100% OOP. It sucks, but that's life. The rest of my insurance is really good, so I can't complain too much.

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