When to switch from OB to RE?

LittleDucky · December 2014

I was wondering if any of you would mind sharing your thoughts about this. I am currently waiting on the results of genetic testing from my second missed miscarriage and D&C in a row. My OB has already told me that if the genetic testing comes back normal, she recommends doing further testing before I TTC again. Of course, I plan to discuss what types of testing she has in mind with her, but I was wondering whether those of you who have done RPL testing have done so with an OB or with an RE? I know there are several different RE groups near me who work with people with RPL, but I'm not sure at what point I may want to seek them out. I trust my OB, but I also wonder if maybe there are advantages to seeing an RE that have not occurred to me.

meredithcarole · December 2014

I would say 2 losses is a good reason to go to an RE. The OB can do testing, but if you need any treatment you will need to see an RE anyway. And some REs like to do there own testing so it is best to not waste time doing with the OB if you may have to repeat.

LittleDucky · December 2014

@furrypaws, I wasn't even thinking of the insurance issue... ugh. I do know that my insurance doesn't require referrals for specialists at all, so I figured I'd just make an appointment. Didn't even occur to me that I might need to get pre-approval or anything. But definitely worth checking on, now that you mention it.

LittleDucky · December 2014

@breemarie08, that's sort of what I'm thinking. I sort of just don't want to waste time/cycles with an OB if I could be getting better treatment with my RE. I haven't been trying for that many cycles, but I had two losses in a row. And while I'm not AMA, I will be 33 in August and I would ideally like to have the option for more than one successful pregnancy in the future (one can hope, right?). I just know that the clock is not as much "on my side" as if I were in my twenties.

Maybe I am getting ahead of myself, because if the testing comes back with some sort of genetic abnormality, my understanding, based upon what my OB said so far, is that (and please, correct me if I'm wrong) that would be a fluke and that I wouldn't need RPL before TTC again. I dunno - maybe I'd want to see an RE anyway for my peace of mind if nothing else. I'm sorry - I think I might be rambling.

Nikolie93 · December 2014

My OB actually told me that specialists usually won't see you until after 3 or more losses. ..even though I'm also AMA.

I so wished I had gone after my 2nd loss so if your insurance is good with it, I would try to get in with an RE.

Good luck!

meredithcarole · December 2014

Nikolie93 said:

My OB actually told me that specialists usually won't see you until after 3 or more losses. ..even though I'm also AMA. I so wished I had gone after my 2nd loss so if your insurance is good with it, I would try to get in with an RE. Good luck!

Really, they told you that?

LittleDucky · December 2014

@Nikolle93, that is a good point about making sure the RE is willing to see me in addition to clearing it with my insurance. The RE group I know of in my area (one a lot of friends/acquaintances have used) says on their website that they see patients for recurrent miscarriage, which they define as "two (2) or more consecutive, spontaneous pregnancy losses." So at least it seems that I would not run into the problem that you had. It sucks that they woulnd't see you after your second loss.

Nikolie93 · December 2014

Yes @meredithcarole‌ ,sadly they did

meredithcarole · December 2014

Nikolie93 said:

Yes @meredithcarole‌ ,sadly they did

That's terrible.

@LittleDucky‌ good luck with your upcoming RE appointment (I'm guessing you're ready to make one now

)

LittleDucky · December 2014

@petitchou1019, yes I was referring to Shady Grove. I know lots of ladies who have gone to then and they are mostly positive about their experiences.

@meredithcarole, I am going to call my insurance company today and see what they, and then call the RE.

BookishMomma · December 2014

My insurance doesn't cover anything fertility related, so I got as much testing as I could with my PCP and OB before moving on to an RE after my 3rd loss. I still have labs run through my PCP so that they are less likely to get denied. Ugh. I hate insurance stuff. Currently working on my second appeal of a denial that I think should have been covered.

kreardon11 · December 2014

I've had two losses this year, and my OB told me since they were not the "same kinds of loss" that she wouldn't send me to an RE. While I love my OB and trust her, I made an appt anyways. I called my insurance and the RE I am going to is listed in the system as an OB. I will pay out of pocket for some testing, but to me, the mental sanity is worth it. She also takes patients after two losses.

I'd say do your research, call your insurance and don't take no for an answer.

((Hugs)) and GL!

LittleDucky · December 2014

Thanks everyone. I just called my insurance company and thankfully my insurance will cover me to see an RE. I called the RE group a lot of people I know have used and made an appointment for January 19. They said I will meet with the doctor, nurse, and financial counselor when I go in. Hopefully that is far enough out that the results of the genetic testing from my D&C will have come back. And this way I at least have it scheduled - I can always cancel it or postpone it if need be.

I really do like and trust my OB, but I figure it can't hurt to get a specialist's take on things. I will feel better knowing that I've explored all my options.

Nikolie93 · December 2014

Glad it is working out!

My insurance told me that they cover anything "up to" the diagnosis of fertility. Did yours say anything about that?

Be careful if that is the case and make sure the RE office uses the right code. I've heard horror stories where an infertility code was used prior to the actual diagnosis and insurance didn't pay.

LittleDucky · December 2014

@Nikolle93, the RE office said they would check everything out with the insurance company before I go for my appointment and meet with the financial counselor. Hopefully they will have all the details sorted out as far as what is covered. The woman on the phone at the RE's office said that my insurance was good.

Thankfully I have very good insurance - I'm a state employee and really, as long as I stay in network (which this RE is) my insurance covers pretty much everything. The benefits guide says it covers "100% of allowed benefit" for "family planning and fertility testing" and "100% of allowed benefit" for IVF and artificial insemination, with a note that "IVF and AI benefits are limited to 3 attempts of Artificial Insemination, and 3 attempts of IVF per live birth." I know I am very fortunate with my health insurance.

kreardon11 · December 2014

Nikolie93 said:

Glad it is working out! My insurance told me that they cover anything "up to" the diagnosis of fertility. Did yours say anything about that? Be careful if that is the case and make sure the RE office uses the right code. I've heard horror stories where an infertility code was used prior to the actual diagnosis and insurance didn't pay.

Do you mean, for example, RPL tests would be covered, but treatment for fertility isn't? Yuck.

Also YES - Be sure to inquire about coding!! My ACL repair (unrelated to TTC, I know) not only was coded wrong, but they used my maiden name and it meant countless hours trying to coordinate between the doc/bcbs.

liznj2775 · December 2014

I went to an RE immediately after my 3rd MC. Although my OBGYN recommended after my 2nd. I'm 37. (And they keep reminding me.) I did check with my insurance and the RE office to make sure testing, etc was covered.

ellebelle2384 · December 2014

LittleDucky said:

@Nikolle93, the RE office said they would check everything out with the insurance company before I go for my appointment and meet with the financial counselor. Hopefully they will have all the details sorted out as far as what is covered. The woman on the phone at the RE's office said that my insurance was good.

Thankfully I have very good insurance - I'm a state employee and really, as long as I stay in network (which this RE is) my insurance covers pretty much everything. The benefits guide says it covers "100% of allowed benefit" for "family planning and fertility testing" and "100% of allowed benefit" for IVF and artificial insemination, with a note that "IVF and AI benefits are limited to 3 attempts of Artificial Insemination, and 3 attempts of IVF per live birth." I know I am very fortunate with my health insurance.

Wow, that is amazing that your insurance covers all of that! Good for you! I saw an RE after my second consecutive loss this past year (which was my third loss since I had one in 2011 as well). I wanted answers as soon as possible so I asked my OB to write a script for RLP in the meantime. So when I went to my initial RE appt he already had some information in front of him and then he ordered the few additional tests that he wanted done. Just something to think about.

LittleDucky · December 2014

GLB30 said:

I went after 2 losses. My OB said bc they happened during the same week (8) he recommended it. If one had been later or another a CP, he said his recommendation would have been to try again. My RE's office actually called to see if my insurance covered everything before they would even take me as a patient. I think if my insurance did not cover it, we would have had to pay prior to testing.

This RE is going to call my insurance before my first appointment, too. They have a financial counselor on staff who you have to meet with at your first appointment before they do any testing.

LittleDucky · December 2014

ellebelle2384 said:

Wow, that is amazing that your insurance covers all of that! Good for you! I saw an RE after my second consecutive loss this past year (which was my third loss since I had one in 2011 as well). I wanted answers as soon as possible so I asked my OB to write a script for RLP in the meantime. So when I went to my initial RE appt he already had some information in front of him and then he ordered the few additional tests that he wanted done. Just something to think about.

I know, I feel super fortunate to have the coverage I have as a State of Maryland employee.

Nikolie93 · January 2015

@littleducky that's awesome insurance you have!

@kreardon11‌ yes, it means the RPL is covered but if I get an infertility diagnosis I'm on my own

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