Health Insurance Does Not Cover Fertility Testing or Treatment

lablover78 · September 2015

Hi ladies,

Just wondering what options might be out there for a type A person in my predicament! DH and I own a business together and have individual health policies which precludes us from obtaining one that covers anything fertility. We found a local RE running a special- $650 for testing (HSG, Day 3 labs & Semen analysis). Currently I am paying cash for weekly acupuncture and chinese herbs. My acupuncturist has suggested clomid, but after calling around on pricing it is much more affordable for me to pay cash to see my est. OB-GYN and hope that she can appropriately monitor me on the Clomid.

I have PCOS sympotms and my acupuncturist felt my FSH was too high per my labs. Even though I have the fancy Clear Blue ovulation monitor I am starting to question whether I am actually ovulating after reading messages on this board regarding surges in the setting of PCOS. What other things do you ladies without insurance do to take control of this journey as best you can? Thanks in advance!

GoldenKeys · September 2015

You can try temping to confirm ovulation, along with your OPK's. What did the RE recommend?

lablover78 · September 2015

Ok, is temping a little more accurate? Just ordered a BB thermometer. My ob-gyn had recommended the testing and said she should read the results for us. Her nurse called and said "everything's normal." When I established with the acupuntruist she also read the test results and said that my FSH was too high and she believed I was on the mild side of the PCOS spectrum. I have been told in the past that I possibly have this by other doctors as well.

ceclarlinetlo · September 2015

An OPK test measures a hormone called LH that is released just before ovulation so an OPK test will tell you that you could ovulate in the next 24-48 hours. After ovulation you release a hormone called progesterone that raises your basal body temperature so Temping is the way to confirm that ovulation did take place.

GoldenKeys · September 2015

lablover78 said:

Ok, is temping a little more accurate? Just ordered a BB thermometer. My ob-gyn had recommended the testing and said she should read the results for us. Her nurse called and said "everything's normal." When I established with the acupuntruist she also read the test results and said that my FSH was too high and she believed I was on the mild side of the PCOS spectrum. I have been told in the past that I possibly have this by other doctors as well.

I've seen enough 'less than competent' infertility treatment from OBGYNS than I care to admit. It's not their fault, infertility is not their specialty. Pregnancy and maintenance care is. My OB ordered day 21 Estrogen to 'see if I ovulated'. Um, yeah. I definitely didn't use him for treatment, and he is a very well respected OB and GYN surgeon. What was your FSH? Did your ultrasound show a lot of follicles? You should get a copy of your labs and at least get a consult from an RE. It shouldn't cost that much just for that...

lablover78 · September 2015

Ok, I really appreciate your advice on paying for a consult. My FSH was 7.46 and my LH was 11.2. Actually maybe she said my LH was too high now that I think about it- she wanted the FSH higher than the LH I think? I had 22 total follicles <10mm. I just read your signature. I am really sorry for your loss!

GoldenKeys · September 2015

lablover78 said:

Ok, I really appreciate your advice on paying for a consult. My FSH was 7.46 and my LH was 11.2. Actually maybe she said my LH was too high now that I think about it- she wanted the FSH higher than the LH I think? I had 22 total follicles <10mm. I just read your signature. I am really sorry for your loss!

Thanks... yeah your FSH seems okay to me. Anything below 8 is consided good, meaning you'll have a good response to stimulation. If your day 3 estrogen is really high (like over 80) along with that FSH, that would be more concerning.

People who have PCOS have a lot of eggs which can create a problem of too many in play or the creation of even more cysts. If your OB can at least give you an ultrasound and bloodwork around Day 9 it might not be a bad idea to proceed to save costs?

riveridgional · September 2015

So, I prepared this when I first saw your post then got distracted at work:

I'm definitely Type A and paying everything OOP. If you can't afford to see an RE at this time or are hesitant to make the step financially, I would purchase a BBT thermometer and download the fertility friend app. Tracking your basal body temperature is the only way to confirm if and when you O. Your doctor may be able to confirm O, but temping is the cheaper alternative. OPKs are not always accurate especially if you have PCOS. For insurance purposes, monitoring through an OB should not be any cheaper. For insurance coding, it's either done for fertility purposes or not. The provider does not dictate whether it is covered. I specifically asked my OB and RE this question and both had the same response.

Surprisingly, my insurance covered a few of my initial tests through my RE since I a had suspected ovulatory disfunction and it could be coded for that reason. Based on your history, your RE may come to the same conclusion. With suspected PCOS and however that doctor may have interpreted your FSH level, it is possible your insurance would cover a "Clomid Challenge" cycle. I don't believe going through your OB, if properly monitored, will save you any money. I stuck with my OB for $ purposes and wasn't monitored. Turns out, I just don't respond any better to Clomid than my natural cycle and Clomid thins my lining. I actually wound up just reducing my chances for pregnancy 2 cycles with my OB and I guess technically one monitored with my RE.

If I were you, I would call an RE office (probably the one that did your initial testing) and see of you can set up an appointment with a financial representative. Most clinics give discounts or bundled monitoring packages for out of pocket patients. One of my friends in a different state (TN) can pay cash and they take off an additional 3% for what would have otherwise been the fee charged to the clinic from the credit card company. Mine doesn't do that, but it doesn't hurt to ask. Yes, it gets expensive, but it hasn't been as expensive as I initially anticipated. And, you can go at your own pace; your months of treatment and overall decision-making is yours. I would be lying if I told you paying OOP hasn't added additional stress and hasn't made me feel limited in my future options. I try to look on the bright side, though, that I will receive closure on this chapter of my life and will know when to stop. I'll either have a baby or know I tried all I could within the limits DH and I set before seeing an RE. We're both open to adoption, so now we will now when to close the infertility door and open the adoption one, if needed.

So, I guess that's another tip. I would set a limit money-wise before seeing an RE. Or, maybe discuss what you two are willing to do. Would IVF be an option? How many IUIs would you be willing to do? Discussing all of it upfront may help in the long run. It's overwhelming, but I think it's helped us with our process and relationship. I will be honest with you, though, neither of us wanted to close the door on IVF but we were thinking we probably wouldn't do it. After finding out injects would be my only medical help early on and finding out an IUI wouldn't really help, we were able to reassess our finances and what we were willing to do. We didn't spend as much as we would have expected at this stage since certain treatments were no longer options. Initially we thought, okay, one round injects, then IVF. Injects turned out being about 1/2 the expected costs, so we are doing one more round injects then IVF.

Good luck and I really don't think you will regret moving on to an RE. I don't know anyone who does regret that decision. I only know ones who regret not seeing one sooner.

turtle148 · September 2015

Depending on where you live research studies may be available. Never hurts to check on it. Here is a link for some.
https://clinicaltrials.gov/ct2/results?term=infertility+AND+NICHD

lablover78 · September 2015

Wow I am overwhelmed by all the detailed responses and advice. Thank you ladies!

yellingbanana · September 2015

I've been diagnosed with PCOS also, and put on metformin to help regulate my cycle. I did one round of clomid, but I read in a medical journal that clomid is less effective for people with PCOS than taking metformin and letrezole/femera. Here is the article I read: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163261/

As for the costs, search near and far. I got lucky with my insurance, but even though they "cover" fertility stuff, I'm still paying a pretty penny.

AL_TwinCities · September 2015

Read Taking Charge of Your Fertility. that book gave me a great understanding of my body and how it works, and explains very well how temping works, why OPKs shouldn't be relied on alone, etc.

lablover78 · September 2015

Thanks ladies! I appreciate the article and will definitely read that book.

twomommiestobe · September 2015

How did everyone come up with the money for all these cycles of iui or ivf? We make enough money to live comfortably and could easily afford to take care of a child, but we do not have all this extra disposable income to set aside. I know most of you pay oop, so I wanted to see if you have ideas on adjusting your budget to help save up.

riveridgional · September 2015

We've been very good about saving money since we have been married. My husband is extremely frugal, so that helps ALOT. I seriously had to twist his arm to buy new boxers--his had so many holes in them I actually wondered if one pair had a poop hole! We eat in all the time and ensure we consume all leftovers, so we arent really wa sting mone on food. We rarely go out to bars anymore and try to entertain ourselves in free ways. Also, I barely ever buy new clothes anymore. Mainly, I'm hesitant to purchase anything cause I'm desparetly hoping to be pregnant, but it still helps save money. Luckily, I paid off my car note the month before our initial consultation, so that honestly helped alot. That money goes straight to the baby fund along with all extra money from raises or bonuses. I'm planning on actually starting a side business and will use any income from that for IVF savings. My hobby is sewing, though I haven't done anything more than pillows in years, so I want to start a baby-toddler clothing line. People in New Orleans are downright obsessed with anything New Orleans, and I've designed a few outfits, diaper covers, etc that fall right into that category. Hoping it'll help me pass some time and allow me more baby-making money!!

twomommiestobe · September 2015

We were doing so great at paying off our credit card and putting money in savings. Well, we moved and needed furniture, I had an unexpected dental bill of $1500, and "life" has just happened a lot lately. So one credit card has a balance again but we have managed to still keep a little in savings. We moved to be closer to family and our donor and got a bigger place in hopes of having a baby, so that is also why it's harder to put money back with a higher rent. Ok, I am motivated! I am going to sit down tonight and really look at bills and just start moving money to savings so we won't "think we have it". Any other ideas of how you pay or save, will surely help all of us!

AL_TwinCities · October 2015

I have $200/month that goes into my HSA. We don't even miss that money because we never had it before! You could do the same sigh savings - have it come out of your paycheck so you never even see it.

We grocery shop every few days, just for what we need for the next meal(s). We waste so much less food than we used to when we did shopping once every week or two!

Plainjanie · October 2015

I contribute 6.5% into an account. It comes right off my paycheck and I'm pretty lucky as my work matches my contribution into the account every pay period.

I agree with @AL_TwinCities, if it comes right off your check, you'll miss it less. We also have automatic withdrawls from our joint account every month and the money goes into a savings account.

I have a small business on the side (baking and decorating cakes and cupcakes for people) and that provides 90% of our spending money every month so that helps a lot.

Also I am married to an accountant so we have a budget for EVERYTHING. Like others, we eat in a lot. I plan an entire week of meals and shop for only the ingredients needed. There are a few websites in Canada that will send me coupons in the mail for a lot of buy one get one free deals so that helps.

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