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Question about Monitored Cycle w/ Timed Intercourse & Insurance Limitations

floridanursegirlfloridanursegirl member
in Infertility

Hi, I live in Florida where infertility coverage isn't mandated.  I have Aetna, and diagnostic procedures are covered but infertility treatments are excluded.

I haven't been ovulating.  I tried Clomid 4 cycles but it wasn't monitored.  I never got a positive OPK.  After that I went to an RE.

The RE just recommended IUI with Femara and trigger shots.  It looks like the cycle would be about $1k or more once its all said and done with the IUI, ultrasounds, meds, labs, etc. 

I was wondering if since I've never really had a monitored cycle, if I should ask if I could try to do those meds with ultrasound/lab monitoring and try timed intercourse.  DH's last semen analysis was normal and all my tests have otherwise been normal, I just don't think I ovulate.  Thoughts?

I was also wondering if a monitored cycle was considered infertility treatment and if my insurance might cover the ultrasounds, etc.  Anyone have experience with this?

TIA......

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Re: Question about Monitored Cycle w/ Timed Intercourse & Insurance Limitations

  • marioana99marioana99 member
    About covering the ultrasounds and bloodwork only your insurance can answer that. You should contact them directly or your RE can do it for you if they have a person who does that. 
    You should also ask for a breakdown of costs, because you will need the meds for sure (femara and the trigger) and you will need the us and bloodwork so they know when to trigger. The only variable is how much the  actual IUI procedure costs (washing the semen and the insemination)
    DOR (FSH 13, AMH 0.48, AFC 6-9)
    IVF #1 -2016 March, antagonist, 5 eggs, 2 fertilized, 3DT - 8 cell and 6 cell no frag, chemical pregnancy
    IVF #2 - 2016 June, micro dose lupron, 3 eggs, 1 fertilized, 3DT 6 cell, BFN
    IVF #3 - 2016 November, estrogen priming + antagonist, 9 follicles, 3 eggs, none fertilized
    IVF #4 - 2017 March, testosterone priming + micro dose lupron, 2 eggs, none fertilized
    IVF #5 - 2017 May, A/ACP protocol, 4 follicles out of 7 seemed to get to required size, ovulated before retrieval, converted into IUI - BFN
    IVF #6 - 2017 July, A/ACP protocol, 3 follicles one stopped growing, LH rising, converted to IUI - BFN
    IVF #7 - 2017 September, antagonist, 5 follicles, 6 eggs,  3 immature, 3 injected, 1 fertilized, stopped growing day 3
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  • J1006J1006 member
    I agree with above.  Contact your insurance. Mine seems similar to yours as they will cover all diagnostic testing, but then you are in your own. For my IUIs they covered the Femara since it's not technically a fertility drug and they covered my ultrasounds. This was a surprise to us. We didn't think they were going to cover anything. I would also as your RE office how much it would be if you had to pay OOP 
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  • puppyluv13puppyluv13 member
    As I can't speak for your insurance company, I will say that we have been in a similar situation. We are in IN and also have Aetna, and IF procedures aren't covered for us. Diagnostic procedures as well as the monitoring IS covered however (again, I can only speak for our particular situation).

    When we first started our IF journey, we saw an RE and didn't really have a diagnosis for our IF, so *at our request* we did 3 medicated cycles with timed BD, so we could save up for the IUI's if it didn't work. I took Letrozole and Prometrium (which only cost me $10 w/ our prescription coverage) and then went to the RE for a few US each month. They also gave me the trigger in office, which I didn't have to pay for because it was considered a "sample". Insurance covered all US and BETA and I only ever paid copays during those 3 months. So all in all each month was roughly $100.

    I would be open and honest with your RE. Ours is very understanding, especially when it comes to financially motivated decisions. They know that this stuff is pricey, and not everyone can spend $1k+ each month on treatments. So it's definitely something worth talking to your RE about. Hope this helped!
    *tw*
    Me: 33 / DH: 30
    Married: 10/19/13
    NTNP since 2010 / TTC since 2013
    DX: Unexplained
    June 2014 – Aug 2014 (3 cycles): Medicated cycles >> Letrozole + Trigger = BFN
    Sept 2014: IUI #1 >> Letrozole + Follistim + Trigger = BFN 
    Dec 2014: IUI #2 >> Letrozole + Follistim + Trigger = BFN 
    Sept 2016: Consult with RE, DH consult with Urologist
    Nov 2016: D&C to remove polyps >> RE required 6 month break
    May 2017: IUI #3 >> Letrozole + Follistim + Trigger = BFP >> MC/CP
    Aug 2017: IUI #4 >> Follistim + Trigger = BFN
    Oct 2019: IVF Consult

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  • floridanursegirlfloridanursegirl member
    Thanks for the input.  I did get a list of prices from the RE office and they just flat out said not to expect insurance to cover anything, but I had read on some threads that some ladies have gotten some different things covered.  Every time I call Aetna it's like banging my head against a wall, so I don't expect them to give me a straight answer.  

    I ended up reaching out to my RE and she agreed to do 3 monitored cycles with meds and timed intercourse.  I suppose we will see what ends up being covered or not and prepare for the IUIs in the near future if needed.
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  • keriberriekeriberrie member
    Glad you were able to get something planned! For us, the medicated cycles kind of eased us into this whole IF life lol, which I felt made it a tad bit easier on us.

    Hopefully your insurance covers most of it and your won't need the IUI's. GL and keep us posted! 
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  • puppyluv13puppyluv13 member
    GL!!!!!!!!!! 
    *tw*
    Me: 33 / DH: 30
    Married: 10/19/13
    NTNP since 2010 / TTC since 2013
    DX: Unexplained
    June 2014 – Aug 2014 (3 cycles): Medicated cycles >> Letrozole + Trigger = BFN
    Sept 2014: IUI #1 >> Letrozole + Follistim + Trigger = BFN 
    Dec 2014: IUI #2 >> Letrozole + Follistim + Trigger = BFN 
    Sept 2016: Consult with RE, DH consult with Urologist
    Nov 2016: D&C to remove polyps >> RE required 6 month break
    May 2017: IUI #3 >> Letrozole + Follistim + Trigger = BFP >> MC/CP
    Aug 2017: IUI #4 >> Follistim + Trigger = BFN
    Oct 2019: IVF Consult

    Report Reply
  • CowgirlK39CowgirlK39 member
    Glad I found this post because I am in the same boat. My RE double checked with my insurance and was told they will cover 90-100% of all diagnostic stuff. Well, I just got a bill for my initial bloodwork, which was $636. I called my RE and they said there's no way that's right so I have some work to do to figure it out. Now I received a statement from my insurance that was not a bill, but simply a form that said "your doctor may charge you: $1450." We just found out today that IUI#1 failed, so I'm about ready to throw in the towel. No matter what these insurance companies tell you, there is always exceptions. Be prepared to shell out at LEAST $1500 of you want to do IUIs or anything like that. Timed intercourse on meds will probably cost $1000 or so. But I'm learning there is really no way to know, even if you ask your insurance. 
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