Insurance Coverage questions

[ryan'smom]

Under my benefits package it says it covers "100% Infertility Counseling, Testing, and Treatment." Then in fine print it says " Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covered depending on your group's prescription drug program".

Then it also says your program will not provide benefits for services, supplies or charges: "related to treatment provided specifically for the purpose of assisted fertilization, including pharmacological or hormonal treatments used in conjunction with assisted fertilization, unless mandated or required by law".

I can't find anything specific about what drugs are and are not covered.

I know I can call and ask questions to my insurance company, but I was wondering if any of you experienced ladies have similar insurance coverage. The way I'm reading this is that it covers my RE visits and bloodtests, HSG's, etc., but would not cover IUI's, clomid, IVF, etc. Am I right on this? Thanks!

Laura

[fek&fuzz]

It sounds like the drugs wouldn't be covered, but that procedures would be covered.

[wtg4miracle]

I agree it looks like your insurance will pay for IUIs but not the drugs.

You might be able to put in a grievence in if you can prove that the drugs can help. Your doc can put in an explanation in. It doesn't hurt to try.

If you try clomid, its usually cheap, but once you hit the big guns like injectables then it will get costly.

I have many headaches from my insurance also, stupid referrals and following what they say all the time.

[ryan'smom]

Thanks for the responses! After re-reading my insurance manual for the 14th time, I realized that the section about what they didn't cover wasn't under the drug section, it was actually under the "services not covered section". I edited my original post to fix the error. Thanks again for reading!

Laura

[mommy112564]

I would definitely suggest calling your insurance company. It may be that insurance may cover treatment procedures if you are trying to conceive naturally (no iui or ivf, just intercourse). I would also suggest requesting a predetermination of benefits from your insurance company before starting any treatments, that way you know in advance what they will cover. You can call your company and ask how that's done. I think most major ins companies have that option. fyi-my company covers infertility diagnosis and treatments (and meds) as long as there is no assisted fertilization involved (iui, ivf, etc). If I have any questions regarding my policy, I always email them my question and that way I have their response for documentation. Meds also may be covered if your rx insurance company has documentation that you will be trying naturally-depends on how your rx plan reads. good luck!