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Discussion Starter · #1 ·
shooting myself in the foot?<br>
I have finally admitted that after 1+ year of trying and one loss that we really might not be able to conceive "naturally;" not even for our first. Just the acknowledgement that I have to set aside my pride as a woman, admit that my body does not do what it's supposed to, and let a team of doctors and nurses "help" me to get pregnant is a big step here, and the rest seems so overwhelming- especially financially.<br><br>
We hope to be starting IF treatments in the winter sometime, when my vacation/sick time recharges, my FSA is fully funded again ($1500 total, of our own money no employer contribution), and possibly my psyche is in a better, more prepared place for what is ahead. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy"><br><br><br>
All that being said, I have pretty decent insurance coverage- they fully covered, with no co-pays the U/S's for the drug-free cycle that was monitored after our MC. The prescription coverage (as far as IF is concerned) is not that great; well, clomid is part of the Formulary List, so that is partially covered but it specifically says that injectible fertility drugs are not covered.<br><br>
However, I have heard that some women can get them covered, even with an exclusion on their policy, but I'm not sure how. And I feel like they would say no if I asked now, and that would be the end of it. I dont want to get into the treatments though, and have the RE say, "next we will try injectables" and not be prepared/able to afford it though.<br>
Also, I don't know if my coverage includes IUI or IVF, but again, I dont want to ask the question before we "need" it, in hopes that if it's in process, they might approve it. (Is that irrational? I feel like they might cover if we're in the midst of treatment...?)<br><br><b>So,my point: I have a few questions for those of you using health/medical/prescription insurance for your IF treatments:</b><br>
1) Did you have to/choose to check into your coverage, in detail, in advance yourself?<br>
2) Did your RE's office (or other practitioner) check for you?<br>
3) If you were not covered, do you have any idea if there is an "average" cost to things like IUI, and injectible meds? I know that IVF is in the tens of thousands.<br>
4) If you didnt check in advance, were you totally burned in the check book if coverage was denied?<br>
5) any tips/tricks to get it covered if it might otherwise not be?<br><br><br><br><br>
I hope hope hope that we could get lucky, and have an early success, but with previous loss, I've unfortunately crossed over to the dark side of cautious hope, never full-on optimism. I'm prepared for a long, expensive ordeal, so I could possibly be pleasantly surprised. How unfair that we even have to think of conception as a financial decision.<br><br>
Sorry for the novel, thanks for reading if you got this far, and for any advice/experiences you can share!<br>
Succinct I am not.
 

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Hi LZP! <span style="font-size:xx-small;">sshhh...I'm not logged on....lurking only...sshhh. But I had to respond.</span> <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink"><br><br>
This was a very hard step for us, too...I know you know that. You are no less of a woman for needing help. I choose to decide that what makes me a woman is my choices, and my commitment to motherhood, not whether or not I was born "fertile myrtle." Ok, that aside: I called my insurance company and asked for their "booklet" or rider or whatever on fertility coverage. I wanted to know super clear ahead of time what was covered and what not. I have heard of a colleague who got IVF medication covered because she declared it as an IUI and the pre-procedure meds are the same. I think I got that right. I don't know if there are any tricks that can be pulled, but I really didn't want to be burned in retrospect. Good luck, and I hope you find a way for full coverage! <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/goodvibes.gif" style="border:0px solid;" title="Goodvibes"> and <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/treehugger.gif" style="border:0px solid;" title="Treehugger"><br><br>
ok...seriously...back to my MDC hiatus. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hide.gif" style="border:0px solid;" title="hide"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngtongue.gif" style="border:0px solid;" title="Stick Out Tongue">
 

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sorry you have to be here :-(<br><br>
So,my point: I have a few questions for those of you using health/medical/prescription insurance for your IF treatments:<br>
1) Did you have to/choose to check into your coverage, in detail, in advance yourself? <span style="color:#0000FF;">yes</span><br>
2) Did your RE's office (or other practitioner) check for you? <span style="color:#0000FF;">yes</span><br>
3) If you were not covered, do you have any idea if there is an "average" cost to things like IUI, and injectible meds? I know that IVF is in the tens of thousands. <span style="color:#0000FF;">Each RE is different. I think the "mass" offices, where they puch you through in batches, are cheaper than offices where you're treated individually.</span><br>
4) If you didnt check in advance, were you totally burned in the check book if coverage was denied? <span style="color:#0000FF;">No, we worked out a deal with the RE and saved a few thousand $$.</span><br>
5) any tips/tricks to get it covered if it might otherwise not be? <span style="color:#0000FF;">No, sorry, the insurance isn't easy to fool. Mine covered everything up until retrieval for a fresh IVF and thaw for a FET under the code of "diagnosis". I also got free drugs from the RE that others had donated to them after they were done with treatment.</span><br><br>
Your insurance will cover whatever they'll cover even if they get a "heads-up" from you calling and asking about coverage. Good luck!
 

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<div>Originally Posted by <strong>LZP</strong> <a href="/community/forum/post/14713134"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><b>So,my point: I have a few questions for those of you using health/medical/prescription insurance for your IF treatments:</b><br>
1) Did you have to/choose to check into your coverage, in detail, in advance yourself?<br>
2) Did your RE's office (or other practitioner) check for you?<br>
3) If you were not covered, do you have any idea if there is an "average" cost to things like IUI, and injectible meds? I know that IVF is in the tens of thousands.<br>
4) If you didnt check in advance, were you totally burned in the check book if coverage was denied?<br>
5) any tips/tricks to get it covered if it might otherwise not be?</div>
</td>
</tr></table></div>
First, yes, it's irrational. They won't take pity on you and cover just because you've already started.<br><br>
1) Yes.<br>
2) Yes - and a lot of what they told me was wrong because I have insurance that is WAY better than most, so they didn't bother to check, they just assumed that the usual exclusion applied.<br>
3) Yes. Well, not average, but here's what mine has been like, for a Clomid + Trigger + IUI cycle with my OBGYN, not my RE, and it's all been covered by insurance:<br>
Fertility Clinic Consult - $350 (clinic 1)<br>
Day 3 bloodwork - $300 (you can totally get your OB to order this, under some other code that's not infertility)<br>
Clomid 100 mg X 5 days = $50<br>
hcG trigger shot = $50<br>
Appointment for injection (which I totally could have done myself and did the next cycle) = $34.00<br>
Ultrasounds X 3 = $1500 (at the OB/Hospital - the OB I'm using now for out-of-town monitoring for the second fertility clinic is a quarter that cost)<br>
Appts with docs X 5 = approx. $600<br>
Sperm preparation and IUI = $400<br><br>
This cycle, I've had:<br>
Fertility clinic consult - $400 (clinic 2 - this is one-time expense)<br>
Cycle supervision fee = $400 (out of town)<br>
3 ultrasounds @ $150 each = $450<br>
3 rounds of E2 bloodwork maybe $100 = $300 (guestimate)<br>
1 semen analysis = $200 (guestimate)<br>
1 round of STD testing for each of us = you can totally get this covered in advance<br>
sperm prep + IUI with midwife (not sure) maybe $400?<br>
Gonal-F injectable medication = $2800<br>
hcG trigger shot = $50<br><br>
So, you can see why your insurance excludes the Gonal-F and Follistim, etc. The good news is that if it gets to that point, a lot of people have meds left over after a successful cycle and they donate them back to their clinic or give them to friends. I'm planning to do exactly that with anything I have leftover, if I ever have anything leftover.<br><br><br><br>
4) I really hope not. (The only thing my insurance might reject is the IUI with the midwife, but I would pay for that no problem. It was an amazingly pleasant experience.)<br><br>
5) Yes. Get as much of the testing covered under some other diagnostic code ahead of time. Sadly, some people have succeeded in getting coverage for infertility as "multiple pregnancy loss" or "recurrent miscarriage" diagnostic codes.<br><br>
I have had friends get HSGs and all the other diagnostic testing covered through codes like "irregular menses" or "absent menses."
 

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So far I have been lucky because my RE is also a OB/Gyn, so she billed my insurance at my first initial consult with her. We did find out that I have PCOS. So all of my office visits with her are covered as well. Before my new job, my Husband only covered me and his insurance paid for my HSG, well except $40.00. Which we were blessed for that because the RE coded it as "inferility".<br><br>
Also you can get Clomid or I should say Clomiphene (the generic) at any of the pharmacy that do the discounted rates. It doesn't matter if you are insured or not. It only cost $9 for every 5 pills. So Clomid 50mg = $9, Clomid 100mg = $18..
 

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Discussion Starter · #6 ·
WOW! Thank you so much for your thoughtful replies. I'll definitely call and find out about the coverage. The reason I asked THIS many questions is that our company will be providing a less expensive insurance option next year, and we have to pay extra to keep our current coverage. I'm trying to figure if it's worth it.<br><br><br>
For now, I'm taking a tiny, not so real, break from trying, but I'll probably be back here more often in the new year.<br><br>
Thank you again for your replies, it really means a lot. I hope when i come back here, you are all graduates. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">
 
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