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Old Feb 16th, 2011, 18:34 PM   1
dreambeliever
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Infertility tests NOT COVERED by insurance! HELP!


So I found out yesterday that my two Dr's appointments to get tests done for infertility are not covered by our insurance. I admit I am not well-versed or accustomed in calling to make sure every little thing will be covered so it's part my fault. But I was also at the OBGYN for my regular pap and exam! UGH! Since my tests did come back normal, my husband was scheduled for an apt today with a urologist and then to see if he could do a SA. Well, after receiving the nearly $1,000 bill in the mail, he again called our insurance who at first told him the office visit would be covered, only to (thankfully) find out it won't be covered at all, NOTHING having to do with infertility will be covered.

Does anyone have experience with this issue? How can we get around this to get some medical expertise? What do we even pay insurance for!?!?!?!



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Old Feb 16th, 2011, 22:04 PM   2
ANC
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Unfortunately, that's very common. Most insurances pay nothing for infertility. Mine doesn't. It's very very hard..I've fought up and down and backward..nothing



 
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Old Feb 16th, 2011, 23:25 PM   3
Rona
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Dreambeliever, what insurance you use? Some insurance cover and some not. Before I do anything I will call my insurance company to make sure what cover and not. If in your fine print doesn't say it covers, then its not I think I am very lucky that my insurance covered mine, but still have some clauses that I must do it step by step. Means from basic and if not successful, I can go further up by my Dr. recommendation. But I know many insurance not cover infertility issues unless it very basic.



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Old Feb 16th, 2011, 23:42 PM   4
MrS. MaBrEy
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usually if you can get a doctor referral for it they will pay...at least for the urologist part...i am so blessed that my insurance covers all testing and drugs related to infertility...



 
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Old Feb 17th, 2011, 20:52 PM   5
dreambeliever
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we have Anthem insurance. My DH is going to tell his regular Dr. that he has been having discomfort from his varicocele (which is actually true) and see if he can get a referral and insurance to cover it that way. It's probably going to set us back another month or two as far as getting some answers. This process is taking much longer than I anticipated! It's such a test on our patience, geez! I know there are home semen analysis tests, but from what I've read, they only tell you the count, not the other factors that can affect sperm's quality. (so what is the point?!)
The other challenge in this is keeping DH motivated to calls/make appointments for this! I think he's kind of wanting to put it off now. (I don't blame him when we have 900 bucks in bills from my visits which we'll have to fight to get lowered!)



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Old Feb 17th, 2011, 21:17 PM   6
SpicyWolf
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We also have zero coverage for fertility through our insurance. I've gotten some testing done through my regular OBGYN by complaining of my irregular cycles. Once there I actually explained about our lack of insurance coverage and the Dr. made sure to code things for that and not fertility. She said one of the blood tests would have to be fertility but the rest for just general health. Sometimes you can get a discount if you pay for services up front. Unfortunately I don't know how to get drugs covered so I plan to just pay for that out of pocket

Also, my DH had his SA done through Midwest Fertility Clinic through a special discount program for people without insurance.



 
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Old Feb 17th, 2011, 21:28 PM   7
camilitary
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sorry but this is very common. We have tricare and they do not cover anything for fertility but they did cover test to see if infertile. the only test i could get was to make sure i was ovulating and my husband was covered for s.a. you also have to watch how you word your request and how the doctors code it.



 
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Old Feb 17th, 2011, 21:33 PM   8
MrS. MaBrEy
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Quote:
Originally Posted by camilitary View Post
sorry but this is very common. We have tricare and they do not cover anything for fertility but they did cover test to see if infertile. the only test i could get was to make sure i was ovulating and my husband was covered for s.a. you also have to watch how you word your request and how the doctors code it.
are you prime?? the only thing i am going to have to pay for is actual IVF or IUI, and they are covering the drugs for that as well. as long as my GP refers me and the FS goes through my GP to run the tests i dont have any out of pocket cost...worth looking into the way they are billing at least



 
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Old Feb 18th, 2011, 16:54 PM   9
dreambeliever
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I am just learning all these tricks of the trade. I spent nearly an hour on the phone today trying to track down someone I could talk to about having my doctor somehow change the "code" and resubmit the claim to my insurance company but they said I have to wait until I get my actual bill. (so far I've just gotten the explanation of benefits aka LACK OF BENEFITS from my insur.) I am going to fight this and do the best I can to get something covered here.

Meanwhile, my DH called a local sperm bank but they said their tests range anywhere from $125-500 depending on what you need tested. I don't know where else to go for a SA in Cleveland?



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Old Feb 18th, 2011, 16:57 PM   10
AndreaFlorida
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I must be really lucky we are Tricare Prime as well and they've covered everything so far and even can do IUI here on base for no cost I must be just blessed or something? There are certain bases you can get that cover every single thing besides IVF....but you can go to Texas and have treatments on base that are discounted much cheaper than going off base you just have to have a referral for the procedures! I have Clomid as well and thats covered too Everything is COVERED but IVF you just have to plan accordingly and of course you have to take leave if you have to travel etc. for treatments and time them well with ovulation.....goodluck girls!



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