DH low sperm/motility, will my insurance cover my IUI?

[alexanne89]

Hi all,

My DH and I are trying to figure out if we can afford IUIs and are really confused if insurance (in the US) would cover it for our situation. We are in a state that doesn't mandate insurance for infertility.

We've been TTC for almost 10 months and I had symptoms of PCOS so we went in for testing. My blood work came back all normal so I'm healthy and I should be able to get pregnant. My DH however has low sperm count and low motility. It's so low that our doctor told us we'd need to do IUI/IVF in order to get pregnant.

I called our insurance and tried to get answers but even with my basic questions they had to research it. She finally said she could mail me some info, which I received today, but I'm still confused and worried they won't cover anything because my DH isn't on my insurance. He has his own. I'm technically not infertile, he is. Wouldn't the insurance company argue that and use that to say they don't have to pay for anything? And couldn't his insurance argue that the procedure is being done on me not him?

I plan on calling in again next week and I'll have DH call his too. For now I was wondering if anyone here was in my shoes at one point and if you did receive help. If your insurance did help, was it yours or your SO?

Thank you for any input!

 

[BronteForever]

Everything technically bills through you as far as insurance and an RE goes. You are the patient as a women so everything goes through your insurance company. Doesn't matter the cause of infertility. Only thing that would go through your husband's insurance is a sperm analysis, infectious disease testing needed for him, or any other tests for him needed prior to procedures starting, since they are his service/tests directly. But everything after that you are the patient. At least at my REs office and that's pretty standard.

You should hopefully be able to figure out what yours covers. Sadly most in the US don't if you aren't in a mandated infertility coverage state. Some do but most don't. It's sad.

Luckily IUIs aren't too expensive (at least compared to IVF) so if there's anything positive it's hopefully it works with IUI Or you find out it's covered. If you have to move to IVF which is a real possibility with sperm issues IVF with ICSI is usually pretty successful. There's also quite a bit of supplements your husband could look into before getting to that point.

Good luck.

 

[alexanne89]

Thank you so much for your input! My insurance does state that it covers IUIs and most of the tests/procedures that come with it up to a lifetime limit of $20,000. I'm just worried that if nothing is wrong with me, they might refuse to cover it.

Without insurance I believe everything would cost around $1600 for one cycle. My doctor wants to do an HSG and an ultrasound. Paying $1600 once wouldn't be the end of the world but if we had to do 3-4 cycles, we can't afford that now.

 

[BronteForever]

If they do refuse you fight that one because there is no way they should be refusing you. Even though your husband is likely the cause there honestly is no way of knowing that 100 percent. Plus it doesn't even matter you are receiving the bulk of the services as a woman. It's just a fact of life. That's why everything goes through you. My husband actually has better insurance then me so we wanted it flipped but neither of ours cover anything after diagnosis so it wasn't worth it to wait and have me switch to his insurance and mine ended up covering the HSG anyway because they billed it as a result of pain during ovulation which I'd had for awhile. But they have covered nothing of IVF. No meds. Nothing. It sucks. I'll be at about $25,000-$30,000 for two cycles with no guarantee it will work.

 

[alexanne89]

Again thank you! Your input means a lot to me as I was stressing out about this. I'm sorry to hear that they don't cover anything for IVF for you. We definitely wouldn't be able to afford it on our own. Hopefully this 2nd time gets you your BFP! I glanced at your journal and plan to go back to read it. I can't even imagine going through all that and try to stay positive and keep going! I really hope IVF works for you!

 

[BronteForever]

You're welcome. I'm so glad yours covers stuff. That always makes me happy to see! And goodness we can't afford it either but we're lucky enough to borrow and set up a payment plan for repayment. It's going to make the next round more stressful though. We have decided to take it one cycle at a time though so we are trying to stay focused on this next one and hope it works.

Anyway best wishes. Hopefully you get to start soon!