FS& Insurance Coverage

[fisher640]

I'm in a bit of a panic today. I finally got a referral from my gynecologist to see a fertility specialist, and I was SO excited yesterday when I scheduled my appointment for later this month. So I decided that it would be in my best interest to call my insurance company today to find out what if any of this fertility specialist visit will be covered by my insurance and it sounds like none of it will be I cried after I got off the phone with them "we will cover all testing up until the diagnosis of infertility". So, no specialist visits, no medications, no testing, no procedures will be covered now. I mean, I figured they wouldn't cover something crazy like IVF, but to not even cover me going to talk with the doctor is heart breaking.

I'm really torn & upset now. I haven't cancelled my appointment yet, I feel like I need to go and see what it's all about, and what they *would* do, and how much it would all cost and whatnot, what my options are. I'm a nurse and my husband is a teacher both fine professions... that make no money.

I wondering how much clomid would cost me? I mean I'm sure the doctor visit in and of itself will be like $500? I guess I could try and come up with a plan, and fill up my flexible spending account for next year and see the specialist again after January 1st (flexible spending is a US add-on for insurance where you pay up to $5000 into a special account that is exempt from taxes but it can only be used on healthcare expenses)... I don't think $5000 takes you very far with infertility though

Any optimism I had after scheduling my appointment has been totally sucked right out of me. Just a general rant, I'm not lucky enough to live in a state or country that mandates any minimal infertility coverage. Any advice or stories on how to proceed from here would be much appreciated (or fellow complainers because misery loves company).

 

[Apple Blossom]

My reply is on your journal hun, as I saw it there first

 

[wanting2010]

Hey hon, I am in the exact same boat. My insurance covers testing but not treatment. It sucks especially since infertility treatments are so expensive!

At my RE, my initial consultation was actually covered by my insurance, but if it hadn't been it would have cost $150. You can call your specialist's office to ask them how much they charge for the consultation. I think it would definitely be a good idea for you to go to the appointment if there's any way possible.

I took Clomid for 5 cycles and got it at Wal-Mart for $9 for 5 pills (50 mg dose), $18 for 10 pills (100 mg dose), and $24 for 15 pills (150 mg dose). It is part of their $4/$9 prescription program thing. If you have to take something like Provera to induce AF, that costs $4 at Wal-Mart.

As for the flexible spending account, I think that would definitely be a great idea in case you have to move on to more expensive treatments. You're right in that $5000 doesn't take you very far with fertility treatments, but hopefully you wouldn't have to go the more expensive route.

Hang in there, hon!

 

[readyformore]

Sometimes your ob/gyn will treat you and dispense meds with different coding.
They can give you scans, drugs, bloodwork, etc and have it labeled as something other than infertility. You would still get the results, but have it paid for by insurance.

Hopefully, your doc will work with you.

Good luck.

 

[TeddyBearPug]

I'm sorry to hear your having such a hard time. I agree with the lady above me. Most doctors will try and code it a differnt way so insurance will cover it. But with that said, i've seen my diagnosis on my paperwork as unexplained infertility and my insurance has paid a percentage of everything!! When i researched my benefits on the insurance website it even stated that they do not cover infertility or any testing, but they have been paying for it. When i had my HSG done, the hospital called to see what insurance would pay and insurance said $0...i went ahead with the procedure expecting a full bill and guess what....insurance paid for most of it!!! So try not to be discouraged. The hospital that i go to my doctors through also has an installment plan where they total up all my bills and let me pay $50 monthly and i can add new bills as they come, so its nice. Hopefully you can get something set up. When i received my insurance paperwork from the FS appt the base price for the appt was $130 and i only paid $30 copay.

 

[readyformore]

Wow, $130 for a consultation?

9 years ago, my doc charged $350!

 

[Mrs. Bear]

My RE consult full price I believe is $150, ultrasounds are about the same. I agree that you definitely need to at least go to the consult so you can get an idea of what your options are. Most OB/GYN just don't have the expertise of an RE to know all the options.

FSA is a great option too - I put some in this year because we were going to do IUIs and am looking to max it out for 2012 because we will probably be moving on to IVF if no BFP this year.

 

[Soili]

Here none of the insurance companies cover ANYTHING that's even remotely connected to infertility. They don't cover diagnostics either.

The only trick that works is if the clinic/doctor you're seeing will be willing to pass your receipts as general OB/GYN stuff.

 

[SmileyKez]

Wow makes me realise how lucky I am to be in the uk and have free healthcare, regardless of how patchy it is sometimes and dependant on where you live! I really feel for you guys, this is all hard enough without the added stress of finding the money to pay for it all! Good luck to you all!