What if insurance doesn't cover RE?

iVillage Member
Registered: 02-19-2007
What if insurance doesn't cover RE?
19
Wed, 08-04-2010 - 12:34pm

Michelle Im sure you know...

Do you remember what the initial cost for workup from RE was?
Since my ins covers nothing Im curious what Id be paying & what Id get for that..
Im not talking IUI or IVF as I know thats $$$$

*mindy*

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iVillage Member
Registered: 07-28-2009
Wed, 08-04-2010 - 1:16pm

Well, I can't tell you what all the cost of the diagnosis stuff was because my insurance did cover diagnostics only - so all the testing was at no out of pocket cost to me (hsg, bloodwork, u/s etc)


But here is the lowdown on treatment as there are less aggressive and therefore less costly treatment options:


Clomid or Femara w/o monitoring: $30


Clomid or Femara w/baseline u/s and b/w only: $300


Clomid or Femara w/baseline u/s and bloodwork plus one monitoring appt: $600 (You normally only have one monitoring appt with non-injectable meds because if you don't respond, they can't do anything about it anyway, like increase your dosage, because you only take the meds for a set number of days and then stop. If they do have you come in for multiple monitoring appts you can add $300 to the total for each appt).


Clomid or Femara w/baseline u/s, bloodwork, no monitoring appts and IUI with + OPK: $850.00


Clomid or Femara w/baseline u/s and bloodwork plus one monitoring appt and one IUI: $1150.00


Clomid or Femara w/baseline u/s and bloodwork plus one monitoring appt and

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iVillage Member
Registered: 10-05-2006
Wed, 08-04-2010 - 7:56pm
Do you know if your insurance will pay for any of the blood tests? I was able to get a bunch of the blood tests done at my normal doctor that were covered. I know that my husband's semen analysis wasn't covered. I would ask your RE what blood tests they recommend and then I would check with your insurance. You never know.

Christy
TTC 1st child since 2006
June 16, 2010: IUI w/ Femara BFP (Ectopic - Methotrexate shot) RE sidelined me until November cycle for next IUI :(

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iVillage Member
Registered: 07-28-2009
Wed, 08-04-2010 - 8:11pm
Yes, that is
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iVillage Member
Registered: 02-19-2007
Wed, 08-04-2010 - 8:30pm

At last check with my ins co. they said nothing for infertility is covered.
im guessing if I could get my OB to do & code it under recurrent loss it would be covered, which my b/w & hsg so far has been. Well I havent see HSG bill yet...

I guess maybe I should start with my OB & see if she has any other ideas of what to do. I think she thought MFM Dr would take over, but they are doing nothing. Im sorta disappointed with OB as I havent heard from her since follow-up to D&C. Before that she was all about 'coming up with a plan for me' The other thing was that when I switched during middle of last pregnancy I just wanted into new practice that was recommended. The Dr I wanted wasnt available, my Drs focus is not infertility, I mean she handles it but I dont think she really cares about it.

Sorry this turned into a long ramble..

*mindy*
iVillage Member
Registered: 07-28-2009
Wed, 08-04-2010 - 8:36pm
No, I think you're right - they do bill it under some other code and I know in my case it couldn't have been recurrent loss because they were paying for some of the blood work before I had any losses at all. I think they treat it the same as they were checking any blood work KWIM? Like if the check for low iron or elevated white cell count blah blah blah...

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iVillage Member
Registered: 02-19-2007
Wed, 08-04-2010 - 8:38pm

Thanks for all the info.

I need to figure out where I want to go from here. My first hurdle is getting Progesterone from OB. Of course they didnt return my call today as they told me they would.

I think I should start with talking to OB about what she thinks next steps are. I feel ditched by her after she ordered b/w. They tried to throw me over to MFM who didnt want me & they tried to throw me to an RE. Part of me wants to give it up altogether. I think I might just try some accupuncture.


*mindy*
iVillage Member
Registered: 07-28-2009
Wed, 08-04-2010 - 8:52pm
I had to BEG and BEG for the Progesterone. They only caved after my 2nd loss and even then they only did it to appease me. And I know I am not the only one that had trouble getting it. They don't like to do it for some reason. It's beyond me. Even if they're right and it doesn't help, it DOESN'T hurt so why not do it??? Even it does nothing but give us a little peace of mind, why can't they just have a heart and do that? Ugh they make me sick.

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iVillage Member
Registered: 02-19-2007
Wed, 08-04-2010 - 8:54pm

That was b/w your RE did or reg OB?

I just see my ins. co saying thats a fertility Dr of course it has to do with fertility & saying they arent covering it.

*mindy*
iVillage Member
Registered: 07-28-2009
Wed, 08-04-2010 - 8:57pm
They covered the Progesterone and hCG at the OB and the RE but then again I have diagnostic IF coverage so that may have been why. Hard to tell, I would call and ask! Don't say anything about IF coverage just ask if Progesterone, LH, TSH, Estrogen and hCG are covered.

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iVillage Member
Registered: 02-19-2007
Wed, 08-04-2010 - 9:02pm

I dont know it drives me crazy too.
Ive definitely seen Drs for it & those against it.
I was shocked when my MW offered to give it to me no problem. I mean earthy crunchy MW, I thought for sure they would say no. I also had TSH checked at that time & something else I dont recall but that was 9/09. They also did TSH again with b/w I just had & it was fine. Granted they also only gave me 100mg which did squat for me & I had to increase it myself.

I got the vibe that my Dr was anti from my initial talk after finding out I was miscarrying. Also, the MFM was way against it & trying to tell me the lack of Progesterone didnt cause my m/c. Um, know it was low b4 I got pregnant & it was low after I got pregnant so how can they say it doesnt matter.

I am prepared to cry at the drop of a hat & wail my TTC story if she refuses to give it to me. I hate having to take it but I know w/o it Id never get pregnant. You cant get pregnant on a 9 day LP

*mindy*

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