Wow, thanks insurance company.

iVillage Member
Registered: 12-14-2008
Wow, thanks insurance company.
16
Thu, 08-12-2010 - 10:06am

I got curious and went to our insurance's website. Here is a breakdown of what they cover (or more accurately, what they don't cover.) It appears that you can have anything done to prevent pregnancy or get rid of it, but not much to try to get pregnant. That's messed up. They'll cover abortion, but not Clomid. Sick.

And...as far as infertility. You can pay a co-pay to go talk to a doctor, but then they won't cover any treatments. Wow, thanks. That's helpful. I guess something like endo might be covered, but not much else I can think of. It's funny b/c when you read it, it's like "Oh, 90 % of eligible expenses....." But then when you see the list of what's not covered....it's almost a moot point.

So, I guess it's au natural for me. Hope others have a better deal.

<<<<<<<<<<<<<<<<<<<<<<

Birth Control Pills - covered

See Prescription Drug Section for pharmacy benefits.

Not Applicable

Reproductive Resource Services Program

Not Applicable.

Infertility

Coverage for the diagnosis and treatment of conditions preventing a pregnancy and to correct the inability to conceive:

Office Visit:

$25 PCP/ $35 Specialist copay then 100% of eligible expenses.

Facility & Non-Office Visit services:

90% of eligible expenses, after the deductible.

Physician (hospital/outpatient facility):

90% of eligible expenses, after the deductible.

Inpatient Admission:

90% of eligible Expenses, after the deductible.

Not covered - Assisted Reproductive Technology.

Non-covered services include, but are not limited to:

· Drug Therapy

· Artificial Insemination

· In-Vitro Fertilization

· GIFT

· ZIFT

· Artificial Embryo Transfer

· Donor Collection and Preparation

Reproduction

Same as:

● Physician's Office Services

● Professional Fees

● Hospital-Inpatient Stay

● Outpatient Diagnostic and Therapeutic Services.

● Voluntary family planning.

The following are covered:

● Voluntary family planning.

● Abortions (Elective and Therapeutic).

● Fetal reduction surgery.

● Health services associated with the use of non-surgical or drug-induced Pregnancy termination.

The following services are not covered:

● Surrogate parenting.

● The reversal of voluntary sterilization.

● Fees or direct payment to a donor for sperm or ovum donations.

● Monthly fees for maintenance and/or storage of frozen embryos (sperm or eggs).

Tubal Ligation

Office Visit:

$25 PCP/ $35 Specialist copay then 100% of eligible expenses.

Facility & Non-Office Visit services:

90% of eligible expenses, after the deductible.

Physician (hospital/outpatient facility):

90% of eligible expenses, after the deductible.

Inpatient Admission:

90% of eligible Expenses, after the deductible.

Vasectomy

Office Visit:

$25 PCP/ $35 Specialist copay then 100% of eligible expenses.

Facility & Non-Office Visit services:

90% of eligible expenses, after the deductible.

Physician (hospital/outpatient facility):

90% of eligible expenses, after the deductible.

Inpatient Admission:

90% of eligible Expenses, after the deductible.
_________________


Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


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iVillage Member
Registered: 08-10-2010
Thu, 08-12-2010 - 10:14am

I hate that so much insurance money is spent on birth control, but fertility treatments are rarely covered.

 


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iVillage Member
Registered: 02-08-2009
Thu, 08-12-2010 - 10:45am

Ugh. It does look like testing might be covered, though. You know, a lot of women get preggo after a HSG (the dye in the tubes to make sure they're clear test).


Also, I'd talk to your ob/gyn. It's possible that they get more covered than you would think. If everything is covered, except a med, that might not be so bad.


Also, if there's a flexible spending plan option,

 

iVillage Member
Registered: 12-14-2008
Thu, 08-12-2010 - 1:30pm

Yeah....the thing is, I don't think I really need testing. I have six kiddos.....I'm pretty sure my issue is just old eggs. And the only thing medically that can help that out is clomid or IUI, etc.

Acupuncture is a good idea. I have to pay $25 per time, though.....how often do you have to go?

We'll see what my OB says. I have a feeling it will be just to wait it out. Hopefully, there's one good eggie left and sometime soon I'll find it, God willing.


Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


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Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


iVillage Member
Registered: 02-08-2009
Thu, 08-12-2010 - 6:30pm

Yeah, I'd still talk to your OB/GYN about it. Maybe they can bill it as a med for something else- hormonal imbalance or something, IDK. It can be all about how something is coded/billed.


I haven't

 

iVillage Member
Registered: 08-18-2005
Fri, 08-13-2010 - 9:11am

Insurance companies are the pits. My insurance doesn't cover birth control, ANY well visit, and no gyn annual exam/pap. Basically, covers no preventative care and all Rx come out of pocket THEN they reimburse you 80/20 after you send in all the claim forms. "Great" for when your Rx bill is in the $100's....and it's all initially out of pocket...

As far as meds, Walmart sells generic Clomid for $4 (not sure of dosing) and one other grocery chain fill Metformin (gen) for free (but you're not pcos, right?). Possibly Clomid wouldn't break the bank if you could get it at WalMart and the dosing is what you need. Though the monitoring of the meds might a hassle if your insurance company won't cover the follow-ups that may be needed.

I was researching clomid costs because I was hoping my dr. would put me on it...I took Femara to conceive my son (which I would prefer over Clomid)...but she won't yet.

Well, like a pp said, hopefully you're pg this cycle and you won't have to worry about insurance and fertility coverage!

*Sari, loving Momma to Kai Lilypie 6th to 18th Ticker

iVillage Member
Registered: 02-08-2009
Fri, 08-13-2010 - 7:43pm

I think I'm going to wait a bit longer on the acupuncture. I've been having a lot of little changes with this cycle, maybe due to some of the new stuff I"m doing, so I want to ride it out and see what happens. Not that I think I'm pregnant, but I feel like some things are much more back to normal, pre-bfing fertility.


I usually have had cramping from like 4 dpo until 7 or 8 dpo, and then start spotting on 9 dpo, with AF coming soon after. So, of course, the first 5 or so times it happened, I was thinking implantation cramping. After that, I figured it was just something my body was doing. No cramping this time so far. At all. The other big thing was that I was having some cervix pain with bding ever since DD was born. I figured just a pp thing, it would go away, OBGYN said she didn't see any reason for it. It made it hard to relax during, though, kwim? This time around, no pain at all. None. Also, my chart is funky. I've never, ever had a chart that looks like this one. I'm not sure what that means. It doesn't look like my pregnancy charts either, though. But, different can't be bad, at this point.


Anyways, all that was to say that I'll call and schedule an appt with an acupuncturist when I get AF, and then I'll let you know how it goes, how often they want me to go, etc.


Oops, I wrote a book :S


Sunday

 

iVillage Member
Registered: 12-14-2008
Fri, 08-13-2010 - 10:46pm

Oh, Sunday. I hope all of these changes you feel mean good things for you! I know what you mean about this cycle feeling different. I feel the same way. From the ultra early O right up to now....everything feels weird.

DD is down to one nursing to get to sleep....and one very short (like 2 minutes) once a night. AND......here and there she is sleeping through! Yes!!! So, I'm assuming DD's cut in night nursing is finally kicking in. I don't think it means anything more than that....but one can hope.

Let's BOTH get bfp's this time around, what say?


Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


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Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


iVillage Member
Registered: 05-20-2010
Sat, 08-14-2010 - 12:11pm

wow!!!

Jessica


momma to 5 lil ones 9 and under, 2 girls and 3 boys, wife to a loving husband for 8 years
Expecting #6 in June, 2

iVillage Member
Registered: 02-08-2009
Sat, 08-14-2010 - 12:33pm

<<>>

 

iVillage Member
Registered: 12-14-2008
Sun, 08-15-2010 - 2:13pm

LOl! Yah, I've done some time. ; )

I was laughing today in the nursery at church....a lady was saying how she HAD to let her 3 month old cry it out b/c she just couldn't function with so little sleep. I thought.....honey, I haven't had a full night's sleep in almost 15 years!

I was thinking how if dd weans........it'll be the first time in 15 years that I haven't been nursing or pregnant. : (

It is funny though....the one night this week-end when dd did sleep through the night.....I had to get up twice (3 and 4 a.m.!) to tell my teen, preteen and their sleepover buddies to go to BED!!!

Any thoughts about this cycle, Sunday?

I got the itchy boob thing back again after a couple days off. So strange. I was telling DH that between O and AF and all these early symptoms....I have cramps, etc. pretty much all month these days. I feel like af is coming tonight and I'm only 8 dpo. I plan on asking Dr. about it.

I'm still hoping different is good, but I think probably different just means I'm 44.

FX for us both!


Dee -- Homeschooling mom of 6 -- Forty-four and praying for 1 more!


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