Made an appointment with a RE.....

Mrs.Jason.9.15.07

And now I feel like crying!  I am not really sure why, but I feel really uneasy about traveling to see them.  I think I am mostly scared of the price tag, ha!  I know my H isn't too keen on the idea of spending a shiit load of money on TTC.  

Anyway, I know this question is better suited for my insurance company, but for those of you who have a fertility testing, was those tests covered by your insurance company?  Is everything leading up to the diagnosis of "infertility" generally covered?  Obviously no two insurance plans are alike and I really need to get on the phone and call but I am worn out from talking to people over the last couple of days and the Macy won't stop screaming when I am on the phone.  

moonstone523

(What is a RE?) 

And I hope it all works out!  

Aegis2005

Most states do not mandate IF coverage, although it looks like Texas is one of the states that do.  That said, there are loopholes to "cover" patients, that barely cover anything, so you should contact your insurance company.

http://www.fertilitylifelines.com/payingfortreatment/state-mandatedinsurancelist.jsp

I have a checklist that my RE suggested I use to call my insurance company to understand what was/wasn't covered before my first visit.  I'll send you the list. 

MrsShawanaB

This is probably not that helpful but I was going to say I think you definitely do need to talk to your insurance because I know it varies by a great deal.  I had a friend whose husband actually changed jobs, in a different city even, just so they could get a better insurance for IVF stuff because it was costing them so much. 

I will keep my fingers crossed that you have great insurance for this stuff!!

Mrs.Jason.9.15.07

Sorry, I should have been more clear!  A RE = Reproductive Endocrinologist, which is a doctor who specializes in infertility treatments.  Most people go to see a RE after one year of unsuccessfully TTC.  I think it's time I make the switch from my OB/GYN, since I am well over a year at this point!   

Aegis2005:

Most states do not mandate IF coverage, although it looks like Texas is one of the states that do.  That said, there are loopholes to "cover" patients, that barely cover anything, so you should contact your insurance company.

http://www.fertilitylifelines.com/payingfortreatment/state-mandatedinsurancelist.jsp

I have a checklist that my RE suggested I use to call my insurance company to understand what was/wasn't covered before my first visit.  I'll send you the list. 

Thanks!  That would be awesome!  I looked online and it appears the BCBS Federal (my policy) does cover all the testing but not fertility treatments such as IVF or IUI or the drugs that are associated with those procedures.  

I feel so lost on how to handle all this, or what the best approach is....... 

But your link is interesting.  I wonder if the reason why IVF is clearly not covered under our plan is because he is a Federal Employee, which they could claim is not a Texas employer?  I am sure that's the case....... 

Mrs.Jason.9.15.07

MrsShawanaB:

This is probably not that helpful but I was going to say I think you definitely do need to talk to your insurance because I know it varies by a great deal.  I had a friend whose husband actually changed jobs, in a different city even, just so they could get a better insurance for IVF stuff because it was costing them so much. 

I will keep my fingers crossed that you have great insurance for this stuff!!

I definitely need to look into this, for sure!  My appointment isn't until mid Feb, so I should have enough time to figure out what's cover and what isn't......and figure out how much we are comfortable paying.  

I did read somewhere on a forum that Federal Employees have access to Aetna Insurance which covers 50% of costly fertility treatments (like IVF and IUI).  So maybe that is something we need to look into?  However good news for me, open enrollment just passed this past Jan 1.  Of course.

Aegis2005

Mrs.Jason.9.15.07:

Aegis2005:

Most states do not mandate IF coverage, although it looks like Texas is one of the states that do.  That said, there are loopholes to "cover" patients, that barely cover anything, so you should contact your insurance company.

http://www.fertilitylifelines.com/payingfortreatment/state-mandatedinsurancelist.jsp

I have a checklist that my RE suggested I use to call my insurance company to understand what was/wasn't covered before my first visit.  I'll send you the list. 

Thanks!  That would be awesome!  I looked online and it appears the BCBS Federal (my policy) does cover all the testing but not fertility treatments such as IVF or IUI or the drugs that are associated with those procedures.  

I feel so lost on how to handle all this, or what the best approach is....... 

But your link is interesting.  I wonder if the reason why IVF is clearly not covered under our plan is because he is a Federal Employee, which they could claim is not a Texas employer?  I am sure that's the case....... 

There's a TON of loopholes in state mandated coverage.  A TON.  I wish I didn't know that, but unfortunately I've become quite educated on the topic in the past year   A policy can do one or two diagnositic tests, and they meet the minimum requirements for "coverage."  The other thing to keep in mind is that if you have a separate prescription plan, they may cover the cost of some meds.  If you got them to cover some of the cost of the progesterone you were on, then they probably cover other meds. 

I obviously can't see into either you or your husbands bodies, but you have gotten pregnant three times, so IUI or IVF may not be necessary.  It trully could be that some hormone or what not is out of whack, and that can be controlled by medication and/or you have scar tissue that can cleared out. 

My main advice is to just have a good understanding of what is covered, so when you start talking treatment, you know that means to you, financially.

SouthSeasBride

I have no insight for you, but I just wanted to say that I hope this step gets you closer to bringing home a brother or sister for Macy

jen812

SouthSeasBride:

I have no insight for you, but I just wanted to say that I hope this step gets you closer to bringing home a brother or sister for Macy

Me either, but good luck.

jennifer80808

SouthSeasBride:

I have no insight for you, but I just wanted to say that I hope this step gets you closer to bringing home a brother or sister for Macy

Me too!  Sending good thoughts your way that you are able to get some insight that will bring you closer to another baby!

lj_n_tj24

Hi, I was seeing an RE and I didnt start seeing the big bills until we tried for IUI (which was postponed since the clomid didnt work for me). I would have paid $500 if we went thru the whole process. I only paid $200 for the ultrasound to check if the clomid worked so I ended up not paying for the rest since we didnt get to do the actual IUI. Before that all the screening like Saline U/S, HSG U/S and other blood work I just paid the copay. I stopped seeing the RE while we took a break and thank goodness we didnt have to see him again.

lj_n_tj24

moonstone523:

(What is a RE?) 

And I hope it all works out!  

Reproductive Endocronoligst

Melis74

As has already been said, it varies greatly by insurance company and state.  My personal experience living in FL and having had BC/BS for some visits and now Humana was that all diagnostic testing was covered for me but no actual treatments.  I was pleasantly surprised with this FET cycle to discover that Humana actually covered my Progesterone and Delestrogen, the other drugs related to IVF were not covered.

Good luck! 

2poodles2Love

When we saw the RE in the fall nothing was covered.  We paid OOP for everything: all the testing to determine a diagnosis and the round of clomid we did.  Total was about $3,000!!

Hoping you get some answers and a plan from the RE.  Hopefully your insurance will help too.