Infertility - Insurance ?

Mrs.Cheri · April 2014

Hi everyone....long time, no "see". Hope all of you are doing well!

I have a question for those of you that have dealt with infertility. My husband and I have an initial appt later this month just to chat and address our concerns. I knew that there might possibly be insurance issues if there was any testing, etc but I never thought there would be issues with visits. We're both state employees and have fairly decent insurance so I was kind of surprised to learn that anything dealing with infertility whatsoever is not covered. Did any of you deal with this same issue? Any ballpark figures as to the cost you paid for visits, testing if not covered by insurance? Thank you for any information, it's much appreciated.

denalea · April 2014

I don't know a whole bunch, but it could be helpful if your diagnosis on lab orders, etc., at least initially, was not for infertility. If you could attribute it to something else (PCOS, irregular periods, thyroid issues, etc.) that might be helpful with the first rounds, until you get to the point where there was no denying what you were seeking treatment for. (I had an order for an ultrasound and blood work that they ordered this way so that it was at least partially covered.)

Definitely be up front with your docs and let them know you don't have insurance for IF and see what they recommend.

Sorry you're in this boat. :-( Praying for quick answers and success.

Meghan&Rich · April 2014

First, I'm sorry you have to deal with this!

To spin off what Dena said, some plans will cover the diagnosis of and treatment of the issue. When I was trying with Mason & Garrett, my insurance was like this. Since I had PCOS/annovulation, everything we did to treat that and get me to ovulate was covered - so my ultrasounds, bloodwork, meds, etc.. I was lucky enough to get pregnant on clomid & metformin, and didn't have to move forward with any treatment that wasn't covered 100%.

This time around, I basically have an "allowance" with my plan for fertility treatments, so everything falls under that. Any treatments, etc. that go beyond that allowance will be out of pocket.

I haven't exceeded that allowance yet, but these are how much my claims were for the following (I did have a consultation appointment, but didn't see that listed anywhere, so I'm not sure if that was a "freebie" from the office.):

Ultrasounds + Bloodwork = $436

IUI = $295

S/A = $125

I would also discuss with your Dr. what some of your options are as far as cost/payment. They understand that many people don't have any or have very limited coverage for fertility treatments, so they should be able to offer some guidance or resources.

Good luck! I hope this was helpful, feel free to ask me questions if you have any!

psychgalbride · April 2014

My insurance paid for everything until the diagnosis of infertility back in 2009. Our initial consult at Magee and first line of testing (blood work and HSG). DH's consult with reproductive urologist was paid for as well but the SA was out of pocket (125)

Once we had the PCOS and Male Infertility diagnosis, our insurance paid for NOTHING. I paid out of pocket for every blood work, consult visit, and treatment.

A full round of IUI (including blood work monitoring, treatment, and medication (Clomid and HCG Trigger) was around $ 2,600

Our IVF consult quote was around $ 12,000 but we never needed to pursue that route.

Good luck! Feel free to message me with any questions. I'm pretty open about our journey to parenthood.

carcrashheart · April 2014

this is pretty typical. IF is rarely covered. for those that have coverage-i'm always jealous of this!

somehow all of our testing was either coded differently (though i swear they said "infertility" on the lab orders) or something was changed because we only got a bill for the s/a. maybe some bloodwork, but nothing huge or monumental. i think the HSG was about $400ish. i know i was billed for the u/s scans the RE did during monitoring and pregnancy. i forget what they cost though-my brain is mush. i'm still waiting for those bills to roll in from this time around. they haven't shown up yet. instead i've gotten the massive bills for the SHG i had done in december, which came to about $900, and the hysterscopy i had done in january to remove polyps, which has topped out around $1700.

Infertility - Insurance ?

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