MM and fertility

hoffse · March 2017

Hopefully it's OK to post this here.

H and I have been TTC since Sept/Oct. It's kind of early still, but I noticed some weird things about my cycles when I started charting. My dad's older brother is an OBGYN with a PhD in endocrinology. I finally decided I needed to suck it up and call my uncle because he's the single most qualified person I know on this stuff, and I knew he would be willing to do a phone consult with me.

Anyway I called him on Saturday. He immediately went into doctor mode and started questioning me (which helped dispel at least some of the awkwardness). Within a few minutes he told me that I need to schedule an appointment with my doctor and go through the complete battery of fertility testing because I likely will need medication in order to get pregnant. He gave me a very detailed to-do list, and he told me that if my doctor won't listen then to call him back and he will "intercede" (thanks Uncle John, you are the best). He also strongly pushed for mid-cycle monitoring throughout the process. He said we will probably just need clomid+progesterone+maybe a trigger shot, but obviously that assumes everything is good on H's end. He's getting tested soon.

The reason I am posting this here is because we don't have insurance coverage for fertility, so we will be 100% out of pocket. We are under contract for a bathroom remodel in May, and we are taking a trip to Spain at the end of the month that's pretty much already paid for. We discussed cancelling or postponing the remodel, but we have the cash saved for it, and our contractor gave us a great price because we have referred a lot of work to him. We are going to do less high-end finishes as a way to save some money there, but we really don't want to suspend the entire project. We have to keep living our lives, and I don't want this to completely consume us.

We can cash flow up to $2300/month in medical expenses, and I have 3 years' worth of HSA contributions that I have never touched (about $12K in that account - and it can be used for fertility stuff, I checked the regs). We also have a $25K HELOC that will not be used on the bathroom remodel (but obviously that's a last resort). Does anybody have insight into the costs of this? I really don't want to postpone the bathroom if our cash flow rate and HSA should cover us.

I am incredibly bummed out that this is happening, but I am so grateful that I found out this early. I know how lucky I am to have my uncle. My doctor didn't want to see me until December, and my uncle was like, "Yeah you would just be wasting the next 9 months if you wait that long. Schedule an appointment as soon as we get off the phone and make her listen to you." He's the best.

julieanne912 · March 2017

Why not call your insurance company to ask them what some of that stuff would cost? Fertility treatments may not be covered, but depending on how your doctor codes it, things like Clomid etc., may be covered. A friend just went through the same thing, she has PCOS and as long as her doctor coded things as treatment for that, everything was covered.

smerka · March 2017

I say this gently. Sometimes you just need to spend money. Having kids is important to you. There's nothing wrong with getting some help to make that happen and you have the money available. People first, then money then things.

LillibetteV · March 2017

I'm sorry you're going through this - speaking from experience it totally sucks but you will get through it. Many fertility specialists will give you a detailed list of potential costs because they know people end up paying out of pocket. My IVF was covered (thank you Massachusetts law!), but I still had to sign a form showing the estimated cost of the cycle and agreeing to pay it should my insurance not cover it (which was never a concern since we didn't do the cycle until the pre-approval was on file). I don't know what the testing and clomid/IUI cycle full cost was off hand, but I remember that the IVF w/ICSI cycle would have cost us about $15k out of pocket. If you have to get all the way to IVF also inquire about storage fees for any extra embryos you want to freeze.

I would also ask your doctor if certain things can be coded such that they don't get flagged as "infertility". Many blood tests and even the HSG should be covered as diagnostic. The only plus side to no insurance coverage is you don't have to wait - my insurer would not have covered any treatment prior to a year of trying. I know it's not much of a plus side, but I learned that finding silver linings where I could kept me sane.

csuave · March 2017

Will it count towards your deductible our your out of pocket max?

jtmh2012 · March 2017

julieanne912 said:

A friend just went through the same thing, she has PCOS and as long as her doctor coded things as treatment for that, everything was covered.

My wife has PCOS too and they put her on metformin for it, but we found that out priot to ever trying for a baby, so it wasn't put down as infertility. Insurance covered it like normal. Our new doctor said if we ever tried for another to let her know and she'd write a new prescription for it.

vlagrl35 · March 2017

I'm coming from a place where I lost a little embryo in December and I've totally given up on pregnancy forums and am trying to get my mind back where it needs to be.

We did basic fertility testing at 6 months in - DH had his semen checked ($90), I had CD 3 blood work and HSG for tubes - all came back normal. I just had my CD21 Prog checked a couple weeks ago and it's in range but on low side so I'm going to start suppositories in a couple weeks. The P pill is evil and gave me so many bad side effects. This will go up my Vag. Hopefully this is all I need to get pregnant and produce a healthy baby. Thru this process I know I could never do IVF but possibly IUI. I've heard it's around $500 OOP.

Come to find out blue cross approved HSG because my doctor put it as having irregular periods and blood work was covered too. If your doctor puts it as fertility testing it won't be covered. I too have no fertility coverage so I'm not looking into an RE at the moment as I don't think I can take much more stress at this point.

Obviously some people need additional help getting pregnant and there is nothing wrong with that - but also know it sometimes takes awhile to get pregnant even if you are very healthy. I've learned that God's plan is sometimes not in line with my plan.

If it came to me needing IVF we would probably end up adopting. I can't stand medications and that P pill drove me nuts and that's just 1 little pill.

vlagrl35 · March 2017

also I've heard clomid/femera isn't that expensive out of pocket - My OB will do up to 3 rounds of clomid and then suggest an RE. I found a pharmacy that compounds my suppositories for $2 a pill so that's the route I'm going and it's not in network but it's still cheaper than the suppository cream walmart makes - easily fill our $100 drug deductible and then $35 co pay all other months. for now I just want to have fun and forget all this crap. It's just not worth it to me.

LillibetteV · March 2017

I would also add that if your regular OBGYN can't code it in a way to avoid being charged out of pocket for fertility treatment then skip them and go straight to a RE. No point in paying full price and not getting a specialist! My husband's PCP did his first semen analysis and said he was fine - turns out he was a complete idiot and completely wrong and we had two specialists (my RE and my husband's urologist) say that there was zero chance of him getting me pregnant without IVF/ICSI. And guess what? After two years of trying I didn't get pregnant until we did IVF/ICSI.

vlagrl35 · March 2017

@LillibetteV - weird and frustrating I'm sure! Is a PCP a regular doctor? DH had his examined at a fertility clinic.

LillibetteV · March 2017

@vlagrl35, yes it's just his regular primary care doctor. He said it was fine but I was suspicious because the numbers were all flagged as abnormal on the report. My fertility clinic took a copy of it and re-did the test themselves. Even still it took the clinic a few months to get to the bottom of the primary issue because he's an unusual case. My husband has partial retrograde ejaculation but doesn't have any of the usual indicators such as diabetes or previous surgery/injury. He was at the clinic almost as much as I was for awhile.

hoffse · March 2017

Thanks everybody this is really helpful. To be clear, H and I both agree that medical costs come first here - I just don't want to suspend plans that make me really excited if we don't need to.

I'll ask my doctor about coding stuff for insurance. I have a fairly high deductible, but my insurance tends to negotiate much lower rates, so I would like billing to go through them first. I'm very prepared to pay the full deductible.

Regardless, it does sound like the OOP rates are going to be manageable for us based on our cash flow, which is a relief. I will need to call my doctor's office and ask to be 100% sure, but your reports are confirming the googling I am doing.

als1982 · March 2017

I hit my OOP max on Friday for a colonoscopy, for just this very purpose!

We obviously don't have the same insurance, but my insurance covered all blood work, hormone testing, HSG and GI work. Out of pocket costs were about $700 for the HSG and around the same for the hospital's portion of the colonoscopy (I'm guessing anesthesia will be billed separately but should be after the max). H's testing was out of pocket.

We're not interested in IVF so I don't know about those specific costs, but my OBGYN in KC said that she usually refers her patients to Chicago because their rates of successful pregnancies are much higher than any of our local providers, so some couples may need to account for travel costs in addition to the costs of the procedures themselves. (But I'm guessing Atlanta likely has an IF clinic with good IVF outcomes.)

It's been a rough couple of years, but it's nice to finally be close to having some answers and regain control.

brij2006 · March 2017

First of all, I am very sorry you guys are finding yourselves here. IF is a mindf*ck and a difficult road to go down.

So I'll just speak from my experience. I had very long, almost non-existent cycles when I first got off BC. So we were actually only TTC 4 months when we started testing with our OB. At 7 months into TTC we did a clomid cycle. Our insurance did not cover infertility. However, my doctor was able to code some things as exploratory amhenorriah (sp?) testing. So we were able to get the initial diagnosis ultrasound and bloodwork covered. However, an HSG was not. Our total cost for the bloodwork, ultrasound, and 1 round of Clomid was about $1,500.
I will add though to not waste your time with an OB. Especially if you have to pay out of pocket anyways. Just go straight to an RE. They're much more knowledgeable and aggressive than an OB is. An OB is great for when you're pregnant, an RE is good to help get you pregnant. An OB will usually only do clomid and then they want you to move to an RE. To which the RE will do a full panel of the same tests. So you'd end up paying twice.

The SA with the RE was priced at $450.

Before we got pregnant with DD we had a goal to save up $5,000 to spend with the RE once we were ready to move forward with another round of treatment.
This time around, IF had been added to my insurance coverage. However, we had scheduled an appointment with an RE and they were booking out by 5 months. So the RE looked over my charts from the OB and gave some recommendations on things to try in the meantime. That was worth it because we knew I needed a bit of assistance to keep a pregnancy in, and ended up being pregnant before our appointment with her. The cost to us was a prescription of Metformin and baby aspirin and B complex vitamin. All from her looking over our charts and saying it doesn't hurt to try XYZ before I can fit you in. Wish we would have made that switch years ago.

vlagrl35 · March 2017

yeah if you don't mind paying out of pocket for these things then just go to an RE - I have a problem paying out of pocket for it all because we don't have the extra cash flow. Just know it won't go towards your deductible because it won't be covered. If my CD3 wasn't covered then it was going to cost me $1300, Progesterone would have be $124, SA we paid out of pocket for at a clinic and it was $90. HSG was covered and I only paid $70 - not sure the out of pocket cost.

I'm totally fine doing all that with my OB because it's basic stuff. When open enrollment comes again in the fall and we still aren't pregnant then we will probably go with Cigna - someone I know told me they have fertility coverage which the others don't. For now though I've packed away all the OPKs and put away the BBT - I"m mentally done.

brij2006 · March 2017

You can also call an RE you want to go to and just ask what their cash price is for things. They're used to it since many insurance's don't cover IF.
Ours was willing to e-mail me a list when I asked and they had a 10% cash discount as well if you wrote a check at your appointment.
It doesn't hurt to ask so you have a better picture of what you're looking at. With your HSA and cash flow, I wouldn't hesitate to go to the RE and just get the best care possible from the start.

hoffse · March 2017

Thanks everybody, again super helpful.

My appointment with my OB isn't until early April (on my fourth anniversary ironically), so in the meantime I will call some REs and see what they cost. We don't mind paying cash if that's better - my deductible is so high that I doubt I would hit it anyway before they start denying things - so maybe we should just start with an RE so we don't waste time.

Weirdly, the second best fertility clinic in the country (per IVF stats) is in Mobile, AL. Random, I know. It's about 3.5 hours away, but they probably have a lot of patients from B'ham and have relationships with local doctors. I will definitely contact them to find out if this is the case and how they handle long-distance patients.

Also, a clinic my H's colleagues used that also gets very good results now has a branch in Atlanta. My H's colleagues were flying to Denver for treatment back when they did it. That is certainly an option as well, since we would have a place to stay and both of our firms have offices there for remote work.

I will contact both, and then H and I will decide how best to proceed.

Thanks for the support and feedback everybody. This really does suck, but I'm relieved to have something I can do.

brij2006 · March 2017

It is likely that the clinic 3.5hrs away may have a satellite campus they use for care further away from their main campus. Our RE was technically out of Iowa City, IA but she worked 2 days/week at the satellite campus in Davenport, IA which is an hour away from us. So we were still able to work with an RE that's contracted through the University of Iowa, but didn't have to travel the 2.5 hours to get to her.
The only thing that hinders it a bit is that they don't do any transfers at the satellite campus. So if we would have had to do IUI or IVF, we would do all of the monitoring at the campus an hour away, but drive the 2.5 hours for the actual transfer.
It's still a great option to have though if they offer that. We're 2.5 hours from the very successful Chicago RE (can't remember the name of the practice), but they were double the price and I would have had to use my local hospital for blood draws and ultrasounds.
So it's definitely worth calling around and seeing what your options are.

brij2006 · March 2017

Duplicate

vlagrl35 · March 2017

it sucks balls @hoffse - I don't do well with things I can't control. Obviously if you've never had a kiddo and you really want that I totally understand and feel ya. I would suggest going ahead and calling the clinic you prefer and get some ball park estimates. Calling insurance because it never hurts to see your options. For us though we have a child so I think we are meant to only have 1 and be done. It sucks I had a total meltdown last week like for a day and half- I'm trying to come to terms with it. It's just best if I let all this go and focus on what i can do with my life and find meaning in that and totally enjoy my DD and be so ever thankful to have her as a blessing from above.

csuave · March 2017

smerka said:

I say this gently. Sometimes you just need to spend money. Having kids is important to you. There's nothing wrong with getting some help to make that happen and you have the money available. People first, then money then things.

Great advice @smerka especially relative to having the money available to do it (which it sounds like OP does in this case).

Slightly different scenario that I will mention in case lurkers are reading is not having the money available and possibly going into debt (once again not the case with this OP). I heard this DR-type guy speak one time and he told his story about how he turned his lifestyle around and got out of debt. Then he and his wife decided to start a family and discovered they would need IF and it was going to cost a lot. He said they decided to save the cash first and not finance it or go into debt. Finally they had saved enough and did the treatments. They were not successful. He said it was such a relief at that point to have paid cash because he didn't know how he could possibly go through the emotions of seeing bills that needed to be paid relative to the treatments after what they went through.

@hoffse I think it is wise to consider MM as you make family plans.

It is also wise in general to know what you (general you for anyone reading) can cash flow, and if you are not able to cash flow think about what that means to your MM plans. Also consider the extra emotional stress it may add if financing/debt is an option being considered.

brij2006 · March 2017

@csauve Has such a good point there. We used savings to fund our Clomid cycle just to have it end in a miscarriage. It was so hard to watch our savings go down at that time, but I couldn't have even imagined if we had put it on a CC and had to pay on the debt that was accrued while mourning the loss of our child.

als1982 · March 2017

Not to stray off topic, but does anyone have numbers for adoption? That's the direction we're headed. Likely older child adoption, which I assumed would be minimal with the exception of filing fees and court costs.

hoffse · March 2017

als1982 said:

Not to stray off topic, but does anyone have numbers for adoption? That's the direction we're headed. Likely older child adoption, which I assumed would be minimal with the exception of filing fees and court costs.

I have looked into it because H and I have discussed adopting regardless of what happens with the fertility stuff.

Adopting through the foster system is very inexpensive. In most states it's under a couple thousand.

Adopting privately through an agency can be very expensive. Where I live it seems to run in the $20-$25K range. If you adopt internationally the cost might be even higher.

smerka · March 2017

There's a pretty big tax credit available for adoption. https://www.irs.gov/taxtopics/tc607.html

vlagrl35 · March 2017

I have a friend that adopted a newborn in our area and then also fostered a little girl for several years that she was eventually able to adopt as well. I don't know the cost of that though sorry - She did put up a go fund me for the adoption costs and I donated a little bit to that.

Money is a huge factor when it comes to IVF with me - IVF is not a guarantee and since we don't have benefits with fertility I would have a hard time doing a HELOC to put all the cost and then if it didn't work out I would be crushed as well with the debt.

bmo88 · March 2017

@hoffse: Others have given good information. So I don't have a lot to add.

**Trigger Warning*** FWIW, I had some basic tests done last cycle. I had a chemical pregnancy in December and we have been TTC since mid-October. I had them check my thyroid and progesterone. I plan to have my CD 3 blood work done next cycle if AF arrives on Friday.

My insurance does not cover fertility treatment, but the tests only cost $13 because I had my OB run it during my annual exam and she classified it under something with my menstrual cycle issues. (I have had 1.5 day AFs for a few months after the CP). So it was almost all covered.

As others have mentioned, getting your office to code it differently can make a huge difference.

**TW**

ETA Grammar

julieanne912 · March 2017

My BFF adopted a newborn baby, but it was a domestic newborn, through a private agency. The cost was astronomical (I don't know exact #'s but we joke that he's the $100,000 baby between the 2 failed IVFs they had and the adoption costs), plus they had to go through a rigorous process to even be considered... including showing they had at least $50,000 liquid cash in a savings account. They were bumped up the list because they had no gender or race/nationality preference. The birth mother chose them.

I have another acquaintance who adopted an older child through the foster system. That was much more affordable.

AprilZ81 · March 2017

My experience:

Testing was covered, but actual IF treatments were not.

Generally speaking you shouldn't go see an RE until 1 year of trying without success or 6 months if you are over 35. I scrolled and didn't read all of the posts, so do you mind sharing what you noticed with your cycles that caused alarm? It can take a few months for your body to regulate after finishing birth control so some of the irregularities may not be an actual issue, just your body going back to normal.

That being said, if your uncle is telling you to go straight to the RE then I'm sure he isn't just telling you that to make you happy.

For me, they did a panel of bloodwork (I can't remember everything, but lots of hormone and vitamin levels) and a one hour glucose test (they suspected PCOS and a lot of PCOS women are insulin resistant). They did a baseline trans vaginal ultrasound to check for cysts on my ovaries and any obvious issues. DH got a semen analysis and then I scheduled an HSG to make sure my tubes were open. This may seem pointless, but there is no sense in wasting time an money on fertility treatments if your tubes are blocked and the egg and sperm can't meet.

First line of treatment will be Clomid or Femara, possibly with a trigger, possibly without (depends on your RE and your comfort levels). Both drugs are cheap, even out of pocket. You will get a baseline ultrasound on Cycle Day 3 then you should be monitored around cycle day 12 (give or take) to check your response. If you do a trigger they will tell you when to trigger or possibly bring you back in for another monitoring appointment.

We did 5 of these cycles before moving on to IUI, it all depends on your comfort level.

Our RE was able to code the baseline ultrasound as "menstrual irregularities" or something similar so it counted towards our deductible/OOPM. Femara also counted since it is a breast cancer drug being used off-label.

There is a great message board for infertility and getting pregnant, a lot of experience over there and I visit a lot.

www.thencomesfamily.com

ETA: We paid about $130 per ultrasound, the Clomid was about $25-30 per cycle, the Femara was about $10-15 a cycle and the trigger shot about $100. We spent about $400 per cycle so while it isn't cheap the medicated time intercourse and IUI cycles are not crazy expensive. If we had done an IUI it would have been an additional $500 over and above the "normal" cycle costs.

MommyLiberty5013 · March 2017

In my experience talking with MDs in general about costs, they have no idea about billing, coding or insurance and their eyes glaze over when you ask. I would call the business/billing office to get an idea.

short+sassy · March 2017

I'm so sorry to hear there might be fertility issues. Sending my best wishes and good vibes.

It bothers me that most insurance companies don't cover fertility treatments. It may not affect me personally, but having a child is an important need for a lot of people and it IS medically related, if a couple needs the help of science. There are a lot of things medical insurance should cover, but doesn't (or it's difficult).

MM and fertility

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