[aubers68]

Does anyone know how you find out if infertility treatments are covered by your insurance? My husband just got his pamphlet from work for benefit enrollment. I was looking in it and I see nothing about infertility. Should there be? Is there something specific to look for? How did you find out if it was or was not covered for you? If you call the 1-800 number asking questions will they put you down so they know you have previous issues? I've heard CIGNA has pretty good coverages so I'm hoping we will be okay if it ever comes down to all that for us.

[~* Natasha *~]

I called my insurance's customer service number.
I also had the receptionist at RE's office to call and verify things.
Unfortunately after procedures are flagged "fertility" my and DH's insurance both don't cover any further.
Sucks really!
I'm waiting for the day when insurances consider infertility a condition along the lines of diabetes, heart disease, etc.
I know that it's not life-threatening in the physical sense, but in the mental/psychological sense it really can be to some!

Sorry, that's my little rant because I HATE the fact that insurance companies view fertility procedures as purely voluntary and not "necessary." Craziness!!!

[aubers68]

After you call and ask questions is that when the flag goes up? Or is it when your DR confirms?

[~* Natasha *~]

I don't think your file or chart is "flagged" fertility until your doctor bills it that way. It's a coding thing. RE explained it to me like this: He can bill GYN checks with testing and so forth under the PCOS code until he Rx's either oral or injectable meds. Then by law, he has to code fertility or he could get in big trouble. Which I understand that aspect of it and I appreciate him coding as much as he can under PCOS when he can.

Does that help any?

[aubers68]

Yea I believe so

[*Manda*]

I was gonna say basically what Tot said. I just emailed my insurance and nothing fertility is covered but my OBGYN bills most everything PCOS. It's one of the things that makes me glad to have PCOS instead of unexplained infertility.

[Dez]

Most of the time there should be a family planning section that explains what is and isn't covered. Calling does help and is a great way to get discounts sometimes if you pre-approve procedures. Most Doctors try to bill as much without "infertility" as the code, but sometimes there isn't another option.

I have Great West/CIGNA care and this is what mine says under family planning:

This Plan covers:
• Infertility testing. This includes only the actual testing for the initial diagnosis of infertility and any surgical procedures that will
correct the medical condition. Any outside intervention procedures (such as artificial insemination, in vitro fertilization) are not
covered under this family planning benefit. Drug therapy is not covered under this benefit.
• Tubal ligations; and
• Vasectomies.

[*Manda*]

Dez, curious but does that mean that Laps and other similar surgical procedures are covered for you?

[LilHerndon]

Hi ladies, so my DH and I just recently went through the whole "does our insurance cover anything" issues as well, and honestly the only way to do it is to call. Another thing to consider though, is that some states do not mandate insurances to cover infertility and some do. Luckily I live in Illinois, which has some of the best infertility statutes around, so our insurance (CIGNA PPO) covers A LOT. They'll do 90% of the costs of anything marked artificial insemination (iui) or infertility (my HSG and blood draws) up until I reach a certain amount of out of pocket (I think $3000?), then they will cover 100%. Also, this plan offers 4 tries of IVF with us only paying a fraction of the cost it normally would be. Now we do pay a whole lot to have this sort of coverage, but in my opinion it's really worth it. Hope yours covers a good chunk too, definitely eases some of the ttc stress!

[aubers68]

Well DH called... once determined infertility it will not be covered. So, question, and I do realize this probably varies from state to state and maybe even pharmacy to pharmacy, but does anyone know roughly what Clomid costs without insurance covering it?

[Dez]

Originally Posted by *Manda*

Dez, curious but does that mean that Laps and other similar surgical procedures are covered for you?

They covered both my LAP and HSG 80%. It's generally one of those things that you should call and ask about just in case.

Originally Posted by aubers68

Well DH called... once determined infertility it will not be covered. So, question, and I do realize this probably varies from state to state and maybe even pharmacy to pharmacy, but does anyone know roughly what Clomid costs without insurance covering it?

Yeah, that's why most doctors are hesitant to outright say "this is what causes your infertility" and bill it under diagnostics. Might want to talk to your doctor and see how they bill and rule these things. That's just the way my OBGYN and RE worked.

As for clomid I found that with my insurance it was cheaper by like $30 to pay for it out of pocket and NOT through insurance. I think it was around $40 for 150mg dosage. With insurance we paid like $80 if I'm recalling correctly.