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question about insurance


Forum: Recurrent Miscarriage and Pregnancy Loss

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  #1  
October 19th, 2006, 11:48 AM
Super Mommy
Join Date: Jul 2006
Location: pennsylvania
Posts: 982
i have to talk to my doctors next week, i really suspect that i have pcos. my question is what is covered under your insurance? i know everyone has different things that are covered and not covered, but what has your experience been.

i looked up my coverage and it says it doesn't cover ivf, gift, zift, embryo transplants, ai and similar procedures. from what i have read the 2 medicines metformin and clomid are both covered.
i'm asking b/c i thought i had read a couple of posts that talked about financial aspects of ttc, not necessarily just for pcos. this has me just a little worried, financially we are ok, but we don't have alot of money to put into this.
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  #2  
October 19th, 2006, 12:05 PM
4iris's Avatar Platinum Supermommy
Join Date: May 2006
Location: Midwest
Posts: 10,732
My insurance covers nothing related to infertility - not procedures or prescriptions - nothing at all, but they will cover viagra - go figure. I guess so long as the men get what THEY want...but I digress. Sorry, that's just a little pet peeve of mine.

Once I got pg this time, doc put me on progesterone, which was immediately denied so I had to pay $81 out of pocket. The next week, insurance said that since it was to sustain a pg they would cover it at the top tier (read most $$$$$). Pg office visits are covered at 100% after the first $20 specialist co-pay. Delivery will be covered at 80%, once the deductible is met.
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  #3  
October 19th, 2006, 12:25 PM
Super Mommy
Join Date: Jul 2006
Location: pennsylvania
Posts: 982
our insurance, the prometrium was 3rd tier and clomid and metformin are 1st tier. i'm fairly sure the u/s will be covered and i will have a specialist co pay and i think all the bloodwork is fully covered. i guess i am hoping they skip the other testing and test for the pcos. i have done reading on this and it sounds alot like me.
and i have never talked to my doctors about af being a few weeks late sometimes, but then when i started thinking back, i was on bcp off and on from my later teens. and this last year and a half it has been 2-3 weeks late alot, causing me to obsess in hpt. and i don't know if this means anything but all of my "accidental" pregnancies were following bcp, so i never realized how hard of a time i had getting pregnant.
i guess i am just nervous they are going to want to do alot of other testing that won't be covered, before looking into this.
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  #4  
October 19th, 2006, 12:40 PM
4iris's Avatar Platinum Supermommy
Join Date: May 2006
Location: Midwest
Posts: 10,732
Have your doc check to see what's covered before you have anything done. He/She should be able to submit a list with reasons why they want to test for it and get a response back as to what's covered. That would save you a surprise bill for things that aren't covered.
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Do not sorrow; the joy of the Lord is your strength." Neh. 8:10
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  #5  
October 19th, 2006, 01:41 PM
Member
Join Date: Oct 2005
Posts: 49
I was really worried about this initially too. My RE's office said insurance usually covers most of the things for diagnosis and after that it really varies depending on the insurance company. I am lucky to have good insurance which supposedly covers everything except IVF and one other thing, I forget what it is. My insurance is through dh's work and we have chosen to pay a little more per month in order to have a better policy. It has definitely been worth it!

Good luck, I hope you're covered for whatever you need. You should be able to find out ahead of time so you won't have any surprises.
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