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Forum: Trying to Conceive with Medical Assistance

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  #1  
November 15th, 2006, 07:25 AM
Veteran
Join Date: Apr 2006
Location: San Antonio Texas
Posts: 125
So, I called the imaging center today to have an HSG scheduled and the lady asked if I would be paying up front or making payments. I told her up front but in the meantime I was hoping to get ins to pay for it. She kinda giggled...

So what if any parts of this did you gals get your ins to pay for? Stupid insurance!
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  #2  
November 15th, 2006, 09:05 AM
Daniellea22's Avatar Platinum Supermommy
Join Date: May 2005
Location: New Jersey
Posts: 9,076
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im sorry about that. I havent seen an RE yet..i know my insurance covers any diagnositc testing but not any treatments..im not sure if the HSG would fall under diagnostic or not but i'll probably be in the same boat as you. My appointment is monday. Good luck figuring all this out
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  #3  
November 15th, 2006, 10:31 AM
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Join Date: Apr 2006
Location: San Antonio Texas
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Good luck on Monday!!!
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  #4  
November 15th, 2006, 11:56 AM
Daniellea22's Avatar Platinum Supermommy
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Thank you!! im so nervous!!
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  #5  
November 15th, 2006, 12:01 PM
jlk jlk is offline
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Join Date: Dec 2005
Location: Michigan
Posts: 14,760
My insurance also covers diagnostic but not the procedure. I just got my HSG done and had to pay the RE clinic and I will be getting more bills from the hospital and radiology for their part. I don't know if or how much my insurance will cover. Good luck to you.
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  #6  
November 15th, 2006, 12:43 PM
Miles
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I havent been to an RE either, but I was told that they wouldnt cover anything to do with infertility. When I went to the OB about the clomid, he had to put it under something else so the insurance would cover the dr visit.
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  #7  
November 15th, 2006, 01:04 PM
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Join Date: May 2006
Location: Roseburg OR
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my insurance doesn't cover anything but my DH's cover 80% after deductible which is 250 and we have already met it. We had to pay 400 upfront to the dr. and then the insurance covers 80% including Semen analysis and artificial insemination. It does not cover my $300.00 meds and it does not cover IVF which hopefully I will not have to have.
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04/30/08been through all of our classes and home studies and waiting to look through the kid books for adoption !!!
starting IVF- decided against IVF
starting glucophage try I more IUI bfn
Starting adoption classes!! Finally getting the process started
IUI #3 BFN
1 laporoscopy, 1 mc, 6mo's of clomid, 3 mo's of injections and IUI's
countless blooddraws and ultrasounds. Hopefully a BFP soon!!
Kelly 29 and JD 29 adopting #1 (or maybe two)
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  #8  
November 15th, 2006, 01:13 PM
Veteran
Join Date: Apr 2006
Location: San Antonio Texas
Posts: 125
How can I go about finding out WHAT my ins exactly will and wont cover. When I called I kind of got the run around... I was told if my Dr. classifys it as "medically necessary" it will be covered. But they couldn't tell me if like the HSG, or IUI's or anything are covered. I did find out though my rx company will pay for clomid... They will also pay for my RE consultation fee...

I'm totally and completely confused! I want a book from my ins company that says we will pay for X and Y but not Z... KWIM!?
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  #9  
November 15th, 2006, 05:17 PM
Super Mommy
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Something is determined medically necessary by how your RE codes it. For example: if you have a laparoscopy done and he uses the ICD-9 codes for pain,ammenorhea or abnormal menstral bleeding it would be considered med. nec. If he used the ICD-9 codes for exploritory surgery or infertility it would not be considered med. nec. You should have gotten a book with your insurance letting you know what kind of coverage you have and what exactly it covers if you did not I would call and ask for one. Also if you have a procedure done and it comes back not medically necassry you could ask your Drs' office to resubmit it to the insurance with a different ICD-9 code. ICD-9 codes are the codes that insurances use for every sympton for example. Cough-786.2, Back pain 724.5.
__________________
04/30/08been through all of our classes and home studies and waiting to look through the kid books for adoption !!!
starting IVF- decided against IVF
starting glucophage try I more IUI bfn
Starting adoption classes!! Finally getting the process started
IUI #3 BFN
1 laporoscopy, 1 mc, 6mo's of clomid, 3 mo's of injections and IUI's
countless blooddraws and ultrasounds. Hopefully a BFP soon!!
Kelly 29 and JD 29 adopting #1 (or maybe two)
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  #10  
November 15th, 2006, 06:06 PM
Mega Super Mommy
Join Date: Jul 2005
Location: Austin TX
Posts: 3,669
My last insurance covered all my follicle scans, Hsg, blood test, and infertility treatments upto $3500 lifetime. My new insurance doesn't cover Jack! My follicle scans are $170 each. You know what my old insurance paid for this procedure... about half. My new insurance did cover my blood test for disease blood screening for both myself and DH prior to the IUI procedure. The IUI was about $390 includes semen wash.

So my suggestion is to get the codes from the doctors office and call your insurance to see if they will cover or have them call to see what the coverage is.
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  #11  
November 15th, 2006, 08:24 PM
alexa's Avatar Mega Super Mommy
Join Date: Jan 2006
Location: Las Vegas
Posts: 2,582
Insurance is such a pain in the butt. I think they make it complicated on purpose to rip people off. I remember trying to figure out what would be covered for my HSG, just to get a rough estimate of cost and it was practically impossible. I had to talk to like four different people and spend almost an hour on the phone.

I have been lucky in that our insurance has covered everthing except for my 35 dollar co-pay everytime I go in. They normally cover 90 perecent of the HSG, but I was out of state at the time that I needed it, so I went out of network and they covered 70 percent of it.
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  #12  
November 16th, 2006, 06:47 AM
Mega Super Mommy
Join Date: Oct 2005
Posts: 1,466
My insurance paid for NOTHING and I have great insurance. I had to pay for all of my progesterone blood draws, all medication, hsg, re appointments, ob appts that were about fertility and even my thyroid tests because they figure it was fertility related. I think I spent almost $2000 the first month going to the RE, with hubby's tests and my initial tests. Crazy. My insurance does pay for my femara because it is a breast cancer drug but they didn't pay for any of my progesterone and clomid. Good luck.

Quote:
Something is determined medically necessary by how your RE codes it. For example: if you have a laparoscopy done and he uses the ICD-9 codes for pain,ammenorhea or abnormal menstral bleeding it would be considered med. nec. If he used the ICD-9 codes for exploritory surgery or infertility it would not be considered med. nec. You should have gotten a book with your insurance letting you know what kind of coverage you have and what exactly it covers if you did not I would call and ask for one. Also if you have a procedure done and it comes back not medically necassry you could ask your Drs' office to resubmit it to the insurance with a different ICD-9 code. ICD-9 codes are the codes that insurances use for every sympton for example. Cough-786.2, Back pain 724.5.[/b]
I used to code insurance also and you are right, coding is part of it. But many insurance companies won't pay for ANYTHING by an RE, no matter what. That's how mine is so they don't have to deal with the coding loopholes.
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  #13  
November 16th, 2006, 08:42 AM
baner
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My insurance didn't pay anything, it went towards my deductible, but only cost me $250!
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  #14  
November 16th, 2006, 09:09 AM
lizm75's Avatar Mega Super Mommy
Join Date: May 2006
Location: Colorado
Posts: 2,045
I have Kaiser permanente and they covered most of the HSG. I had to pay $114. Not bad... Good Luck!
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  #15  
November 16th, 2006, 11:35 AM
Mega Super Mommy
Join Date: Oct 2005
Posts: 1,466
My hsg was $245.
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