Unfortunately I don't benefit from my state's mandate because my company is self insured.
The whole diagnostic/treatment seems to be such a gray area. I talked to my insurance company three times now and still can't really get a straight answer. They tell me infertility treatment is covered when it for diagnosis and treatment of an underlying medical condition, but isn't PCOS an underlying medical condition, and isn't annovulation a symptom of said medical condition? Then the other tells me yes bloodwork and ultrasound are diagnostic, even after I asked if it was during a cycle of treatment. The only thing my insurance specifically said was IUI and IVF are not covered.
I mean technically, bloodwork and ultrasounds are diagnostic tests, they aren't treatments.
So two of the people I talked to I wasn't specific with, they only said diagnosis was covered. The last lady I was extremely specific with (short of giving her the billing codes..) and she told me the ultrasound and bloodwork is covered. I told her I really needed to know if it was or not to decide if I would go back to the RE, and when she told me it was I made the appointment. If they come back and deny my ultrasounds and bloodwork, I will be really upset. And there won't be much I can do about it, I mean I can call them all day long and say Marsha said at 6:30 PM on 8/5 that bloodwork and ultrasounds are covered, but really what is that going to do...
At least I do know that the day 3 bloodwork and ultrasound is definitely diagnostic. Now the day 12 ultrasound and bloodwork is the gray area, since I would be taking Clomid and they would be seeing if the Clomid was working.
The RE is billing under the PCOS code, so I guess that helps.
It's added stress I don't need. I'm frustrated with the whole situation since my company was bought out last year and prior to Anthem we had Cigna, which would have covered the infertility diagnosis AND treatment.