PCOS Message Board - View Single Post - This is what my insurance says it covers for infertility, translation please?

WifeyC · 08-12-2009, 01:29 PM

Quote:

Originally Posted by debdebdebby13

I have United, and this is what it says about infertility coverage:

Covered expenses are limited to diagnosis and treatment of infertility, including surgery and a maximum of 6 cycles of drug therapy (Drugs covered through pharmacy plan.) Diagnostic Testing that a physician may require during the drug therapy cycles is covered if:
● The Diagnostic Testing is specifically related to the monitoring of the drug therapy cycles. ● The Diagnostic Testing is not related to or billed in conjunction with the expenses for procedures which facilitate a pregnancy.
The Plan does not cover expenses for procedures which facilitate a pregnancy and do not treat the cause of infertility, such as in vitro fertilization, artificial insemination, embryo transfer, gamete intrafallopian transfer, zygote intrafallopian transfer and tubal ovum transfer.

Okay, so I get some parts. 6 months max of drug coverage. So does that mean Clomid and Femara type pills only or does that mean injectible drugs and trigger shots etc too? It says surgery, like ovarian drilling, do you think that it what they mean by surgery?

Also sounds like they'll cover labs and ultrasounds to see if the Clomid (or whatever drug) is serving its purpose, right?

No IVF, or basically anything invasive is how I'm reading it, but most everything before that they will cover.

Is that what it sounds like to you?

Beware of the wording of "6 cycles of drug therapy." From my own experiences (and thank goodness I have a primary and a secondary insurance), with Clomid especially, one therapy cycle is considered to be 5 pills. Most insurance companies put a limit on the number of pills they will cover. My husband's insurance had a cheaper prescription copay than mine, so I was using his. They only cover 3 cycles, but the reality is that they only covered 30 pills. Considering that my RE upped the milligrams again for me, I take 3 pills a night, which is 15 a month. I do hope your insurance company means the full 6 cycles, regardless of how many milligrams you need.

Definitely sounds like an IUI or Invitro are absolutely not covered. But getting an u/s to monitor the Clomid is a diagnostic test, so you should have no problem. The same should go for the bloodwork, if any. The HSG, if you were to need one, should also be covered because it is not a procedure to facilitate pregnancy, but rather one to make sure your tubes are not blocked. I hope that helps!