My husband (41) and I (36) have been trying to conceive for a few years and had to take a break due to the constant disappointment. Emotionally drained! We have decided to get 100% back in the game because we are both older and our chances of success are dwindling. My husband's SA came back and the results were much better than average. I have not been diagnosed as of yet.
I go to a new gyn this Friday to have my yearly exam. At that time, I plan to discuss my suspicions of possibly having PCOS. After reading all of the problems so many of you have had with insurance companies, I was wondering if I should go about a PCOS diagnosis a different way??? Meaning, instead of walking in spouting off the possibility of PCOS, just tell the doctor my symptoms and see what she says???? Any suggestions? Anything you wish you may have said or not said to your doctor that would have made a difference insurance wise?
I have Blue Cross (California Care) which is now Anthem (Blue Cross) through my husband's employer. He works for the county in which we live, so there are thousands of employees on this insurance. I see that they cover 50% of infertility treatment; however, on the prescription information, it looks as if they do not cover fertility meds. Is that odd that they would cover 50% of the treatment but not the meds?
To be clear, I am not trying to rip the insurance company off! If anything, they rip me off....most of us!!! My husband was injured at work and the county does not pay any part of your health insurance if they dispute your claim....so, I pay over $900.00 per month for the three of us for health insurance ALONE! That does not include the dental insurance we are obligated to maintain!
I would appreciate any suggestions/comments! It really stinks to look back and think...shoulda coulda, woulda and then have to write an additional large check to the insurance company because I used the wrong word which in turn makes the doctor use the costly insurance codes!
I don't see that would have much of a problem either way. PCOS is not a fertility only diagnosis, and many, many of us have years of PCOS treatment that was completely unrelated to fertility issues. I don't think carrying a diagnosis of PCOS will have a negative impact on your coverage. Actually, if you are on an employee sponsored program, I don't think they can drop you or anything.
I have no info on the RX coverage. It varies so much from one employer to another that it seems everyones coverage is different. However, it is good that they at least pay 50% on the medical portion.
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Thank you Stacie for taking the time to reply to my post!
I have read so many stories of ladies (on this site and others) having problems with their insurance companies when their doctors use infertility codes when they technically could have put other codes that would not affect insurance coverage. I am hoping to avoid that!
We were fortunate that our insurance picked up fertility coverage this past year. However, previously we did not have any coverage.
I've never had a trouble getting coverage after a PCOS diagnosis. I saw an RE (specialist) for several years for PCOS before we were TTC and it was covered under the normal coverage. It would probably be a pre-existing condition, but if you've maintained steady coverage then that doesn't come into play.
Once we were officially TTC and first seeking fertility treatments, we did not have coverage. There were several procedures (like u/s, tests, investigative issues, etc) that they coded under PCOS, NOT infertility, and insurance covered it without question. Some procedures, obviously, are strictly infertilty though (like IUI).
I do know some people who have had infertility coverage but not any of the meds covered. It is definitely possible, but I would check with your company to make sure.
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dx PCOS Fall 2000 TTC since Sept 2006 1st BFP Dec 2006 lost @8 weeks To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
I go to a new gyn this Friday to have my yearly exam. At that time, I plan to discuss my suspicions of possibly having PCOS. After reading all of the problems so many of you have had with insurance companies, I was wondering if I should go about a PCOS diagnosis a different way??? Meaning, instead of walking in spouting off the possibility of PCOS, just tell the doctor my symptoms and see what she says???? Any suggestions?
I wouldn't 'attempt to get' a pcos diagnosis. Prior to your appointment, take the time to list ALL of the problems you're having (to make sure you don't forget anything.)
Also bring in a VERY comprehensive menstrual history, and take it from there.
The symptoms of PCOS are similar to a few other disorders, to best to simply start with a baseline. PCOS is a dianosis of 'exclusion', meaning that your doctor should first exclude other possible explanations for your symptoms before deciding on PCOS.
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It makes me feel better to know that a PCOS diagosis does not automatically mean lack of insurance coverage! I'll have to check into the fertility med coverage after I have my consults.
Thanks again!
KatCarney, Thank you for the advice. I have already started a list of all of the problems I am experiencing and my menstrual history for the past 6 months. I hope 6 months is long enough for exact dates. You are absolutely right! Hopefully my doctor is able to exclude other factors besides just settling (for lack of a better word) on PCOS.
PCOS would likely be a pre-existing condition, though, so make sure you are happy with your current ins. b4 getting dx -- unless you gotta get dx. to get surgery to stop pain like I am for a female problem (just striked out PCOS completely off othe possibility list).
To avoid health insurance denials???? 
