From what I read, MD was listed as mandated state for infertility coverage, but according to the person I spoke with from my insurance company (Anthem BCBS), only the diagnosis and testing is covered, but not the treatment. Now, when they say that, does that mean the test (can't remember what it's called) where they put the dye in my tubes to make sure they're open is covered, or is this considered part of treatment? Is the ultrasound to confirm you have ovulated when you take Clomid considered treatment? My question is when does it move from diagnosis to treatment?
And why the heck does my insurance not cover it even though I'm in a mandated state?
__________________ ~*~Christie~*~ Mommy to Ashlyn (4) To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
(2007) Started TTC#2
(2008) 2 rounds Clomid/Injectables - BFN
(2009) BCP to regulate cycles, stopped November 1, TTC naturally while trying to lose weight
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The infertility has to be associated with endometriosis; exposure in utero to DES; blockage of, or surgical removal of, one or both fallopian tubes; abnormal male factors, including oligospermia, contributing to the infertility
If you have one of these conditions, they have to pay for in vitro if you have been infertile for two years. It doesn't cover treating PCOS with drugs.
They will cover anything up to a diagnosis of why you are infertle. So I would think that would not include monitored Clomid cycles because you are doing that after diagnosis and for the purpose of getting pregnant. It will most likely cover the HEG to see if your tubes are blocked.
__________________ Melissa (30) To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts. DH (32)
Metformin ER
miscarriages To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts. 8/03, 4/06, and 5/08 DS #1 Jackson Matthew born 3/15/07 after 4 1/2 years TTC.
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DS #2 Carson Ronald born 7/27/09!
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I wonder if coverage would extend to DES 'granddaughters'?
That's interesting to think about. The granddaughter was definitely exposed if the daughter was since a baby girl develops her eggs in utero (doesn't she?)
That's interesting to think about. The granddaughter was definitely exposed if the daughter was since a baby girl develops her eggs in utero (doesn't she?)
I live in NY and although IF coverage is mandated, my company is "self-insured" so I only have coverage through dx. However, my HSG, u/s's, work-ups, and b/w have all been covered. I've paid for IF drugs and IUIs (and now IVF) OOP. HTH!
__________________ Age 34
TTC 11/05
PCOS dx 8/07
HSG and SA good
5 rounds clomid (3 w/ IUI) = BFN
Lap 4/3 shows adhesions and scar tissue and endo - oh my! Tubes are damaged.
Surprise break cycle BFP 6/08 = ectopic, left tube ruptured.
IVF September '08
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I made an appointment for my HSG next week, and the lady at the radiology place tried to argue with me that my insurance would most likely deny my HSG. She told me because it's like a treatment, that a lot of times women get pregnant shortly after. She said that they do it to "clean out the gunk" so that you can get pregnant.
That was NOT my understanding when talking to the RE. I was under the impression that they were doing this because of my previous ectopic, my endometriosis and multiple surgeries to treat the endometriosis. I thought this was to check my tubes before they started me on Clomid, so that it wasn't just wasted effort if my tubes were blocked.
I'm scared the radiology place is going to submit my claim incorrectly, and my insurance will deny it. Do I fight it if they do?
I also talked to the financial coordinator at the fertility clinic that did confirm my insurance only covers diagnosis. It specifically says it will not cover IUI and IVF, but doesn't mention ovulation induction. The financial lady said they would bill the ovulation induction blood work and ultrasounds as "blood work and ultrasound" and that my insurance would most likely pay it, but if it went to underwriting, it would probably get denied. Although I don't know what the RE is going to say at my follow up and what treatment she will suggest, I'm hesistant to do a lot for fear it will all get denied. I have $2,500 in a HSA, but I also have a $1,500 deductible and a $3,000 out of pocket maximum, so I don't want to use up all my funds on my HSA for something not covered, and in the event I get pregnant (which will be a high-risk pregnancy like my last..) I won't have the money to cover my pregnancy care!! I'm so depressed right now, I can't afford fertility treatments.
__________________ ~*~Christie~*~ Mommy to Ashlyn (4) To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
(2007) Started TTC#2
(2008) 2 rounds Clomid/Injectables - BFN
(2009) BCP to regulate cycles, stopped November 1, TTC naturally while trying to lose weight
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I thought I lived in a mandated state.. 
