Of course, all insurance plans are different, but I can tell you how mine works. My plan also specifically excludes fertility medications and treatments, but so far all of my office visits and consultations with my obgyn and RE have been covered. My diagnostic lab work and ultrasounds have also been covered. Medications that can also be prescribed for other conditions have been covered, but not clomid, since it is only used to induce ovulation. The good news about clomid is that it is pretty inexpensive, even without insurance. At my pharmacy, I believe I paid about $30 for a 5 day supply of the 50 mg dose, which is what you would be started out at.
I would recommend asking your dr. to test you for insulin resistance, since it commonly goes along with PCOS. If you are insulin resistant, you will probably be put on Metformin, which should be covered by your insurance. For many women, treating insulin resistance is enough to get their hormones back in check and they will start ovulating on their own, without clomid. I would also recommend asking your obgyn for a referral to a reproductive endocrinologist, if you are not already seeing one. While PCOS does cause infertility and all sorts of other gynecological problems, it is at its heart, an endocrine disorder. I love my obgyn, but I really to feel much better about my chances of conceiving now that I am seeing a specialist, someone who is experienced in treating my specific condition. Good luck to you!
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Me-29, DH-34
TTC #1 since 2/2006
6/06- 11/07- Clomid resistant
4/24/07- OD Surgery
1/08- HSG- All Clear!
2/08- Follistim 75 IU/day...CD16 E2 level dropping, cycle canceled
2/11/08- CT scan- Ovarian fibroma on right side.
2/20/08- Bloodwork results indicate possible malignancy. Revised diagnosis: granulosa cell tumor
3/18/08- Right ovary and tube removal; final disgnosis: SCAT tumor
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