This is what my insurance says it covers for infertility, translation please?

debdebdebby13 · 05-23-2009, 02:29 AM

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?

Smorgan128 · 05-23-2009, 04:35 AM

Mine reads similarly, except all the mumbo jumbo about surgeries etc. Mine basically says it covers the diagnosis and treatment of underlying cause of infertility. So far mine has covered the testing related to starting infertility treatments, ie HSG, Ultrasounds, bloodwork. It also covered my clomid and my femara on the cycles I have done....and the ultrasounds during both of those cycles and the bloodwork.

Nikisix · 05-23-2009, 05:26 AM

Yeah, it sounds like they'll cover all the diagnostic testing like bloodwork and perhaps even the HSG procedure. 6 cycles of drugs probably Clomid and all the ultrasounds that come with monitoring those 6 cycles. Definitely no IVF and probably not even IUI is covered. It sounds like they'll cover procedures like ovarian drilling or endometriosis surgery though. All in all, it's not too bad considering that most insurances don't cover infertility at all.

realisticdreams8 · 05-25-2009, 01:25 PM

Yep I agree clomid is probably covered under it, it's pretty cheap anyway. And the workups and bloodwork (progesterone/betas) to go with it.

pcosblogger · 05-26-2009, 11:07 AM

Hi,

I work for United and I am licensed in Insurance

. I can tell you that you have a better plan than I do and I work for them! From what I can tell it doesn't cover the IUI's or the IVF. I can tell you that you should go to Walmart for your clomid b/c the price listed is only $12. I would tell you or your spouse if the option of an HSA is available to take it. Depending on your state most fertility will be covered under HSA accounts.

Jen

mrogal2 · 07-29-2009, 01:52 AM

How funny I work for United too small world lol but yes chlomid is covered under the rx and sad to say I work for united and have no infertility coverage but it coveres for the diagnosis and treatment. The way it is described in your benefit package can be very confusing and the best thing to do is always get pre approved. I advise you to get the doctors billing codes and call United and they can tell you if it is covered described under your plan. It always depends on the way it is billed by the provider and I would never take there word for it cause they always say one thing and mean another. If you ever need any help let me know and I can help you through the process. I hope this helps and the best of luck to you

redsoxfan · 08-12-2009, 12:27 PM

Quote:

Originally Posted by mrogal2

How funny I work for United too small world lol but yes chlomid is covered under the rx and sad to say I work for united and have no infertility coverage but it coveres for the diagnosis and treatment. The way it is described in your benefit package can be very confusing and the best thing to do is always get pre approved. I advise you to get the doctors billing codes and call United and they can tell you if it is covered described under your plan. It always depends on the way it is billed by the provider and I would never take there word for it cause they always say one thing and mean another. If you ever need any help let me know and I can help you through the process. I hope this helps and the best of luck to you

Small world indeed. I also for for UHC. I do have coverage for IUI, but not for drugs (THANK GOD CLOMID IS CHEAP!!)

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!