Can someone help me understand insurance coverage? *Updated with another question in post

I'm doing a little research into our IF coverage since I have a sneaking suspicion that we might be headed in this direction.

Can anyone tell me what is and isn't covered under their insurance?

I spoke with someone from my insurance company and got an idea of coverage, although since I'm very new at this, I don't know a lot of the IF terms.

From what I'm understanding from my conversation with this person (and they're mailing out the information to me too, which I should have in 7-10 business days), here is what's covered:

Basic Diagnosis
Basic Treatment
Supplements

He said that "basic treatment" covers insemination, 6 per lifetime - unless you conceive, then it is renewed. It covers some medications like Clomid as well as injectables (not sure what that is) and syringes and supplies that go along with that. He also said it covers male testing (sperm analysis, and even testicular biopsies).

He said that "advanced" treatments are not covered. IVF, GIFT, ZIFT.. I'm not sure what all of those are.

Does this seem normal?

Any advice/information would be greatly appreciated!

Message edited 5/21/2008 3:17:19 PM.

Re: Can someone help me understand insurance coverage?

This pretty much is my coverage. I had 3 IUIs covered and no IVF. That said, about 35% of my IVF cycle was exams, bloodwork etc - so I will get back 80% of the 35%.

Most of my drugs were covered - just co-pays. One drug was not. Total drug cost for me for a cycle was about $380.

Injectibles (like Gonal-F) are usually used as the next step after clomid.

Let me know if I can be of more help.

Re: Can someone help me understand insurance coverage?

It sounds like you are covered for the initial line of IF treatments which would be Clomid and/or injectables with IUI. This will save you a lot of money unless you had to move onto IVF in which case each cycle is around 10K.

Re: Can someone help me understand insurance coverage?

Injectibles are the drugs used for IVF (well most of the time). It sounds like IVF itself is not covered, but you should be aware that there is an IVF grant available ... jsut in case you do need it

Re: Can someone help me understand insurance coverage?

Thanks everyone

We have been trying for about 8-9 months with no luck. I will be seeing my ob/gyn (a new one since I recently moved) and having a regular annual exam, then if necessary she will be able to give me a referral to an RE.

What are typically the first steps to figuring out if there is a problem?

I've been reading about these things on the board:
-CD 3 bloodwork
-CD 21 bloodwork
-sonograms
-SA
-HSG

Are these typically the first steps?

Thanks again.

Message edited 5/21/2008 3:17:08 PM.

Re: Can someone help me understand insurance coverage? *Updated with another question in post

Posted by maybeamommy

Thanks everyone

We have been trying for about 8-9 months with no luck. I will be seeing my ob/gyn (a new one since I recently moved) and having a regular annual exam, then if necessary she will be able to give me a referral to an RE.

What are typically the first steps to figuring out if there is a problem?

I've been reading about these things on the board:
-CD 3 bloodwork
-CD 21 bloodwork
-sonograms
-SA
-HSG

Are these typically the first steps?

Thanks again.