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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Dear Insurance...
Seriously, s*ck it!!!! 
I called my insurance yesterday just to check if I'm covered for IUI's and how many. Ended up finding out that ALL fertility treatments are excluded completely and I am not covered for any IUIs. Then I call doctor's office, who has to date told me nothing about not being covered (and I've asked)...Tells me that I've used up my $2K fertility maximum (which insurance did not mention, but whatever that's a seperate discussion) with my last round which was just Clomid & intercourse...And that the cycle I just started on Friday w/ Clomid is not covered and for intercourse also will cost me $1600 if I want to move forward.
WTF!??!?!?!?
I also have no idea if all the claims they've put in so far which add up to about $10K will even be covered. Insurance says no, doctor says yes.
No idea how to move forward. I'm so pissed and angry and sad and upset. I realize $1,600 is not a crazy amount especially given price if we had to end up doing IVF -- but I'm so upset that this is not being covered and it comes out of nowhere. Looking to switch to DH's insurance now but doubt that will be any better.
Just feels like a big slap in my face and now need to figure out by Monday when my monitoring test is what we want to do...
I'm also really emotional in general over the Clomid so this just adds to it.
SIGH. Thanks for listening.
Message edited 11/7/2013 11:18:41 AM.
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Posted 11/7/13 11:17 AM  |
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moonmist09
Thank you, St. Gerard!
Member since 2/11 5043 total posts
Name:
Antonella
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Re: Dear Insurance...
uuuugh, A!!!!!!!!!!!!!!!!
I feel you!!!!!!!!!!!!!!!!
when we were trying for DD, at least I was covered for IUI's (not medications though) and it was a huge help.
This time around, my DH's insurance covers no infertility treatments so its all OOP. I'm hoping this go around is as successful as the last!
If you have it, I would move forward with the IUI this cycle. you already started with Clomid, I would move forward to not lose this cycle. However, call your DH's insurance and see if you can be added onto it. Some insurances don't let you add/change your plan at random times of the year. Others make you wait a 30 day waiting period, so better to find out now and not lose time. Does your DH have infertility coverage?
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| Posted 11/7/13 11:22 AM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
Posted by moonmist09
uuuugh, A!!!!!!!!!!!!!!!!
I feel you!!!!!!!!!!!!!!!!
when we were trying for DD, at least I was covered for IUI's (not medications though) and it was a huge help.
This time around, my DH's insurance covers no infertility treatments so its all OOP. I'm hoping this go around is as successful as the last!
If you have it, I would move forward with the IUI this cycle. you already started with Clomid, I would move forward to not lose this cycle. However, call your DH's insurance and see if you can be added onto it. Some insurances don't let you add/change your plan at random times of the year. Others make you wait a 30 day waiting period, so better to find out now and not lose time. Does your DH have infertility coverage?
Ugh, it's the worst. I hope this is it for you guys also!!!
The $1,600 does not include IUI - that's just monitoring cost, no medication, and us doing intercourse. I've been paying for medication out of pocket which is fine, but it also means if this cycle doesn't work - we have to take it from there....Sigh.
Calling DH's insurance soon to get details, so I can switch over potentially.
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| Posted 11/7/13 11:24 AM |
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moonmist09
Thank you, St. Gerard!
Member since 2/11 5043 total posts
Name:
Antonella
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Re: Dear Insurance...
when we started this cycle, the RE's office told us that a normal cycle, excluding medications, would run us anywhere from $1,500-$3,000.00
After the IUI and all monitoring and bloodwork we are at close to $2K now. Obviously, if we have to go in for more bloodwork and sono's we'll easily get to the $3K mark 
I hope you can switch and he has better coverage!
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| Posted 11/7/13 11:26 AM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Dear Insurance...
What if the RE bills your monitoring under PCOS and not infertility?
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| Posted 11/7/13 11:27 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Dear Insurance...
OK< I wouldn't do a darn thing more with this doctor, to start. Second, I wouldn't pay a single penny out of pocket to this doctor either. They should have informed you PRIOR to starting this cycle that there was going to be OOP expenses, since they didn't (as a practice manager myself) I would NOT expect you to pay anything. It is THEIR responsibility.
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| Posted 11/7/13 11:28 AM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Re: Dear Insurance...
Posted by jessnbrian
OK< I wouldn't do a darn thing more with this doctor, to start. Second, I wouldn't pay a single penny out of pocket to this doctor either. They should have informed you PRIOR to starting this cycle that there was going to be OOP expenses, since they didn't (as a practice manager myself) I would NOT expect you to pay anything. It is THEIR responsibility.
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| Posted 11/7/13 11:33 AM |
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starr
little whale on the way
Member since 6/10 1288 total posts
Name:
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Dear Insurance...
wow that majorly sux. still boggles my mind that infertility treatments aren't fully covered thru most insurances, as if its some fun boob/nose job we elect to put ourselves thru 
hopefully ur DH's ins covers something
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| Posted 11/7/13 11:48 AM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
Jess - would that go into legal situations then if I said no? DH said I should have recorded my last conversation with them but I didn't because didn't think this would be the case!!!
Just called Dh's insurance - they cover all fertility treatments - 80% if in network (my doctor is not,) and 60% if out of network) up to a maximum lifetime of $4,000 and/or $2,000 annual.
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| Posted 11/7/13 11:54 AM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
So what do I do now? I'm wrapping up 100mg of Clomid. Do I not do anything with it? Still BD by monitoring it on my own somehow (how does that work with PCOS), or suck it up and pay out of pocket and do it? I worry in case the 100mg over-stimulated or something and I have way too many follicles.
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| Posted 11/7/13 11:55 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Dear Insurance...
I'm FM-in you in a few
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| Posted 11/7/13 11:57 AM |
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moonmist09
Thank you, St. Gerard!
Member since 2/11 5043 total posts
Name:
Antonella
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Re: Dear Insurance...
Posted by AKD
Jess - would that go into legal situations then if I said no? DH said I should have recorded my last conversation with them but I didn't because didn't think this would be the case!!!
Just called Dh's insurance - they cover all fertility treatments - 80% if in network (my doctor is not,) and 60% if out of network) up to a maximum lifetime of $4,000 and/or $2,000 annual.
That's wonderful if they are covered!!!!!!!!!!
I would definately switch to a RE in network!!!!!!
your not allow to tape any conversation without telling the person you are being taped. However, If you kept asking if there would be a cost and they kept telling you know, they should have given you something in writing to show you nothing was due. My RE office gave me an outline of how much everything cost up front.
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| Posted 11/7/13 11:57 AM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
Posted by moonmist09
Posted by AKD
Jess - would that go into legal situations then if I said no? DH said I should have recorded my last conversation with them but I didn't because didn't think this would be the case!!!
Just called Dh's insurance - they cover all fertility treatments - 80% if in network (my doctor is not,) and 60% if out of network) up to a maximum lifetime of $4,000 and/or $2,000 annual.
That's wonderful if they are covered!!!!!!!!!!
I would definately switch to a RE in network!!!!!!
your not allow to tape any conversation without telling the person you are being taped. However, If you kept asking if there would be a cost and they kept telling you know, they should have given you something in writing to show you nothing was due. My RE office gave me an outline of how much everything cost up front.
It's only $4K maximum but atleast it's something. Switching over ASAP. Just need to figure out what to do with this cycle.
And yes, they never gave me any cost breakdowns at all.
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| Posted 11/7/13 11:58 AM |
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moonmist09
Thank you, St. Gerard!
Member since 2/11 5043 total posts
Name:
Antonella
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Re: Dear Insurance...
Posted by AKD
Posted by moonmist09
Posted by AKD
Jess - would that go into legal situations then if I said no? DH said I should have recorded my last conversation with them but I didn't because didn't think this would be the case!!!
Just called Dh's insurance - they cover all fertility treatments - 80% if in network (my doctor is not,) and 60% if out of network) up to a maximum lifetime of $4,000 and/or $2,000 annual.
That's wonderful if they are covered!!!!!!!!!!
I would definately switch to a RE in network!!!!!!
your not allow to tape any conversation without telling the person you are being taped. However, If you kept asking if there would be a cost and they kept telling you know, they should have given you something in writing to show you nothing was due. My RE office gave me an outline of how much everything cost up front.
It's only $4K maximum but atleast it's something. Switching over ASAP. Just need to figure out what to do with this cycle.
And yes, they never gave me any cost breakdowns at all.
$4K is about a cycle and a half. try to find another RE now if you can and set up a consultation. When you meet with them, if you want to salvage this cycle, let them know you are taking Clomid and they might be able to move along as normal with this cycle. Were you seeing Kofinas? Do you want to stay in Bklyn with your RE or are you willing to spread out?
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| Posted 11/7/13 12:01 PM |
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APT910
Let It Be
Member since 2/11 5021 total posts
Name:
Ashley
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Re: Dear Insurance...
I totally feel you, our insurance doesn't cover anything! We have to pay out of pocket for anything infertility related - it s*cks!
Sorry you're dealing with this.
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| Posted 11/7/13 12:05 PM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
Posted by moonmist09
Posted by AKD
Posted by moonmist09
Posted by AKD
Jess - would that go into legal situations then if I said no? DH said I should have recorded my last conversation with them but I didn't because didn't think this would be the case!!!
Just called Dh's insurance - they cover all fertility treatments - 80% if in network (my doctor is not,) and 60% if out of network) up to a maximum lifetime of $4,000 and/or $2,000 annual.
That's wonderful if they are covered!!!!!!!!!!
I would definately switch to a RE in network!!!!!!
your not allow to tape any conversation without telling the person you are being taped. However, If you kept asking if there would be a cost and they kept telling you know, they should have given you something in writing to show you nothing was due. My RE office gave me an outline of how much everything cost up front.
It's only $4K maximum but atleast it's something. Switching over ASAP. Just need to figure out what to do with this cycle.
And yes, they never gave me any cost breakdowns at all.
$4K is about a cycle and a half. try to find another RE now if you can and set up a consultation. When you meet with them, if you want to salvage this cycle, let them know you are taking Clomid and they might be able to move along as normal with this cycle. Were you seeing Kofinas? Do you want to stay in Bklyn with your RE or are you willing to spread out?
Long Island Nassau would be a lot better for me so I'm totally open.
Thanks all for listening.
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| Posted 11/7/13 12:16 PM |
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MrsGoldie
<3 Miracles can happen <3
Member since 9/12 1700 total posts
Name:
R
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Re: Dear Insurance...
I'm so sorry insurances are so sh*tty when it comes to IF...like we CHOOOSE to have it and it's no big deal
Can your RE bill your insurance for the monitoring under a diagnosis different than infertility? I feel like your RE should eat some of the cost too. They are supposed to check your benefits and let you know what you are and are not covered for in the beginning.
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| Posted 11/7/13 1:46 PM |
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AKD
LIF Adult
Member since 1/12 2637 total posts
Name:
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Re: Dear Insurance...
Posted by MrsGoldie
I'm so sorry insurances are so sh*tty when it comes to IF...like we CHOOOSE to have it and it's no big deal
Can your RE bill your insurance for the monitoring under a diagnosis different than infertility? I feel like your RE should eat some of the cost too. They are supposed to check your benefits and let you know what you are and are not covered for in the beginning.
Yeah I have to talk to them about it --- I'm suppose to go in on Monday to monitor follicles now that I'm done w/ Clomid tonight. I don't even know if I can do that now. So frustrating.
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| Posted 11/7/13 2:03 PM |
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tara5533
LIF Infant
Member since 11/12 182 total posts
Name:
Tara
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Dear Insurance...
I totally understand I have no fertilty benefits either my Dr puts it under my dx which is pcos so it gets covered and I have to pay for iui which will be 325.00
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| Posted 11/7/13 3:55 PM |
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