We have always wanted more than one child, and neither of us wanted a huge age gap between our kids. My OB told me to wait 12-18 months after having Baby Jumper before starting to TTC for my body to really heal itself after my c-section. We had to use fertility treatments to get pregnant with Baby Jumper, and while it was such an emotional roller coaster, things really fell into place for us once we finally figured out the correct dosage of Clomid to use. We were told that when we were ready to get pregnant again, we could go right back on the Clomid.
Our insurance plan currently covers certain aspects of fertility treatments. Doctor visits, for instance, are covered. So is blood work and ultrasounds. But some testing procedures, like a Sonohysterogram, aren’t covered in full. We did the math a really long time ago, and even though we pay a lot for our coverage, it’s far less expensive for us in the end to have to pay out of pocket to see my Reproductive Endocrinologist.
I bring this up because we are eligible for open enrollment this fall. We’ve been researching available insurance plans and wanted to downgrade, because we figured we didn’t need to see my RE again. Our plan was to TTC in Spring 2013. I’d see my OB, get a prescription of Clomid, and be on my way since all I needed was just a prescription for Clomid.
It turns out we can’t. You know what they say about assumptions, right? Papa Jumper encouraged me to call my OB’s office to find out about their fertility treatment policies. A doctor explained that they prefer I see my RE to start a new round of Clomid. For one, my OB doesn’t specialize in infertility. Secondly, it took a few rounds of Clomid for us to get pregnant… and again, my doctor’s office doesn’t specialize in this. It’s kind of like if I had knee troubles, and saw a general practitioner instead of an orthopedic surgeon. They’re both doctors, but one has better expertise in a specific area than the other. This kind of threw a wrench in our downgrade our insurance plan option.
Next, I called my RE’s office. I wasn’t super excited about the news they gave me, either. As my OB had suggested, they do want me to be re-tested. The initial testing I went through took about six months and wasn’t exactly the most fun experience I’ve ever had. They want me to have another HSN done, blood work, and a glucose test. If we want to start to TTC in Summer 2013, we need to start seeing my RE this winter.
Are we excited about this news? No. We honestly thought it would be as simple as getting a prescription next spring. But, we have a solid plan that is going to (hopefully) help us have another baby.
Were your RE visits and fertility treatments covered by insurance?
blogger / wonderful cherry / 21628 posts
Everything that lead to a diagnosis was covered by our insurance. We did have copays for my husband’s SAs and his varicocele surgery. Now that we’ve started IUI, we are no longer covered.
blogger / nectarine / 2010 posts
Yes, mine were covered completely – I have two insurances though, my own from work and my husband’s as my secondary insurance. It’s a very fortunate situation. However, more advanced IF treatments like IVF are not covered at all.
Is a HSN the same as a HSG? I get lightheaded at the thought of having to do one again. Actually, I wouldn’t. It was so painful. I was thinking about what I would do regarding an RE if we ever decide to have a second baby (currently not in discussion). I decided that I wouldn’t even try on my own, that I’d want to have the daily monitoring during the first few weeks. Plus, I would want my same MW and doula for delivery. So that means if we do want a second, it has to be in the next 2.5 years before we have to move again. It seems so soon to me!
guest
It seems ridiculous for you to have another HSN when everything was clear the first time. My insurance paid for most of our treatments including 2 rounds of IVf (there is mandated coverage in my state) so we were very lucky. As much as I liked my RE’s office, I do think they recommended unnecessary and/or redundant procedures in order to bill my insurance. I could understand updating bloodwork, since hormones can change after pregnancy and as we get older. But another HSN seems like a waste of time and money, not to mention that procedure is not fun!! Best of luck to you!
grapefruit / 4669 posts
Yuck, that sounds like a pain! But I guess it’s good that you researched before dropping your insurance. I’m not sure exactly what ours covers regarding infertility.
nectarine / 2152 posts
So frustrating you have to start the process again instead of picking up from where you left off! I have heard that after you have a baby, sometimes you ovulate more regularly on your own so maybe you won’t even need to do the Clomid! Our coverage includes everything up to $10,000 towards IVF (except that one round of IVF at our clinic is more than $15,000!) but I am obviously grateful for what we get, since it is certainly more than many and we’ve had to use it pretty extensively…
blogger / pomegranate / 3300 posts
None of ours was covered but it was five years ago and coverage was a little more sparse. I would really question why they need to do all the tests again. Some blood work I understand but six months if testing seems a little much.
I also seemed to be a little more regulated after my pregnancy. Although my cycle was long and a little irregular it wasn’t as bad as before. In fact my daughter was conceived the first month we were not preventing. Go figure. I was planning on it taking way longer
squash / 13199 posts
Sorry to hear how frustrating it is to have to repeat everything. I’m not very knowlegeable on the subject but is it ridiculous to start TTC while all of this is being sorted out. I ask this because I know someone who had to have fertility treatments for her first baby but then got pregnant really quickly with her second baby without fertility treatments
grapefruit / 4187 posts
Ugh, that is so darned frustrating that they won’t just give you the Clomid, esp since you already went through all the testing, etc. not too long ago. I’ve heard that some gyno’s prescribe it no questions asked without a referral to an RE and I’m just like “The lucky saps!”
I can’t complain about my insurance, it’s not amazing or anything but it does pay for a lot. It’s confusing to understand (which I’m sure is intentional) but basically it covers ‘infertility’ for up to $20K. There are copays here and there and certain small things aren’t covered. But I’ve been billed for probably close to $5K worth of treatment so far and only had to pay around $200 so like I said, I can’t complain.
I wish I was seeing an RE who didn’t run the bill up so high though.. every time I go in they need to take blood and run some additional tests and charge an insane amount any time I speak to a Dr. Considering I haven’t even started fertility treatments yet (just testing so far) I’m getting nervous about them running up the bill faster than I get pregnant!!
grapefruit / 4110 posts
This does not bode well for us. Our son was IVF and we have 5 embryos left. We want to conceive next August for our second (they will be 3 years apart, longer already than I wanted).
guest
Our insurance changed after our daughter was born (she’s almost two and was conceived via IVF) and my husbands company no longer offers the insurance that covers infertility. We have to pay for all infertility treatments and pretesting out of pocket. We tried again when she was about 14 months with our leftover embryos, and we did have to do pre-testing again. The HSN also looks at the condition of your uterus which can change after having baby so I get why they had to repeat it. We did get pregnant again, but I miscarried at 9.5 weeks. Paying about $10k only to lose a baby is pretty much a slap in the face
We’re gearing up to try again after the holidays and I was told my pretesting was good for a year. Best of luck to you!
blogger / coconut / 8306 posts
@Mrs. Stroller: I think they’re the same procedure, but one is done with Saline and another done with Dye.
blogger / coconut / 8306 posts
@Mrsbells: TTC now isn’t an option for us, for several personal reasons. Our goal is to TTC in Spring/Summer 2013, but have to start the treatment process this winter.
blogger / coconut / 8306 posts
@Oceanis723: The repeat testing is to make sure that nothing has changed. I completely understand the process, and don’t disagree with what they’re suggesting — it’s just not my ideal situation.
In our TTC Journey post, I explained why it took six months for testing to be completed. It’s was purely a financial thing for us.
This time around, we are more prepared and have a better understanding of what is covered and what isn’t, and are financially prepared. My best guess is that all the testing will take 1-2 months this time around.
wonderful olive / 19353 posts
Insurance can be so frustrating and costly! Sorry you’re having to deal with this – good luck to you!
blogger / pineapple / 12381 posts
The RE makes money doing procedures. They are incentivized to test more. I’d push back on the RE and say you know what worked last time and that all the testing didn’t find anything and you don’t want to do it again.
It’s your body and your decision.
pomelo / 5628 posts
We had almost nothing covered by insurance. But my OB definitely would have prescribed Clomid although i guess I had all of my testing done at the time. Shop around a bit for testing options. My HSG cost $300 at an Imaging Specialty Group whereas I’ve seen others cost significantly more. I think my SHG was $400 or so at my RE. If they order everything at the same time it shouldn’t take 6 months, should it?
I agree with Mrs. Jacks. RE’s have to run a business so try to negotiate.