So, I just got off the phone with billing department of RE and found out that timed intercourse and IUI are not covered BUT IVF is. So, if we were to go IUI/timed intercouse it will be out of pocket. Has anyone esle run across this?
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I haven't run across this personally, but IUIs are usually a cheaper option than IVF. My company actually offers unlimited IUIs and offers a dollar limit once you get to IVF. Do you know which route you're thinking about taking? You could always try one IUI and move straight to IVF if it doesn't work?
Do you know how much of IVF they cover? Is it by cycle or a dollar limit?
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@2PeasinaPod: They cover 80% IVF. But per RE, he wanted "low tech" option since all of our test results have been normal and we are on month 7 currently TTC. I've had 2 pregnancies before, so there is no known issue.
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I'm curious if TI is covered but in a different way. So maybe they will cover all the medications and monitoring since they would be billed one by one. Does your RE have a billing department that you could talk to? They usually know the ins and outs of insurance and might be able to give you some ideas on what to ask about.
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Whoa! Nice. I only have coverage for the initial testing (which is nothing compared to IUI/IVF costs.)
Maybe they are thinking if you can get a dr to recommend IVF, it means you really need it?
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So when they say they don't cover IUI/TI do they specifically mean they don't cover meds/monitoring, or just the actual procedure of IUI? IUI itself is only a few hundred dollars. If you've been pregnant before you most likely don't need the IUI, just monitoring and possibly some meds.
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@spaniellove: they don't cover the monitoring
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@littlek: That is pretty bizarre. And your HSG is normal right? Because if everything is normal (and you don't have recurrent m/c?) I can't see why you should move to IVF just to have something covered.
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Wow that is odd. Clomid is cheap if you start there but the monitoring would add up fast. I can't see the rationale to push people to Ivf which is expensive?
My insurance does still push you somewhat. Their standard coverage is 2 oral med iui, 2 fsh med iui, then Ivf. Your dr can request they cover more iuis but I'm waiting to see if that will come through for me. I guess their theory is if it doesn't work pretty quickly you may as well do Ivf. But I don't like that since Ivf is no walk in the park and makes more sense for some than others.
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@littlek: can you all back and get more information?
So they won't cover ultrasound & bloodwork if you do TI or IUI?
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@spaniellove: yep HSG normal
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@Mrs.Someone: I was talking to billing and she was very surprised IUI and TI was not covered.
DH and I talked and we have a game plan. My guess is they are going to put me on clomid so I can "ovulate stronger." We will probably try that a few months. If we don't get pregnant we will move on to IUI.
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@littlek: I wonder if they maybe assume IVF is more likely to be successful and therefore a one time cost rather than multiple IUIs followed by ending up doing IVF anyway?
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@MamaMoose: no idea but I don't feel ready for IVF and RE prefers "low tech" help since there is not an identifiable issue.
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@littlek: If it's not a huge hardship for you guys, that sounds like a good plan. Since your numbers are good it would just seem like jumping the gun to go straight to IVF at 7 months TTC. Best of luck!
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@spaniellove: Not really, DH said he will do whatever it takes.
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@littlek: wait, your insurance won't cover IUI under fertility services? My RE's office somehow billed my IUIs as regular medical procedures because insurance didn't take money out of our fertility services for those.
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@swedishfish: I'm so shocked because everything else is covered including IVF.
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@littlek: talk to the RE's billing department. Maybe they can bill it under your regular medical coverage.
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@littlek: oh I agree. I also wouldn't want to do IVF before exhausting other options. I'm just thinking there must be a financial motivation for the insurance company's policy.
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@swedishfish: I think I'm going to do that.
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@littlek: Wow, never heard that before. I wish I had that coverage, since we had to do IVF and didn't have coverage. But really, never heard of that. Since you are unexplained, usually from what I've heard IVF is actually a better option than IUI's. IUI's usually only help with sperm issues (low count, motility, etc.) and IVF is really good with unexplained infertility. I have three friends in the last few years that tried many IUI's, didn't work, but IVF worked for all for all of them. (They all have unexplained infertility.) I would try the Clomid, though, since that is the best first option as you said. Good luck!
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@Jenn23: IVF just feels too fast (right now)since I have gotten pregnant before without assistance.
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@littlek: Oh, that's good that you've been pregnant before. That's a great sign! The friends I mentioned with unexplained never were able to get pregnant until IVF. So this is great news! Hopefully the Clomid will do the trick then!
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Does your insurance cover "artificial insemination"? That's how mine categorizes IUI.
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That's weird. My cousin's insurance won't cover IVF, because they consider it "bypassing the problem." They think fertility treatments should improve her actual fertility or something? It just infuriates me that these things aren't always covered like they should be.
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@LindsayInNY: nope, doesn't mention that.
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Insurance is so odd!!! Mine covers nothing IF related even so much that when I did my first IUI I took Crinone and when I found out I was PG I had to continue it, so my RE office re-wrote the prescription so that my insurance would cover it as it was not IF meds anymore it was for a viable pregnancy......insurance still denied since the pregnancy was achieved with IF help?????? So crazy!!!!!!!!!!!!!
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@FaithFertility: it is!!!
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@FaithFertility: It was so weird...our insurance covered Endometrin when it was IF-related but refused to pay anything for progesterone injections when I needed it for pregnancy. That's so backwards!
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@spaniellove: right............it was as if I was not really pregnant or something...I mean a pregnancy achieved naturally or with any IF treatment is the same.....right?!...lol
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@FaithFertility: Yes, it doesn't matter how you get there...your baby still needs the help!
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@littlek: all I can say is .. wow.. you're lucky!
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IUI is not expensive for us (mabye around $300-$400?)--it's the meds that are a kick in the teeth! But if you start with Clomid, that's really affordable. Femara and injectables are what run up a big bill. I hope Clomid + IUI does the trick for you!
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It's not the same thing but I imagine the same idea is behind it (saving money) i've found that in England, for unexplained (very broad definition of that here) they jump straight to IVF after two years your own. Doesn't make sense to me either. We are paying oop for all our treatment now.
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@Snowdrop: We will be paying OOP too. It's going to be about $1,500 for timed cycle and $3k for IUI.
@CatchAFallingStar: I guess.... we will still be racking up some debt with IUIs.. $3k a pop
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