Hey Ladies,

OK, there is a big mess with my insurance. Originally before my RE appointment I spoke with a lady at the clinic-I guess in charge of new patients, etc. She called my insurance and they said they pay for everything up to infertility treatments-IUI, IVF, etc. Well, I guess with my initial visit last week I was already diagnosed with infertility-ovulatory dysfunction-which is considered an infertility diagnosis.Which the lady said technically this means I have already been diagnosed with infertility so further testing will not be covered. I had the IDS-Infectious Disease Screening today, which hopefulyl is covered, I just called the insurance and they said it was-test just to make sure no diseases prior to IUI, etc. I also had an ultrasound last week at my initial visit so I wonder if that will be covered or not.

My question is...now that I am diagnosed, which I didn't know I would so early, now my tests/ultrasounds, etc will be out of pocket. Has anyone had to pay for an HSG? I have mine on Tuesday. I am trying to figure out what hey are coding it as-if it is billed with a diagnosis of infertility then I pay. Then I have the day 12 ultrasound. Below is the cost of IUI...so this is what we would be paying when we have IUI done.

Thanks for your help...any info yall have would be great!

**The cost of an IUI cycle mostly depends on the types of medications that you will taking in conjunction with the procedure. The cost of a cycle of IUI with Clomid is usually $700-$1000. If you are using injectible medications (which are more expensive and require more monitoring from the physician) the cost is about $3000-$5000. Here’s a breakdown of our fees (this doesn’t include the cost of medication).

- Baseline and Follow-up sonos = $180 (you will have more of these if you are using injectibles)
- Intrauterine Insemination = $170
- Sperm Wash = $180 (this is done in conjunction with the IUI)

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Your HSG should still be covered - appeal it. My HSG was covered even though I had a diagnosis - the HSG is not testing for ovulatory dysfunction, it is screening out additional issues. Many companies will initially reject all claims that come from an RE, but then if you appeal and get the right paperwork submitted, they will pay. I also had to have my HSG done NOT at the RE office in order to get full coverage (silly). My u/s, etc. were all considered fertility-related and were only reimbursed at 1/2 price. Whatever bloodwork I could have done at the lab (and not through the RE) I did because that was covered at 100%. For example, a pregnancy test at the lab - covered, but a pregnancy test at the RE office - only reimbursed at 50%. So stupid!!

As for the cost of the u/s . . . I think it was $500 or $600. BUT, even when insurance doesn't pay, I still had an insurance-related discount (it is the rate the dr agrees to accept as payment) which was maybe 50% of the original charges.

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Appeal of course - anything helps and even if they deny it mine at least did a "one time" grace thing which saved a good amount. Not sure what happened but they were covering u/s and b/w but then after the HSG they stopped paying anything. Even b/w at a lab comes right back to me. It is a true PITA so I understand your frustration. I did not have to do many U/S this cycle or get any extra FSH so my cycle isn't near what they estimated for injectibles but i know it varies

HSG was covered but w/ our crazy high deductible it all went to that so not much insurance help on that one.

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Mar. '08 - 1st IUI ,
Apr. '08 - clomid, IUI
May '08 last clomid run, IUI (clear HSG)
Jun. '08 - 1st IUI w/ follitism
July '08 - 2nd IUI w/ follitism

Thanks for all the info. Have been on the phone with the clinic and insurance. My HSG is coded as infertility so it will cost us $685. Then the ultrasound on Thursday will be $180. Still not too sure why I am diagnosed with infertility already before testing???? Ughhh.

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UGGGGGGGGGGGH that's so frustrating. I hope that you can get it changed.

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sorry you are dealing with this! ~try~ not to let it stress you out but i understand it is really hard.

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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TTC since July 2007-off bcp! but not ovulating and irregular cys

March '08: REI consult, dx with PCOS. DH is good-no MFI!
March-June: clomid-no O
June: injectibles, no luck =(
July: officially reached 1 yr TTC mark =( =(
August: taking a break from meds and the hit to the wallet they cause. =( =( =(
Will try injectibles again in '09 (if we need to fingers crossed =)

Talk to the nurse about whether they can change the code - tell her that the HSG is not properly coded as infertility since it is diagnostic, and that is a mistake they need to correct. I got them to fix a few of my codes, too.

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You're lucky to get any part covered. After reading this thread I called my insurance company and was told flat out that anything I have done in an effort to get pregnant is not covered, including any prescriptions. So not only did I confirm they don't cover what I've already paid for, I now realize that the price I've been paying for clomid and progesterone is the full price. Here this whole time I've been telling people that at least part of the prescriptions are covered.
Good luck, I know how frustrating insurance can be.
Laura

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JennyT: I agree with TKeys - see if you can get it recoded. They should cover that since it's technically not IF related.

Laura: for your clomid, check with WalMart - I believe they have it on their $4 or $9 price list. It's worth a shot!!

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How frustrating. I know that my Dr. who just did my HSG said they had to put it as infertility because there was no other reason to do the test. It made me mad, because, actually, the problem (we found out after the HSG) has nothing to do with me. My HSG is going to cost about 1200, but after reading here, I think I am going to appeal it with my insurance as well, or at least get it down a lil bit if I can. I haven't gotten a bill yet, so I'll see. GRRRRRR I feel your pain. Nothing is covered with me, and even tho it is diagnostic, my Dr. said that they have to put down Infertility as the reason for the test, unless I'd have endemetriosis or something (which they didn't see anything), then it might be covered, but the catch 22 is that they wouldn't know until AFTER the test and by that time, they already coded it Infertility.....ridiculous...

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Jenny- I agree with getting it recoded, when I had the clinic do that it ended up paying for the test.

Lauralee- I get my 100 mg Clomid for $18 at Walmart.

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TTC 8+ years
2003- 3 unmedicated IUI's w/o monitoring
2004- 3 50mg Clomid cycles w/o monitoring
2007- 3 100mg Clomid cycles w/ monitoring and Ovidrel Trigger
11/11/07
1/4/08 U/S confirmed Missed M/C
1/9/08 D&C
March & April 2008- 100mg Clomid cycles w/monitoring and Ovidrel
May 2008- Follistim+Ovidrel
5/29
6/3- Chemical Pregnancy
August 2008- Follistim+Ovidrel+ Prometrium=
8/28- Chemical Pregnancy-