I have a question regarding medical insurance & coverage. I've already called my provider & my REs office today, EXCEPT, I didn't get the CPT codes for the testing that I would be having tomorrow. Instead, I have the billing codes. grrr. I should've known to ask, when I called!
Anyhow, I would be having a sonohystogram(saline) & Bloodwork - (fertility workup & pcos workup AND I have the billing codes for those).
When I had Anthem beforehand, I believe they covered it, but now we have UHC and am not sure if this 'diagnostic' testing is not covered under our medical ins.. We do have our co-pay. I know the 'other' stuff won't be covered, like ie. iui/ivf etc; etc..
Could anyone tell me if this kind stuff is 'generally' covered? I'd hate to go in/have the bloodwork & procedure done & be out at LEAST $1500-(this is what the bloodwork WOULD costs). The provider is 'in-network' & I'd be having it done in office under an RE.
I'd hate to cancel tomorrow's appt. & can't get in any other day of the week, because they need to have these tests done normally in the beginning of your cycle.
JLR I really don't have an answer for you - I'm not familiar with your companies and I think coverage varies by state. When I was going through IF stuff I thought none of it would be covered, but all testing was covered as well as IUIs and meds. Only IVF was not covered for us. It seems like your RE's office should be a bit more familiar with what will & won't be covered. I know that my RE's office checked everything for me as far as coverage and they also told me that even if I had to go there for multiple visits in one day that it would just be 1 copay - I didn't know that tidbit of info and thought I'd never even be in that situation of being there for more than 1 appointment a day, but I was on occassion.
Do you have a copy of your explanation of benefits? If not, I'd request one from your insurance carrier -it's always nice to have to refer to.
JL- my old insurance did not cover any IF treatment but did cover diagnostic tests. They covered all those types of tests that you mention. They also covered DH's tests (SA, bloodwork etc). Good luck! I hope you will get some answers soon.
THANK you diam & the same goes for you too! I'd just hate to cancel my appt. for tomorrow morning to have ALL of this stuff done & then, yet wait for another cycle. I don't mind having the tests done & NEED them done, but I have to wait to forge ahead w/the monitored cycle & Ttc(due to dh's job being in jeopardy).
and thank you too, Mcg. I remember when we had bc/bs, they did cover all of the 'diagnostic' testing from what I remember 5 yrs. ago, so I'm assuming my current ins. will. I hope my REs office calls me 1st thing tomorrow morning before my appt.! I have to go digging for the book, but otherwise, I will look online for the info.
Mine was covered by United but that doesn't mean anything since our policy is company specific. Also, my RE's office said the tests for me would have been covered regardless bc I have a diagnosis and it's endometriosis. So if you have a diagnosis (other than "unexplained"), you could consider that route for coding too.
Hi ladies! I know this thread doesn't get a ton of activity but I thought I'd try. I recently had blood work done to check hormone levels. THey were only supposed to run progesterone on the post-O draw and everything else on CD3. There was some screw up with the order, of course, and they ran everything on both, so it ended up being CD23 (I O on CD20) and then CD4 of the next cycle. My levels of everything looked normal except for FSH. It was normal (2) on CD23 and then high (15) on CD3. My doctor said this was weird and confirmed that it was definitely time to talk to a fertility specialist and that they would see this as a red flag. Admittedly, I don't know a lot about this and from what I've read FSH of 15 or higher is not good. I know I"m ovulating each month, so does the high FSH mean I'm not releasing an egg or it's of poor quality? Or is strictly measuring reserve? Despite being a scientist, this stuff for some reason just is not sticking in my head.
TIA!
Lori & Scott October 26, 2002-9 years down, a lifetime to go...
Different doctors have different opinions regarding FSH and it indicates both (quality and quantity), but all my doctors said quality, and based on the loads of research I did during IF, I believe it is very indicative of quality. 10 is borderline, 15 is high, but it definitely doesn't mean you can't get pregnant. FSH levels can vary greatly month to month and even differ throughout the day!
And you can't take FSH by itself. It's part of the picture. When I consulted with CCRM, Dr. Schoolcraft said because I was 31, he would treat me, but with my FSH levels, had I been older (high 30's), he would not treat me. I believe my FSH was 14 at the time.
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