Help!! I just found out my insurance doesnt cover Infertility!?

I was checking over my insurance benefits today for something else and I saw on my benefits schedule that nothing to do with infertility is covered! No IVF, No testing, treatment, nothing. EEEK! We have been trying for over 8 months but we have had one miscarriage and Ive been told I have endometriosis and Im not ovulating. Im still going to keep trying but when I get to the 1 yr of trying mark, it looks like I wont be able to get medical help!!

I have a Blue Shield PPO, its supposedly good but doesnt cover it. Anyone go through this? Does anyone know if Kaiser covers it or if I could get a secondary insurance? Or maybe is this common with insurance policies not to cover this? This is freaking me out! We are secure financially but we cant afford tens of thousands of dollars for IVF on our own.

Advice?

Update:

The one year mark is when doctors will even consider you for infertility treatment if you are under 35. If its been less than a yr of trying, they just send you home and tell you to keep trying. Im ok with that except for the miscarriage and no ovulation...

Update 2:

To answer some of the questions: I havent ovulated in at least 5 months. Ive been tracking it with monitors, charting, my doctor has checked and no ovulation. As for Endo, I have had every test but the laporoscopic one and there are no blockages or any lesions, cysts, tumors, etc. Just chronic pelvic pain. They say endometriosis cos they dont know what else it could be.

Update 3:

To TTC: I checked. Not all Blue Shield PPO's are created equal. The one formulated for my husband's company does not cover anything to do with infertility and it listed everything.

Update 4:

This is what IS NOT covered:

> Office Visits

> Laboratory/Radiology

> Injectables/Treatment

> Artificial Insemination

> Surgical Treatment

> Hospital Services

> IVF

> GIFT

> ZIFT

Clomid is covered so I would assume that the one answerer is right in that an OBGyn could bill it as something other than infertility to cover the office visit.

18 Answers

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  • Anonymous
    1 decade ago
    Favorite Answer

    First of all, screw all the pissy answers. They have no idea what it feels like to want nothing more than a baby and to be told that without medical intervention, there is almost zero chance of you getting pregnant. I had Blue Cross/Blue Shield PPO and had the exact same problem. I found a doctor that was an infertility specialist but was also a regular OB/GYN. He was able to do a lot of the same testing that infertility doctors do, but he filed it to insurance under gynecological problems, not trying for pregnancy. This way, all the procedures were covered, except of course IVF. I don't think there will be anyway to get around the costs of that but at least now maybe you can save some money. Also, if you are not ovulating and haven't gotten pregnant then I would not even let IVF come into my mind. There are lots of things they can try for people who don't ovulate naturally like Clomid. These are usually very successful. And though it will not be covered by insurance, these medications are very reasonable to help you achieve the end result of a pregnancy. Best of luck to you and I hope all works out. Baby Dust!!!

  • 1 decade ago

    Unfortunately most insurance companies do not cover infertility procedures or prescriptions. If you are not ovulating, the first course of action that a specialist would do is put you on Clomid or other inducing drug. As for the endometriosis, they would probably perform a procedure using a laser to remove some of the excess tissue. However, you said you have been told you have this, but what tests have been run to check for this? Until you have had ultrasounds & a hysterosalpingogram (usually performed to see if there are blockages in the tubes - which could be why not ovulating, but can also provide doctors with a better view of endometriosis) I would not assume that is the problem. A lot of women experience the symptoms and do not have it (I'm one of them) and others have no symptoms and have a severe case of it. It's one of those things that really needs to be properly investigated. The fact that you have only been trying for 8 months, and have already had one pregnancy means you have a good chance of conceiving again, it just may take longer than you thought. Good luck - I know the waiting can be very hard.

  • elsie
    Lv 6
    1 decade ago

    Don't get too scared yet. Its very hard to get insurance to cover fertility, as other posters have explained. However, some fertility treatments (like clomid) are really inexpensive even out-of-pocket, and can be very helpful! You have been pregnant before, which is a great sign that you won't need IVF or anything else too invasive. You must be ovulating, even if it is not regular, since you have already been pregnant. There are simple things that can get your body going, don't worry.

    You've already been trying for 8 months. Why not call the doctor and explain your situation? Perhaps they can get you started on something sooner if you'd like. Good luck, hun!

  • 1 decade ago

    I would check with the laws of your state. Many states are now requiring insurances to cover aspects infertility treatment. Check the link below. I believe the state the insurance is issued takes precedence over if you live in a different state than it is issued. For instance, I live in MD but my insurance is from an employment plan out of New Jersey, so I have to follow New Jersey rules. I THINK that is the way, check it out.

    I am sure you have looked into Shared Risk Programs for IVF as well as payment plans. Many payment plans go from 24 - 60 months, just like a car. If you cut some expenses that could make it more feasible.

    Did you actually call and talk to an insurance rep? Sometimes, I know with mine, it doesn't list all benefits online or in the literature. And if you do have these sources they could be outdated. As someone mentioned, sometimes you can get an OBGYN to order tests that aid you in your infertility search, but I doubt many would be able to fudge Clomid, embryo freezing, etc.

    What I would do is have an infertility clinic (reproductive endocrinologist) run your insurance information for you. They SOMETIMES get a better set of representatives looking at the insurance plan.

    Good Luck!

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  • 1 decade ago

    Did your insurance company mention drugs that you can take in pill form, such as Clomid? My insurance company does not cover any infertility treatments either....but did cover Clomid. Anything that I had to take in a shot or any Procedure would not be covered, not even my husband's semen analysis.

    Usually Clomid is step one in treatment. My doctor did not make me wait a year because he diagnosed me with PCOS. Once he had a scan done to make sure i didn't have any cysts, he started me immediately on Clomid. Call your insurance company and ask them specifically about Clomid. You may be pleasantly surprised and Clomid may be all you need to conceive.

    If you know that you're not ovulating you should definitely go see an OBGYN before a year...I did and it was one of the best decisions I made!

    EDIT: if it doesn't cover the Clomid, its costs about $50-$60/month in my area which isn't terrible. You should have $15/week to spare if you're trying for a child anyway. Like I said before, maybe that is all you'll need!!

    Good luck!!

    Source(s): ~16 weeks with baby #1 after six cycles of Clomid and OPK testing~
  • 1 decade ago

    I have to disagree with most people here. Most insurances now a days cover some aspect of infertiltiy. At the minimum they cover diagnostics. I worked in benefits before and also have been through infertility. In addition endometriosis is not just a fertility problem it's painful and there are other risks involved with endo. Unless your a pro at reading your benefits leave that to the doctor. If you are already trying for a year get to the doctor. Talk to your obgyn and see what they say first. The OB can help you on a local level for awhile moinitor you and get you started on tests and such. Then when that doesn't work you can get a referral for the infertility specialist.

    Also asking here about your specific insurance is impossible for anyone of us to answer. Each policy is written different for the specific employer so do as i said have your doctors office research that.

    Good luck.

  • 1 decade ago

    I know what your going through girl, my hubby's insurance is PA blue cross ppo Independence and it covers only select procedures when it comes to fertility treatments. when I had my tubes untied in March 07 it was covered in full but that was because it was done before his employer had the insurance change some things on there medical plan with Blue cross to make it more affordable to the employees. Now the only thing that is covered when it comes to fertility is clomid or progesterone and nothing else. that really sucks because we would have liked to try IVF.

  • 1 decade ago

    I have Kaiser and it only covers 50% of treatments and medications but does not cover the IVF itself. I know it sucks that we have to go through all this... but if I am to choose between money and a baby I will definetely choose a baby even if I get into a loan for that. Capital One has a plan for infertility in case you have to go that route....but I hope you don't have too. Good luck!

  • 1 decade ago

    That can't be possible. I have the same insurance and it covers infertility. Sometimes it's not in the handbook cuz it wasn't in my handbook. So I called Blue Cross, spoke to a representative who was kind enough to tell me exactly what it covered...and guess what, it did! It covered IUI, a certain $ amount for IVF, etc...I think you should call and find out...They're very nice and will tell you in detail! Good Luck!

    Edit: It covers 90% of infertility for me.

  • Anonymous
    1 decade ago

    Most insurance companies will not cover infertility. Mine also did not. I have had 3 interuterine inseminations that I had to pay out of pocket. It is a lot less expensive than IVF. I feel your pain, good luck to you.

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