Advice for RE appt

[djmommy]

So I am FINALLY seeing an RE on Thursday!! I am so glad to finally try and figure out what is going on. My insurance does not cover any infertility so I am trying to figure out something if I need a lap done. I know for sure one tube is blocked, at least that is what the HSG showed and they did not cover that procedure because it was diagnosed as infertility. I want to be able to have any procedure done but not diagnosed as infertility. Any way to do that? Any other advice on what to ask is also welcome. My consultation fee includes an US as well. What can they actually see on an US? My mom had endometriosis so I guess that is possible but can it just come out of nowhere?

Thanks!

[atomic sagebrush]

I'm sorry, I know I should know this already but I have about 6 people in the same boat right now but I BEG ya, before you shell out any money on laproscopy, etc. I need to be absolutely sure that your husband has had a recent sperm analysis (I know, I know, we talked about this in another thread but just blasting through q's as quick as I can here)

I wonder (do not know, but wonder) if you can get it diagnosed as dysmenorrhea instead of infertility if insurance will cover. It is dishonest though.

[djmommy]

Atomic, my DH has not had an analysis yet and I am sure it will happen. Just wondering if she will want to unblock my tubes before anything?
To be honest I do have painful cramps and a heavy flow for 1-2 days so I wouldn't be totally dishonest.

[djmommy]

I wonder if I should have DH start taking OLE? If so how much and what kind?

[XXforhubby]

I sure hope you get some answers! In regards to having it coded as dysmenorrhea, that is not being dishonest. That is how my RE got bloodwork and US covered by insurance until we had accumulated enough evidence for them to cover the infertility. They explained to me that insurance will cover infertility before the specified time frame if it is proven medically necessary. They will do what it takes to get things covered for you. Check with them first though. Most RE places have someone who does the billing that you also meet with. That is the person that you can talk to about getting things approved/covered with insurance. At least my hospital in town does it that way.

I am praying for you! I also hope you get a BFP soon!


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[djmommy]

Thank you so much XX!! I appreciate the info. Praying that you caught the GOLDIE this month! Your temps look great! Nice and high!!

[atomic sagebrush]

Since you have to pay out of pocket, my personal opinion is that it would be foolish to proceed with this, erm...procedure, if there is any outside possibility that it could be at least partially coming from DH's side.

One unblocked tube should not render you infertile.

[atomic sagebrush]

I wonder if I should have DH start taking OLE? If so how much and what kind?

I would wait till SA to do this. But if he's not gonna do it, then 500-1000 mg dry leaf OR use liquid and follow dosing guidelines on bottle because the liquids are formulated differently by company and too hard to generalize there.

[atomic sagebrush]

Sorry, I don't mean to say dishonest in a negative way LOL, simply in the meaning that "this isn't strictly the case" because yo're not going in for painful periods really, KWIM?

I really dislike the way that we have to pay for things we will never use (like my insurance I have to pay for drug and alcohol counseling that I'll never use by thte grace of God anyway) but chiropractic is not covered and it really helps my back. I would so love to be able to ahve a Chinese menu approach where you can forgo things you don't want and keep things you do. :)

[djmommy]

I would wait till SA to do this. But if he's not gonna do it, then 500-1000 mg dry leaf OR use liquid and follow dosing guidelines on bottle because the liquids are formulated differently by company and too hard to generalize there.

Well he WILL do it! LOL! Seriously, after everything I have done and put into this there is no excuse!! :) I guess I will see what the doc says and go from there! I will update when afterwards. I also may purchase a plan after to dive in and get pregnant (with a girl preferrably) but really I want a baby! I got a VISA gift card for Christmas and I was going to use it towards my dr. appt but DH said I don't have to! :) Thanks atomic!!

[maidentomother]

I HATE that health insurance is legally required here (and in the US, too.). I hate all kinds of insurance, though. They are always a waste for me.

dj, I personally think you should get that tube unblocked ASAP regardless of DH. As I explained in another thread, it could be really impairing your fertility. I hope the appointment goes well!

[atomic sagebrush]

But if she has to pay it out of pocket, and DH is shooting blanks, it seems ~to me~ to be a better use of the $$ (which seems like it is limited, yes?) to get DH checked first. But, I can be wrong, happens all the time!

[djmommy]

Well I don't know exactly what my health ins will cover. I am pretty sure diagnostic procedures are covered and there is no way we could pay for the lap procedure out of pocket. I so want DH to have an analysis done, it can't hurt right? We will see what happens.
Thanks for all the advice ladies!! XXOO

[XXforhubby]

You can always call your insurance and ask what all is covered for infertility. I did that and was surprised what all was covered. As long as your doctor uses the appropriate codes, you can ask your insurance agent for those too, you can then tell your doctor which ones to use.

I been around the block or two with insurance!


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[djmommy]

Honestly I hate insurance companies at times! The lady called me this morning and told me my fee for a consult $530! to me that is crazy but I feel like I need to go so we will have to figure it out. Diagnostic procedures are covered which is good. But of course after our deductible is paid, which is $5000! Looking forward to tomorrow.

[XXforhubby]

Ugh! That stinks! Well I hope you see someone who listens and is competent! I can't wait to hear how things went!


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