Pretesting Dr. B

[NYFamilyOfFiveRoses]

Is pretesting usually covered by your health insurance? Is it covered if you do not have infertility issues and you are doing GS?

Have any of you used or are planning to use Dr. Braverman in Long Island, NY and had pretesting or going to have pretesing done?

How did it work with your insurance?

I have Empire.

Thanks in advance.

[Daisy Mae]

My pretesting was not covered by insurance. In fact, I almost passed out when I found out what it cost me... close to $2,000! It seriously made me so sick b/c I had not planned on those charges. Maybe your insurance will cover it. Some do. You can call and see what your infertility coverage is. For me, if the test could be connected to fertility treatments in any possible way, they would not cover it. GL!

[Daisy Mae]

Btw, I cycled with Dr. P at HRC so I am not sure how his pretesting requirements compares to Dr. B.

[nuthinbutpink]

I did all my pretesting with my OB and it was covered as diagnostic. I had BCBS at the time but it will depend on your plan. I am not sure how they filed it, but it was all covered.

[bluex2]

FoFR,
I am considering on cycling w/dr B because he is very good and takes my insurance. What insurance do you have? The Empire Plan- NYSHIP (for NYS employees) covers 100% of infertility coverage- lifetime max 50K. It does not cover PGD. I do believe you need to be experiencing infertility for most insurance plans to cover pre testing and or IVF. Such as unexplained infertility (trying for over a year without becoming pregnant).

[NYFamilyOfFiveRoses]

Hello bluex2,

I am considering on cycling w/dr B because he is very good and takes my insurance. What insurance do you have? The Empire Plan- NYSHIP (for NYS employees) covers 100% of infertility coverage- lifetime max 50K. It does not cover PGD. I do believe you need to be experiencing infertility for most insurance plans to cover pre testing and or IVF. Such as unexplained infertility (trying for over a year without becoming pregnant).[/QUOTE]


I just called my insurance and they said that pre testing would be covered if it is listed as infertility. It would not be covered if it is listed as ivf/pgd. My insurance covers infertility and testing and iui. But does not cover ivf.

I just e-mailed the lady at Dr. Bs office to ask them when I did pretesting if they would write it on the claim as infertility and NOT ivf. I also asked them about the drugs.

Do you know if the drugs would be covered.

Most women that go for gender selection for the most part fo not have infertility issues.

So your empire plan does cover ivf? Guess they are all different. My husband works for a non profit organization.

I hope that there is a way that it can be done and covered. If not, it will just mean saving more money.

Are you cycling for Gender Selection or for IVF for infertility. If you are doing GS do you know at all if you will be covered for pre testing and drugs. Did you speak to anybody in the office about it?

[nuthinbutpink]

Most clinics really don't care how they get paid and if you have insurance, they will file it and the doctor is the one that puts the diagnosis code down on paper. 628.9 is unexplained infertility. Insurance companies are not well-versed in IVF/PGD- the whole gender selection thing and aren't necessarily looking for it when a claim comes in.

IF you have coverage for infertility, it will be up to the RE's office and them alone as to whether or not it will be covered based on HOW they submit the claim. They know how it works and if they choose to write GENDER SELECTION in bold on the forms, then it will not be covered. If they treat you like any other patient, they will use the generic unexplained code and it should be covered.

Drugs is totally seperate. IF you have infertility coverage for meds through your prescription drug plan, they could care less nor do they even look at a diagnosis code of any kind. If they get orders, they fill it and cross-check coverage. Either they cover meds for infertility or they don't. My RE was out of network so I had zero insurance coverage for the IVF but ALL of my meds were covered because they don't care which doc you use and there is no in/out of network for prescription drug benefits. One has nothing to do with the other.

I maxed out my coverage at $10,000 for meds with my cycles. It was a HUGE help obviously. Paid cash for IVF. If I would have cycled elsewhere, it would have been covered had the office submitted it with a 628.9 diagnosis code.

So, I would wait until you go for a consult, ask to speak with whomever does the billing or ask the lady at the checkout counter how they handle people with insurance coverage. Hand her your card and try to get the initial consult covered IF there is a fee for that from that RE. Start there. If they will submit that for you, then you have a good chance a the cycle being covered.

My experience with billing at 2 different places was the same. They looked at my insurance card and knew right away if I was In or out of network. There was no discussion from them about why I was there.

The only place that I have heard of making a statement about refusing to submit for GS patients is GIVF.

[NYFamilyOfFiveRoses]

Ok I called the pharmacy part of the health insurance, and just named some drugs off hand that I know are drugs used for ivf and she said Menapour is covered and gonal F is covered with preapproval.

She did say though that no exclusions were listed for IVF drugs so that sounds pretty good so far right?

Oh I am not going to go meet with the Doctor until we have at least 1 cycle saved for. We are hoping for the timeframe that we set.

Thanks.

[nuthinbutpink]

Sounds like you should be okay with drugs then. Hard to say with the RE/insurance until you know what they will do with your claim.

[Daisy Mae]

Wow! It sounds like your insurance is pretty good. Mine did not cover precycle testing or drugs. Actually, I guess you can say it covered NOTHING! My local monitoring was so expensive, too. I am in the process of collecting all my medical expenses for 2010 for tax purposes. My cycle cost me a pretty penny so if your insurance is going to help with your cycle at all, you are pretty lucky! It sounds like you may not have to save as much as you think and that you may be able to cycle sooner than you think as well. That is great news! :)

[NYFamilyOfFiveRoses]

Wow! It sounds like your insurance is pretty good. Mine did not cover precycle testing or drugs. Actually, I guess you can say it covered NOTHING! My local monitoring was so expensive, too. I am in the process of collecting all my medical expenses for 2010 for tax purposes. My cycle cost me a pretty penny so if your insurance is going to help with your cycle at all, you are pretty lucky! It sounds like you may not have to save as much as you think and that you may be able to cycle sooner than you think as well. That is great news! :)

Daisy,

I have to wait to hear back from the office. I sent them an e-mail with a copy of my insurance card so the lady is going to pass it to billing and I really hope that she gets back to me.

It sounded good when I spoke to my health insurance, but I am not holding my breath until I really know. KWIM?

With pretesting I am not sure either until I hear back from her. But with pretesting it is no biggie because somebody else that replied to me which I forgot if it was on here or IG said that the pretesting does not cost too much.

I will give it a week and if I do not hear back from the lady in the office, then I will e-mail her again.

Thanks so much.

Well anyway now something else came up that I hope that I am covered for. It has to do with oral surgery. So hopefully I am either covered by my health insurance or dental discount plan covers some of it. - There is always just something that comes in the way. And when it comes to your health, you cannot just say, I am not doing it- PGD is first. So frustrating. Sorry I went off topic.