When are things ever easy! XP *updated*

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Joined: 07/26/04
Posts: 1595
When are things ever easy! XP *updated*

So the RE just called and the SA is actually worse! She said the ONLY option is IVF BUT BUT BUT BUT BUT it looks like the insurance will not cover it unless other less expensive ways have been used first (IUI). She told me that IUI will be pretty much a waste of my time. She is hoping if they can fax the insurance the information and prove this to them it can be made an exception. I have very little hope. I really really hate to think that I will have to do IUI for nothing just so I can have the IVF! This is ridiculous!!!! I'm so flippin mad right now!

In other news.... I have high testosterone as well as a slight hormonal imbalance. I have to start the metformin tonight to regulate my levels. TSH levels were 2.3 so that's good!

SO, what do u girls think? Do you think the insurance will budge??? I would hate to have to do an IUI for nothing that's too much stress! I mean my DH's SA is that low, but she said that insurances don't see it that way. AHHHH!!!

I found out yesterday everything was approved!!! YAY!!!!

DancingNancy's picture
Joined: 08/30/11
Posts: 520

No advice because we had to pay for all of our IUIs (at a different clinic) and all of our IVFs (and future ones) out-of-pocket. Hopefully the RE will be able to get the insurance to skip over it. It actually saves them money in the long run. Good luck with it all!

kadibug's picture
Joined: 07/17/11
Posts: 247

I can't give much advise with insurance. There is/was no coverage of any IF treatments for us. I have heard of doctors being able to petition insurance for their patients though. For instance (m/c ment), when I had my tri18 angel, the insurance wasn't going to cover the termination but the doctor sent a letter to the hospital and my insurance stating that it was an nonviable pg with no chance of making it to term. It took a few months for everyone to get on the same page to my medical needs, but it happened. Doctors have a lot of persuasion with medical billing if they are willing to do it. I do think you have a chance with your insurance. Besides, you never know until you try.

Being told IVF is really it for you was a shock but I am sure you are glad to be told something with substance. Finally, you know what stands a chance to work for you in IF treatments! Finally.

Is testosterone pretty easy to balance with medicine?

meggyrn's picture
Joined: 02/16/09
Posts: 2263

I have no advice in regards to the insurance either as we paid OOP. If the only way your insurance were to cover IVF is to try an IUI, it'd be worth a shot. That stress will end up saving you a lot of money in the long run. Worrying about money will equal more stress also. I hope it all works out and they can convince the insurance company it'd be a waste.

Joined: 07/26/04
Posts: 1595

I hope the doctor can persuade them and she is actually hoping the same thing.

I was put on metformin, just finished taking the first pill. I will eventually be taking 3 a day but I have to gradually increase it each week. I just read online that it is one of the treatments for this so I'm hopeful it will work.

celticbandgeek's picture
Joined: 06/14/10
Posts: 950

Are you in the SEHBP? I have Horizon Direct10, and I've found that they've been really easy to work with. I could have gone on to IVF a lot sooner if I had wanted to, and that was with Unexplained IF diagnosis. With male factor, they may be willing to go right to IVF when the Dr gives them all the details. Fingers crossed!!!

Which RE are you going to? (Feel free to PM if you don't want to post that publicly! Wink )


Joined: 03/02/07
Posts: 473

I really hope your insurance will see the reason in going straight to IVF. My insurance had the same rule of trying IUI first. We skipped IUI altogether not because of male factor but because I have tubal damage documented in a surgical report. According to my doctor, IUI held no benefit to us over trying naturally. I don't know what my doctor had to send them, but they approved it right away. I actually spoke to a representative about it and she was so puzzled by my story I ended up on the phone with her for a while explaining. Once I got to the end, , she agreed that with tubal damage, IVF was the only thing that made sense. Then she said to call her back later and let her know how it all turned out. Smile Obviously, she was a pretty nice one. I don't know if she had anything to do with the quick approval or not.

If your reason for IVF is really clear, it's more cost beneficial for them to skip IUI. Hopefully they get that! Good luck!

Joined: 04/21/08
Posts: 1063

We were able to get our insurance to cover IVF without doing IUIs. Hopefully yours will too. I ended up talking to the nurse coordinator in the infertility department and that helped.

Joined: 07/26/04
Posts: 1595

well she said she will try her best. she said in our case it is medically necessary so she will get back to me. they still signed me up for IVF class and are still treating me like an IVF patient right now so Im still hopeful.