newlifemom Posted April 21, 2009 Share Posted April 21, 2009 Once again I have a doctor who wants me to see a reproductive endocrinologist and once again I cannot b/c my insurance considers it infertility and will not pay for anything related to infertility. All I want are a few blood tests to determine why my body rejects so many of my kids. I would even sign a paper saying I won't do IVF(I have 4 kids, if I cannot carry to term then I will have to just accept that.) Why is this such a big deal? I can have kids. I just want one more. Obviously I am asking for too much. Why does my insurance or worse yet, my husband's employer get to tell me which doctors I can go to? :mad: Sorry, this has been a very bad weekend and now I have a lovely post-op infection to add to my ongoing drama. Quote Link to comment Share on other sites More sharing options...
Ria Posted April 21, 2009 Share Posted April 21, 2009 Once again I have a doctor who wants me to see a reproductive endocrinologist and once again I cannot b/c my insurance considers it infertility and will not pay for anything related to infertility. All I want are a few blood tests to determine why my body rejects so many of my kids. I would even sign a paper saying I won't do IVF(I have 4 kids, if I cannot carry to term then I will have to just accept that.) Why is this such a big deal? I can have kids. I just want one more. Obviously I am asking for too much. Why does my insurance or worse yet, my husband's employer get to tell me which doctors I can go to? :mad: Sorry, this has been a very bad weekend and now I have a lovely post-op infection to add to my ongoing drama. Have you tried having your doctor call the insurance company? There is probably some way to appeal a denial of benefits...I'd look into it. My guess is that if your doctor claims that this is a health concern for you, the ins. company might be more compliant. :grouphug: Ria Quote Link to comment Share on other sites More sharing options...
chiguirre Posted April 21, 2009 Share Posted April 21, 2009 Can you talk to your doctor's office and ask if they could find an alternative code to bill for the tests? With a bit of flexibility they may be able to get them covered. For example, our insurance won't cover anything if it's coded with the autism code (even when it's a physical, neurological test, not therapy) but will cover the exact same things if they are coded differently. I've had the same issues with an ultrasound of my thyroid, even though that should absolutely be covered, some genius coded it as part of my annual physical. It is, but only because I have a goiter! I hope this tip helps and you can get your testing done. :grouphug: Quote Link to comment Share on other sites More sharing options...
sleepy Posted April 21, 2009 Share Posted April 21, 2009 I'm sorry. :grouphug::grouphug: Would it cost too much to just go to the reproductive endocrinologist and pay for it out of pocket? Quote Link to comment Share on other sites More sharing options...
LNC Posted April 21, 2009 Share Posted April 21, 2009 Have you had 7 miscarriages? I'm so sorry! I have had several also, and the problem was autoimmune -antiphospholipid antibodies. I will have to stay on a baby aspirin always, so in a sense it is a health concern for me also. So, maybe if your ob tells your insurance company a repro endo needs to do a work up that includes the possibily of autoimmune disorders for mom the insurance company will pay? Quote Link to comment Share on other sites More sharing options...
Nestof3 Posted April 21, 2009 Share Posted April 21, 2009 Well, you could probably see the fertility doc, it's just that this is not in your health insurance contract. I agree that the doctor might get more results if he/she phones the insurance company to provide details. I'm sorry you are having such a dificult time with your pregnancies, and I can understand wanting to know why your body is not bringing them to term. Could you find out how much these tests would cost if you paid cash for them and did not file it with your insurance? Your husband's employer is not the one saying which doctors you can see -- the employer just picks a company. I know you are hurting right now, but you have no idea how expensive insurance is for an employer. Don't lash out at them. And, coming from a self-employed family, just be thankful you don't pay for your own insurance. We pay $400 a month for a $5,000 deductible, and if we even wanted another baby, we'd have to pay $71 a month for 16 months before I even conceived, then we'd have to pay an additional $71 a month for the 9 months of maternity, and then we'd have to pay $5,000 for the delivery. That's on top of the $400 a month we pay. Quote Link to comment Share on other sites More sharing options...
Nestof3 Posted April 21, 2009 Share Posted April 21, 2009 Have you had 7 miscarriages? I'm so sorry! I have had several also, and the problem was autoimmune -antiphospholipid antibodies. I will have to stay on a baby aspirin always, so in a sense it is a health concern for me also. So, maybe if your ob tells your insurance company a repro endo needs to do a work up that includes the possibily of autoimmune disorders for mom the insurance company will pay? That's a very good idea. It seems the reason you cannot carry to term might also be a medical concern outside of child-bearing??? Perhaps your doctor can go this route. Also, do the tests have to be done by a fertility doctor? What if they are performed by someone not affiliated with fertility? They might code it differently. If they are blood tests, you would think another specialist could do them. Quote Link to comment Share on other sites More sharing options...
newlifemom Posted April 21, 2009 Author Share Posted April 21, 2009 I hear you Dawn, I not really mad as I am frustrated. I thought with this new insurance we had a lot more flexibility than before. I may try the pay out of pocket it's just that we are a single income family who needs a new car and money is just so tight. My guess is that it would cost at least $1,000.00 to get properly diagnosed. I tried going through my regular dr a few years ago with an indepth physical which revealed nothing. The RE I spoke with was very understanding but could not help. Just going to them would exclude payment. I need to pray,think and get over this current loss. It just has been difficult b/c nothing is going well. I normally miscarry naturally. I have never hemorraged(sp?) before and I have never had a post-op infection before. I am loopy, in pain and due to blood loss very tired. Taking massive iron right now. Feeling seriously low. I know I need to get over myself and then tackle the difficulties, might take some time though. You guys are wonderful and quite frankly, I don't know what I would do without you.:001_smile: Thanks. Quote Link to comment Share on other sites More sharing options...
anissarobert Posted April 21, 2009 Share Posted April 21, 2009 Pam, :grouphug::grouphug: I hemorrhaged after losing a baby six years ago and it was an awful experience. I'm so sorry for your loss. I hope that your doctor can help somehow. In my case I was able to basically diagnose myself with a Luteal Phase Defect, but there were no expensive blood tests involved for me. Good luck. I hope things get better for you soon. Quote Link to comment Share on other sites More sharing options...
swellmomma Posted April 21, 2009 Share Posted April 21, 2009 I had a series of blood work done to see why I kept miscarrying. Your dr should be able to order most of them without a problem. The ones that test blood clotting times and such any dr can order. I did have genetic testing done which I think you need the endo for, but the first set of stuff your php should be able to order and have covered by your insurance. In the end no reason was found, I just can't maintain a pregnancy properly, 6 m/c and 3 preemies prove that, but testing shows nothing. I would talk with your php first about what tests he can order that your insur will cover and go from there. If those don't show anything then have your dr call you insur to explain why you need an endo seeing you. Quote Link to comment Share on other sites More sharing options...
Blessedfamily Posted April 21, 2009 Share Posted April 21, 2009 (edited) Pam, I think I missed some news, here? I'm sorry. I had infertility issues too. Reproductive Endos cost $200 just to talk to here, and our insurance doesn't cover infertility issues. I was afraid of the cost, but went anyway. RE's offices are very much aware that insurance doesn't cover just "infertility". There was a reason behind my issues (there usually is), and they just billed the insurance company for that. No infertility billing codes were used, and my insurance paid 100% (except my $20 copay). You could call and ask to speak to the billing person about how you'll be billed. ETA- I just re-read the later post and see you already called one RE. I'd call another. If they bill it right, the insurance company will pay. Edited April 21, 2009 by Blessedfamily Quote Link to comment Share on other sites More sharing options...
littlebug42 Posted April 21, 2009 Share Posted April 21, 2009 :iagree: First, I am so sorry for your losses. I have been there twice myself. I second what blessedfamily said above. I suffered from infertility issues caused by polycystic ovarian disease. The RE I went to billed it as treating the underlying disease but never as fertility issues which would not have been paid for. He showed us a billing code sheet that had the fertility codes highlighted and they just didn't use them unless necessary. Another idea is that I know around here there are several OBs that also have a fertility arm of their practice. Maybe you could see someone like that who could fly under the radar. I hope you can get the answers that you need. Quote Link to comment Share on other sites More sharing options...
Mommyof4ks Posted April 21, 2009 Share Posted April 21, 2009 A friend of mine has some interesting medical issues. Her insurance will not pay for blood tests ordered by her natropath but it will pay for blood tests ordered by her primary care dr. She convinced the two doctors to talk and now the natro faxes the PCP with which tests she needs run and the PCP orders them. Maybe you could just pay for a consult from the specialist, have your primary dr. do the tests and then a phone consult for the specialist to go over what the tests mean? Please let me know if I can help. I was thinking this too. We have to have docs work together or our doc bills will eat us alive. Is it just that the OB cannot order those specific blood tests or they don't know how to read them? If they can order them and then consult an RE about what the results mean then perhaps you could avoid the RE charge. Docs consult each other often, and perhaps your OB knows an RE that will be able to help. Hopefully you get answers soon. Quote Link to comment Share on other sites More sharing options...
HollyDay Posted April 21, 2009 Share Posted April 21, 2009 can you find a practice that has a RE within the practice? Perhaps he/she could order the tests through your reg ob/gyn? Or how about a MFM (maternal fetal medicine) doc? Years ago, I got my pre-pregnancy labs done via my ob/gyn who had a working relationship with a MFM. It wasnt insurance related, the ob/gyn didnt know if he would take me due to my high risk pregnancies! Quote Link to comment Share on other sites More sharing options...
BakersDozen Posted April 21, 2009 Share Posted April 21, 2009 Just want to pop in and say that coding and the right RE can make all the difference. I knew after #7 and yet another loss that something was wrong and that my OB could not help me. I went to a RE, presented my case, he took me seriously once he got over his surprise at having a mom of 7 in his office, ordered the right tests with the right codes, and just like that I was diagnosed. A RE knows things regular OBs do not so it was worth the appointment which I would have gladly paid OOP for just to get an answer. I wasted too many years and too many lost babies w/OBs who didn't know their FSH from their LH. ;) I hope you get the tests you need and answers soon. Quote Link to comment Share on other sites More sharing options...
Jann in TX Posted April 21, 2009 Share Posted April 21, 2009 I've also had multiple losses--early and mid/late term. After my last loss in January of 2001 my OB asked me to see an RE. We were NOT necessarily wanting to get pg again--especially with my odds but I NEEDED to know what was going on with my body. The RE visited with me in his office and then wrote lab orders. He ordered blood work and an HSG. The HSG was NOT comfortable--but it did reveal part of the mystery. My uterus was heavily scarred by previous losses and my 2 full term pregnancies. Besides that scar tissue I had a type of rapid-onset scar tissue from my recent loss (also known as Asherman's syndrome). I NEEDED surgery because it was a threat to my health. The RE also told us that some of the scar tissue would most likely return and that after surgery I would have about 3 months to conceive--if we wanted another child. During the surgery the RE took a 'look around' and was SHOCKED to find a TON of endometriosis (stage 3-4). The outside of my uterus was completely covered--something that would interfer with a pregnancy. He lasered it off, cleaned out the scar tissue and 2 months later we were pregnant with youngest dd. The RE did NOT do any 'fertility' treatment--he did restore my body to a HEALTHY state---DH and I took care of the rest:tongue_smilie: Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.