Fertility workup & insurance help
14 Replies
Lynn27 - February 2

Well, I went to the doctors today to talk about my long long cycles. He told me that fertility drugs were my only options, so me and DH are going in for a full fertility work up in 2-3 weeks and then starting fertility meds when we get the results. I'm just wondering what tests everyone got, and what was covered by insurance. Also is there anyway I can make DH feel better about getting a SA.. He is very uncomfortable with the idea lol, and I don't know what to do to calm him down. If anyone can help it would be greatly appreciated. Thanks.


Ann - February 2

Hi Lynn27, all insurance is different, so you have to call to see what they cover. My dh was very uncomfortable, too, about providing "the sample" for the sa. You can help him along before (make sure to follow the directions regarding lubricants, etc). You can take it to a clinic close to your house, if available, so he can do it at home (I think it had to be delivered within 30 minutes or an hour--can't remember which). Regarding tests, I took blood tests to see if I ovulated and to check my fsh and estradiol levels. I also did an hsg. My dr insists on checking dh first, because the test is easiest and least invasive. Good luck to you! How long have you been ttc?


Lynn27 - February 2

I just talked to my insurance company and they suck! Nothing is covered at all! Stupid stupid insurance. We will have to come up with the money ourselves, I'm thinking about selling a kidney lol j/k. All well, nothings ever easy is it. Ann I've been trying for 2 years. Umm the doctor just told me that I need to bring DH in for a SA he didn't say anything about doing it at home but it would be much easier lol. ERR im so frustrated right now.. I have no idea how much this is going to cost. Anyone going through fertility treatments with no insurance coverage? Tomorrow I'm going for blood tests, Lh,prolactin,tsh,fsh and insulin. I have no idea what any of that means, im confused. I just cant wait until I go to the doctors and ask how much this is all gonna cost. I'm going through with it either way, it just sucks that we will be broke. Anyway thanks for responding Ann. What is hsg? Is that when they check your tubes? I don't think I'll need that, my doctor is pretty confident that my only problem is anovulation.Or does everyone need it? This infertility business is so confusing!


Ann - February 3

Lynn27, I am so sorry to hear about your insurance...since you don't have insurance, maybe your dr can try some cheaper treatments before running expensive tests. I think clomid helps you to O and it is really cheap (only about $45/month). I am not sure about the O issues/treatments. The blood tests usually aren't that expensive, and if I remember right, the SA was $100-125 (not covered for us). Yes, the hsg is for tubes. Normally they want to check that, because they could give you drugs, etc. and if your tubes are blocked it does no good. We have been ttc for 2 years as well. All of our tests have been normal so far, although I had a little bit of endo (removed). It is all so frustrating!! Do you have the kind of job where you could go to another company that has better benefits? I know that sounds like an extreme option, but this stuff can be so expensive! Good luck!!


Lynn27 - February 3

I just cant believe that nothing is covered by insurance. Such a pain in the butt. We don't get any benefits from work, we have independent insurance which we pay an arm and a leg for and its useless right now. Somehow we will manage, I just don't understand why infertility would not be covered at all. It seems to be such a big problem. When I go in to see the doctor I'll see if we can do something a little cheaper to start off with and then if it doesn't work we can move onto the move expensive stuff. We will see what he says.Thanks Ann, and good luck ttc.


Ann - February 3

Ouch! I've heard that private insurance is bad about that. Even a lot of the group insurances don't cover infertility. I guess they don't consider it a "need." It seems so unfair! It is just all about the $$$. If you ever do need to do something "drastic" like find a job for insurance, it is possible to get coverage. I just switched plans at work and, even though I had been diagnosed with infertility, the new plan still covers it (since they don't want a big company to not use them anymore). Hopefully, you will just get pg very soon and not have to worry about it! Good luck!


Annie - February 3

Does anyone know a website that talks about the infertility laws in all the states? I thought some states have to give compulsory coverage.


hopeful06 - February 3

Lynn27........I have long cycles too. (Very irregular--3 months for the last one) How old are you? I'm rather young (23, my dh is 25) so my dr wanted to start out with as little meds as possible. I had a couple of blood tests to check hormone levels, insulin resistance, etc. and my dh had a semen analysis done. I did not have an hsg. My dr said that I was not ovulating and put me on metformin first to see if that would help before trying anything else more invasive. My insurance covers metformin, but I did a quick search online and I found out that the dosage that I'm taking would only cost $30 (or less, depending on where you fill your prescription) per month. Of course, as the dosage increases so does the price. A lot of people take clomid along with metformin, but I'm not at this time. The generic name for clomid is CLOMIPHENE CITRATE. I looked this up at walgreens.com and the cost for this is higher than metformin, but is still reasonable (10 for $50---I don't think this is a med you take daily, but I'm not sure....) I hope this info helps somewhat. Good luck!


SashaP - February 3

Make sure when you call your insurance that you have the procedure and diagnostic code mine said they wouldn't cover anything to do with infertility. I called them with the codes and they were covered they paid for all my testing including my HSG and dh's SA. It's all about the code. The EOB for my HSG said it was about $400 if that helps. They even ended up paying for my Femara since it's not technically a fertility drug. It took me about 6 months to get the SA from dh too. His big fear was I would leave him if he was the problem poor guy.


Lynn27 - February 3

I'm young also, im 22 DH is also 25. My doctor is pretty sure that the problem is no ovulation so i'm not really sure we will start with the expensive test or not. Hopefully we can start like your doctor did hopful06. I really do hope so. I looked on my policy last night and it only said advanced infertility testing and treatment is not covered, but the lady told me that no infertility was covered, I am sooo confused right now. I'm going to have DH call them again tonight, he can usually get answers out of everyone. I think DH's problem is that he has to "shoot" into a little cup lol and when he comes out of the room people will know what he was doing. I told him atleast he can do it in private, he wont have his legs up in the air with lights pointing down there lol. Thank you so much for your comments, you've helped alot. Good luck and baby dust.


hopeful06 - February 3

Lynn...I can totally relate with the dh!! I told mine the same thing!!!!!! They act like getting a semen sample in private is so much worse than having your legs in the air and being probed with foreign objects....:) My dh was able to obtain the sample at home though--maybe yours could do the same. About the "infertility" label...I can understand it's about the codes as SashaP said. Sometimes the doctor's office will be willing to put something rather than "infertility" on the lab slip too---I think mine said "irregular cycles" when they did my blood work. Technically, this could be done to check other things rather than just fertility and it was the truth. As for your dh, our urologist put "testicular pain" on his lab slip. Although our insurance would cover it, he said that it is more work to put it through that way than to just say that he had pain. I'm pretty sure this isn't the way you're supposed to do it for the dh though, but they might be willing. Or, have your dh say he has testicular pain and ask for a semen analysis to check for prostate infection (it turned out my dh actually had one).....It's an idea. Good luck!!


Lynn27 - February 3

Is there anyone on clomid? I'm guessing that that could be what we try first. I just wanted to know how many times you go to the doctor each cycle.How many u/s and blood tests etc. This way i can figure out some kind of $$$ in case i need to use it. Thank you.


SashaP - February 4

Lynn I would still checking on the codes Dr's are very creative. My insurance said absolutely no infertility testing or treatments are covered and like I said before they covered everything. It was all in the wording I'm only 25 and dh is 27. I put off taking the test because of the insurance but I ended up getting the codes and getting the procedures approved. It's worth a shot. Clomid is about $45 for a 100mg a day for five days that insurance wouldn't cover. But they are paying for my Femara. I go to the doctor 1-2 times a cycle. Have you done any OPK's or BBT for ovulation?


Lynn27 - February 4

SashaP, I've tried bbt and my temps were erratic, opk's never showed a positive but I already knew I wasn't ovulating because my cycles are 3 1/2-4 months. I'm going to see what my doctor say's about my insurance and if there is anyway we can get around it. We will find something, some way to do what we need. Thanks a lot everyone.


kandigrl92 - April 8

thanks to everyone for all of your helpful posts regarding prices for all these tests. I have been ttc for approx 2 years now, and from what I've heard, the hsg can greatly improve your chances of concieiving. So I wanted to see if maybe I could just pay for that test and see how it comes out since I don't have insurance at the moment. I was thinking more in the range of $1,000 so $400 sounds wonderful. I know I should start with all those other more simple tests first like bloodwork, but I'm sure I'm ovulating. I get all of the symptoms of ovulation every month (thinning of cervical mucous, ovulation pains), and my cycle is pretty regular at 25 days. And I did have an episode of chlamydia in my teen years, so I'm thinking I've got some scarring or blocked tubes from that infection. Hopefully I'll be able to save for the hsg and that'll be all I need. This is the most frustrating time of my life. I'm 26 and my dh is 25. Good luck to everyone, and hopefully we'll all have better things to worry about in the near future....like dirty diapers!!!



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