Wednesday, September 2, 2009

Insurance Questions

26 more days till my appointment! It's kinda strange that after this appointment I will be "marked" as infertile on my charts and insurace. Speaking of insurace, my Dr. told me to look up and see exactly what they will be covering, and I'm confused by what this means.

Office Visits: Copay: 50% Per Visit, Copayment maximum applies
Laboratory/Radiology: Copay: 50% Per Visit, Copayment maximum applies
Injectables/Treatment: Copay: 50% Per Visit, Copayment maximum applies
Surgical Treatment: Copay: 50% Per Visit, Copayment maximum applies
Hospital Services: Copay: 50% Per Visit, Copayment maximum applies

Everything else like IUIs and beyond are not covered. So what exactly does that mean? That they cover 50% of the above listed? What does it mean when they say "copayment maximum applies?

Edit: I did more searching and it says that the Co-paymnet maximum is $1000 for individual and $2000 for family, whatever that means, I don't know the difference between the 2? But it says that's the most you would have to pay for applicable covered covered services.


My Vegas said...

Umm, yeah, being marked as an "infertile' was tough for me. I actually found out I was infertile from the help desk of my insurance company hotline: I called to find out why a blood test wasn't covered. She told me it was coded as infertility, and that is not covered under my plan.

I bawled for over an hour. The help desk girl diagnosed me.

suz said...

Ugh. I hate everything about insurance. It's so cold and stupid. :( I hope you can figure it out!!

ArmyWife said...

Hello know it always amazes me how little coverage you get from insurance companies,doesn't seem fair. It looks as if yours will pay half of the amount of treatments.Usually insurances will cover all when it's just a diagnosis appointment. When you get into the treatments that's when those office visits get a little bit pricy. I am very thankful for my husbands military insurance they cover everything except IUI's and Invitro. What I wanted to tell you is that when you go to your appt don't be afraid to find out all of your options. Some of these doctor's will drag out several appts before actually helping you and I would hate for that to happen to you. I was on clomid almost a year from my regular OBGYN with no results or monitoring and I ended up in the ER twice with ruptured ovarian cysts. I finally got my referal to see a specialist and he took me right off of it, ran every test we needed (which thankfully everything came out good) and put me on injectabiles. I really think you should ask your Doctor about that. It makes you priduce many eggs and they monitor you with ultrasounds and blood work to make sure you are developing follicules and then you are given an HCG trigger shot that makes you ovulate within two days. It's perfect b/c you can time your ovualtion exactly. My husbands deployment date got moved up so we didn't get the chance to reap the benefits of it but I'm definetly going try it again when he gets home, which I just found out will be within a week! Wish me, Sorry this was so long but I just wanted you to be aware of this treatment and I don't want you to have to wait any longer than you already have for your bundle of joy. Best of luck and you are in my prayers.
Oh and I don't know if you have done this yet but get your husband tested if you can before your appt. I know from eperience that a Doctor won't proceed with testing and medications unless they can rule out it's not the male first. Just a helpful tip.