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I would schedule with the RE just to get the ball rolling. You mentioned that was the next step and it sound super logical.
Good luck!
@Mrs Green Grass: Have you had all 6 allowed Clomid cycles yet? And does your current insurance cover testing (bloodwork and ultrasound)? Mine didn't cover any medicines or infertility procedures, but anything labeled "testing" was covered.
The reason I ask about Clomid is because, esp. if testing is covered, Clomid cycles are cheap. They are even cheaper if an OBGYN is doing them (no out of pocket RE costs). But if you have had your 6 Clomid cycles already and are about to move on (or if Clomid didn't work for you and you need injections), then I would consider the new insurance. January is not that far away, and the idea of having full infertility coverage is just awesome.
One thing to think about is if they would cover this right away or make you wait 6 months since it would be considered a pre-existing condition. I think since you already had the work up they might consider that a diagnosis and not cover it.
I'm a teacher so no cost with either option. Just copays.
@heathaah: I have done absoltutely nothing besides testing. So no Clomid cycles. I do believe my OB would prescribe it, but it sounds like they don't go very far in the infertility process. They refer out rather quickly and it seems that I would be paying for each visit since they would all be under an infertility umbrella.
I agree I can't not get the full coverage (esp if it's free), it's just hard to wait! DH and I really feel like we need to know more of what our options are right now. Do you think the OB or the RE would be better for that?
@mrskesslertobe: Excellent point. I need to check on that. Checking insurance just seems so overwhelming!
Well, you do need an OBGYN just in general. Is there one that takes both your current insurance and your future insurance? Then you can start seeing him/her now, and when you get the new insurance, they can refer to you the RE. That way, when you meet the new OBGYN, they can tell you how far they go with prescribing Clomid, and when they think you should see the RE (if it is before January).
I think your best option is to get to an OBGYN that you can stay with even when you insurance changes, and get the Clomid process started if they will do it.
@Mrs Green Grass: If you start with the RE, private pay, will the insurance kick in and start covering that RE in January??
Of course it depends on your financial means and how much you can afford to pay out of pocket. I know you want to get the ball rolling, but if full coversage would help out financially (especially around the holidays), then maybe waiting might be a safe bet.
Would you be able to make an appointment with an RE just to see what your options are for treatment and then decide if you want to switch your insurance to Kaiser? If you need to do injections for an IUI cycle it can get pretty expensive. If we had to pay out of pocket, our two IUI cycles w/injections would have cost us almost $5,000. BUT I also had to stim longer than most (3 weeks rather than 10 days) which means I had a lot more ultrasounds.
I know how hard it is to wait. I switched my insurance in January and then had to wait until March just to get an appointment. Our first IUI cycle didn't even start until the end of May by the time I got all their required testing done (which you've already done so that is a plus!).
Also, as a note about the pre-existing condition. When I switched I had to provide a letter of creditable coverage from my prior insurance stating that I had no lapse in coverage and as long as my new insurance had that letter my infertility was not a pre-existing condition, even though I had some testing and treatments with my prior insurance. So I would definitely look into that.
@sweetkate: Thanks for mentioning the coverage. I'm thinking that's how it would work...but I'll definitely have to make sure.
I cannot see the same OBGYN or RE if I switch to Kaiser. They do everything in house until you get to the in-vitro stage.
So I'm thinking it doesn't really make sense to see the OBGYN on my current insurance. But I do think I'll go to the private RE just so I am talking options with somebody. Then try to be patient until I can be seen by Kaiser....ugh.
Make sense?
@Mrs Green Grass: It does make sense if "testing" is covered. If not, it could get pricey. Keep in mind, my insurance strictly stated no infertility coverage, but testing was covered. So definitely get that clarified multiple times. The RE's nurse and/or financal department can help with that.
For your first Clomid cycle (which they may not even have you do immediately) you will need bloodwork on days 3, 12, 21, and 28 at a minimum. These were free for me, but would have been about $100 each otherwise. You will need ultrasounds on day 3 and day 12, and possibly 14 or 16 depending on how your follicles are growing. Those would have been about $250 each for me. Clomid is $50 (and may need to be repeated during the cycle if you do not respond) and an HCG injection is $100.
This does not include any consultation costs. And if for any reason they have you do IUI on top of all this, that is about $450 more. Of course all places are different. These are Boston prices.
Waiting sucks, but so does the cost!
My vote is to go to the RE now, and just plan to start treatments in January...unless testing is covered! I promise it will come sooner than you think. I am seriously wishing you the best of luck! I just don't want you to go broke in the process just to have an extra month or two of trying.
Can I ask how your weight is? The reason I ask is because at my first RE appointment, I was told to lose 15 lbs. I didn't hear this (too much on my mind that day), and didn't even attempt. I ended up being reminded by the RE's nurse a year later. I joined weightwatchers and lost the weight, then got pregnant the next month. I am not saying weight loss is the answer, believe me!!! I am just suggesting it as a possible way to keep your mind occupied and get your body healthy before January. A healthy body weight makes a huge difference. I was not fat by any stretch, but just too heavy for my body, which helped cause the infertility problems. But getting healthy is cheap, distracting, and sets you up for success when you do start treatments. If you are super-skinny then disregard all this!!
Sending love and luck!
@heathaah: You are awesome, really : ) I will absorb any and all advice you have!
I am normal weight, 5'4, 125.
I need to check on the testing coverage. It was weird the last time because it looks like my bloodwork was paid for even though I thought I would have to pay. I guess I have a phone call to make!
To clarify...do you think I should do the Clomid with the current insurance for now?
What I really want is progesterone testing in the second half of my cycle since I spot every single month for at least 3 days before AF.
@Mrs Green Grass: I would definitely get the progesterone taken on this next month if you're not preg. It's typically day 21, 7dpo. My doc took mine at 4dpo which I think was too early, and she agreed it was after realizing it (even though I told her that day!) Your spotting pretty strongly indicates a progesterone issue. I'd hold off on the Clomid until you know what you have to treat.
@Mrs Green Grass: Aw, thanks! I do think you should start Clomid if testing is covered. If not, consider the prices I mentioned and make the decision if you can financially do it, and if it is worth the extra couple of months. It just might be. But I can't make that decision for you. Day 21 bloodwork is the progesterone check, so you will be covered there. Your weight does seem fine, so just making sure you are taking your folic acid and eating healthy should do it!
@Mrs Green Grass: I'm in the same situation as you are. I was originally going to keep my insurance under DH and add Kaiser through my job. The only reason I decided not to due to my age. Being over 40, I need to be more aggressive so I realized IUI will be out of the picture.
I do have a colleague who is going to switch to Kaisier just for the IUI. She'll just have double coverage.
Like @heathaah said, certain tests are covered because it has to do w/ your health and just not fertility. My robotic myo was completely covered because it was affecting my health instead of just a fertility issue. If you want to check if a prescription drug is covered by your insurance, check out through your prescription provider. Clomid and Fermara is covered by mine but injectibles are not. You'll be amazed how much insurance will covered if the doctor codes the appt a certain way.
Also my RE office visits are covered because he also is an GYN as well. I made sure that he was covered before I agreed to meet w/ him. Have your RE's office contact your insurance to find out what coverage will be covered. This is how I found out that we would be paying for fertility treatments out of pocket.
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So my current insurance does not cover infertility. I have the option to switch to Kaiser this month where everything would be covered through IUI. I want to wait to see what happens with this cycle before switching to Kaiser (I prefer my Hospital System). I also need to check and see the process I have to go through if I do switch. The coverage won't start until January and I don't know how long it would take to actually see a fertility specialist. I recently switched OBs after a bad experience with a nurse so I feel like I'm in limbo with no doctor.
I have already done Day 3 blood work and HSG and DH has done Semen Analysis. All is normal, but DH has a slightly abnormal morphology.
So I have three options right now for appointments.
1) A current appt with a new OBGYN in my current Network on Nov. 9. (Probably will pay out of pocket.)
2) Go to private RE on my own. They are scheduling 2 weeks out. Initial visit is $245.
3) Wait for Kaiser (probably not going to do this!)
Should I schedule the RE before I see the new OBGYN? Should I skip the OBGYN since I have to pay anyway? My previous OB basically said that the RE would be the next step, but we didn't meet to discuss our test results (which were basically normal). I guess either place can order the next round of tests.
As I'm writing this, I'm thinking schedule RE right away and if I feel the need to go to OB, go, otherwise just cancel after seeing RE.
Advice Please!