TI, IUI, IVF - insurance requirements


#1

Me and my DH have been trying to get pregnant for almost 5 years. Last year finally made it to the FC, but it turned out our then insurance (Anthem) would only cover diagnostics. My job offers Aetna coverage, so with new year we switched to Aetna PPO (and new clinic, since the new insurance wasn’t accepted at the old one) and I’m happy to say it covers not only diagnostics, but also IUIs and IVSs (I believe up to 3 attempts). However, Aetna also requires that you do treatments in a certain order, i.e. clomid & TI first (3 cycles), then IUI and then IVF.

My EN recommended going straight to IUI, but the insurance wouldn’t pay for it, unless we stick to their recommendations.

Has any of you had to go through this as well? I have to say it’s a bit frustrating and to me it feels like just a waste of time.
I know I should be happy to have the coverage, but it would make sense if EN-recommended treatment could be covered right away.

One more thing - I chose a pretty big clinic, hoping their success rate will rub off on me. :wink: However, even though everyone is really nice and professional, I still feel like a case number… my EN suggested that some couples decide to go directly to IUI even though the insurance won’t cover it, if they skip the clomid-only (TI) phase. I said we wouldn’t be able to afford the long-term treatment this way, and would stick to the insurer recommendations.

I actually had to repeat this on three different occasions, and each time the nurse sounded like she was hearing it for the first time. I only got a schedule for IUI and had to do a tone of talking to make sure we were all on the same page.

It felt weird, almost as if - just because I decided to stick with what my insurance asked me to do - I didn’t really want to get pregnant strong enough…

Has that ever happened to you? How do you handle that?


#2

I would say stick to what insurance pays for if you both are normal. IUI with a couple who have no IF issues give you the same success rate as TI. So why not just give TI a few tried before jumping the gun.

One thing to remember is you are the patient. If you want something or don’t like something speak up.

Goodluck!


#3

Thanks [B]missingmy#2[/B]! I feel like I’ll probably still have to make a few calls to the clinic to make sure I have all the details. It’s almost like being a new kid at school, you don’t know how things work and nothing has changed for everyone else, so unless you know how to ask the right questions, you’re kind of left to yourself… :wink: