Preparing for Infertility Consult

So we finally made the decision to see a Reproductive Endocrinologist. After 3 years of TTC (trying to conceive) on our own, Trust me we tried everything.
What finally was the straw that broke the camels back and made us take the plunge?

Well, it was Hubby that had been disinterested in seeking medical treatment. I think the month after month of no pregnancy, me constantly talking about babies maybe he finally realized that this isn’t going to happen with out help.
I had provided him with two options, See a doctor or start foster/adopt process. He was more keen on international adoption. (I may be misinformed but) I think international is too much work, too expensive, and there are some unethical practices in certain regions/agencies that I am skeptical about.

Once I got the go-ahead from Hubby, I started prepping for our Infertility consult.

Step 1 Choosing a Clinic / Doctor

For us it wasn’t very difficult to choose a fertility clinic, but for others this is a very important step.
Location: to me this was probably the main driving factor on where to go. I live in a rural area and work out of the home 4 days per week. A simple google search of “fertility clinic near me”. I didn’t want the commute to the clinic to be more than an hour. During treatment times it is likely that I will need to be there multiple times per week. We really only had one option, so it was easy for me to “choose”.

Hours:  Depending on your lifestyle hours of operation may be crucial to you. Be mindful of your obligations and select a doctor/center that will work with your schedule. Of course some times this isn’t always an option and you may choose to re-work your schedule around the clinic, I don’t think either is a right or wrong choice but for me, my schedule has very little flexibility and I will not re-work my life over treatments. (I say that now but we’ll see I guess!)

Success rates:  It seems like every clinic says their success rates are higher than the national average! Success rates do not take into account your personal diagnosis.  I have found the most non-bias information would be from the CDC 2015 Assisted Reproductive Technology Fertility Clinic Success Rates Report . Luckily the clinic closest to my home has higher success rates than any other in the state, and is higher than the national average. But again this doesn’t mean anything in particular for me as I have no clue our actual diagnosis or how challenging it will be for us.

Step 2: Set up the appointment

Call the number, and see what happens. Different clinics have different new patient intakes. The lady I spoke with was very well-organized, listed the info I’d need to be able to schedule the appointment with her. Like insurance card info, PCP / OBGYN names/numbers, Basic personal and heath info. She told me it would take about 20 minutes and asked if I had the time/info now to do this. I did, so we continued. She also let me know I had called during a busy time of day where she may need to put me on hold periodically to check other patients in. We were lucky again and were able to schedule our first visit only 2 weeks away, I think they typically book at least a month out.

Step 3: Paper work / medical records

We had to get out paper work/ medical records transferred ASAP due to Christmas /new years coming between the day I scheduled and our first visit. I called all my Dr.s that day and had them fax my records. This was easier than I expected, I didn’t have to sign any record release forms or anything, and they all agreed to do it the same day. I printed our new patient packet off the website and filled it out, it was pretty in-depth on health, sex and genetic questioning.

Step 4: Insurance

I live in a state that mandates fertility coverage. Boy did I think I hit the jack pot. Turns out it’s still very expensive even with “Insurance coverage”. This was the most difficult step for me. My employer doesn’t offer health insurance. I buy my health insurance through our state health exchange, and because of our income level I don’t qualify for any subsidies. It was open enrollment period so I had the option to change health insurance plans, but only for a very limited time. The health exchange website gives ZERO information on services covered/not covered for infertility. I had to call each insurance company directly and ask lots of questions, it was time-consuming and frustrating, eventually I got them to e-mail the actual plan policy to me so I could read and digest the info.  Turns out even the most expensive policies only cover fertility treatments after the deductible is met and is still subject to all co-pays and co-insurance.  It’s hard to really estimate what that would be as they don’t tell you what procedure costs what.

The “Gold plan” costs $550/mo. (x 12 months is $6,600) the deductible is “low”  at $1200. So Premiums + Deductible would be $7,800. Each visit to the specialist is $40 and does not count towards the deductible, RX co-pays do not count towards deductible. Even AFTER the deductible is met you still have to pay the same co-pays. They also have a long disclaimer on how cheaper/less successful procedures need to be done first before IVF, It’s a mess. So basically in my opinion it was not a cost-effective plan for me. Why would I throw away $7,800 to possibly get coverage but still have to pay $40 per visit and  up to $150 per medication? with an out-of-pocket max at $4,400. So the maximum price out of pocket (including premiums) would be $11,000.

I selected the Catastrophic plan. They make this plan sound horrible, but I wish I took advantage of it sooner. The Premium is the lowest possible ($200/mo). Preventive care and 3 doctor visits are covered at 100%. The deductible is astronomical @ $7,150. After the deductible is met every thing is covered at 100% , no co-pays or co-insurance.  So premiums are $2,400 + deductible of $7150 = $9550.

Infertility is expensive with or without insurance. The clinic probably has many options in how to pay, and may even offer cost sharing or multiple cycle discounts. I am going to look into this more once we get and actual diagnosis.

I did need to get a referral from my PCP sent to the insurance company, This was somewhat confusing as some people on the phone at my insurance company said I needed it, some said I didn’t. Turns out I did, and I’m glad I kept asking for clarification.

When dealing with insurance companies keep pressing them if the information they are giving you is unclear. You will always be at fault for not following their rules, even when they don’t tell you about them, and they frequently give false information. The people at the call centers are human just like us, and do not know every detail of every plan so keep asking if something seems unclear. It’s a good idea to take notes while on the phone, and ask for things in writing when possible.

Step 4: prepare yourself / show up

This is the time to do research and write down questions to bring with you. I’m so excited for the actual visit!

Leave me feed back in the comments section! What questions are on your list to ask at your first visit?



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