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A question for those ladies in the US

This is a general medical insurance question. I know they all vary/differ but I was wondering for the most part what is covered?? I know general gynecological appointments are covered but what if I have to see a reproductive endocrinologist. Is that type of visit usually covered? I mean for real now no period in 5 months I would assume tests for this would fall under normal/specialist coverage right or would they say that is reproductive counseling/testing and not cover it? The coverage I have covers all annuals and things deemed medically necessary but reproductive counseling/testing I would have to pay $2000 grand up front then would be cosidered covered. I just don't have the $2000 straight up. Considering my severe irregularity I am hoping it would be seen as medically necessary for additional testing...Does anyone agree????

6 Answers • 12 years ago


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member

of course it all depends on your insurance but generally speaking, you should be able to go and see a specialist. you sound like you have a very legitimate and compelling reason to do so. Some insurance policies let you self refer to a specialist in your network, others require you to go to your primary care provider (doctor) to then refer you to a specialist. You should call your insurance company to find out who is in your network and if you can self-refer to avoid charges. That being said, visits and meds and treatment should all be covered. However, if you are thinking about infertility treatment, that is may be another story. Some insurance plans do not cover any fertility treatment b/c its expensive. Others may only cover IUI but not IVF and its likely that they only cover 1/2 the cost of treatment, procedures, visits and meds AND you will likely have to go to an in-network provider (not a private clinic). Or you may have a super plan like the citizens of Mass. and europe have!GL

12 years ago


Right now I am not thinking about iui and ivf yet. I just want hormones checked and possible meds to stimulate ovulation. I'm hoping they view regular menstruation as a valid reason for some testing. I really want to know if I could possibly have pcos or another kind of hormonal imbalance. Right now like I said I just want hormone levels checked and meds to help with ovualtiion because there obviously is something not right with me.

12 years ago • Post starter


member

any gyn. can prescribe blood work (to test hormones), even clomid. not sure what other meds are available re ovulation but unless it is meds to make you ovulate more (ike ivf drugs) then your regular gyn. should be able to do so. i think you will be covered.

12 years ago


member

Insurance companies can vary so much. If you want to make sure you are covered, you'll probably need to call your company directly and talk to them about it. I know some women who have had things covered that others haven't. The only way to know for sure is to talk to them. Good luck!!!

12 years ago


member

i forgot to say that your gynocologist should also be able to perform an ultrasound, you should be covered b.c. your issues are general health of a woman issues.

12 years ago


Yeah I will be calling once my hubby is able to add me. I just fishing for some opi ions on it. I know most donKt cocver infertility or like my hubbys there is a pretty high deductable then covered 100% so its not bad and I will do it if I have too but if i can get a diagnosis without paying towards the dedutable that would be great :)

12 years ago • Post starter


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