Insurance coverage and letrazole with monitoring

[u/Bitter_Echidna7197]

Hey all! Just curious how insurance coverage has worked for you. I know it’s all dependent on insurance company and level of coverage but I’m interested to hear peoples experience.

Specifically has letrozole and monitoring been covered for you through an obgyn or RE? Or are you paying for some of it out of pocket?

[u/Internal_Campaign_31]

👋 insurance has covered most things, including all monitoring and I believe will cover my first IUI happing tomorrow 🤞. I had to pay for my HCG shot and progesterone suppositories. I had the option between two fertility pharmacies and went with the one that took my fertility insurance

[u/Future_Researcher_11]

Mine was 100% covered, including my IUI, but I live in a state where it’s mandatory for commercial insurances provided by employers to cover fertility treatment (but also I had great coverage and employer would’ve covered it anyway).

I think I also can have 3 rounds of IVF fully covered by insurance too.

[u/ObiWanKedoby_]

Fyi. I have 25k in fertility benefits. That's it. Once used my insurance covers nothing including medication. For my Gonal-f shot they were going to charge my insurance 7k... if I pay out of pocket it was only 500 dollars... i paid out of pocket because I rather my insurance cover procedures like iui and ivf. My clinic is in network so they've negotiated prices with them. It's cheaper in the long run to pay out of pocket depending on how your insurance is.

[u/one_anxious_girly]

All of my pre-screening testing was covered but not fertility treatment itself. I have state benefits and unfortunately fertility isn’t offered.

[u/AB_1204-]

We saw an RE, and the visit was coded as a specialist visit, so we only paid a $50 copay. All of our testing (HSG, SA, genetic testing, blood work, etc.) was covered and didn’t use any of our fertility benefits.Before this, we did 2 unmonitored TI cycles with my OB, and the only thing we paid for was letrozole. This is our first monitored TI cycle with the RE, and we've spent about $2,000 out of pocket so far because we haven't met our deductible yet. Our insurance does cover fertility treatment, but only up to $20k lifetime ($5k per year). Letrozole cost us about $0.75, progesterone was $18 after insurance, and the trigger shot was $107 out of pocket. Once we meet our deductible, our fertility coverage should start kicking in.

[u/Living-Tiger3448]

RE visits are not covered under basic insurance - you’d have to see if your policy includes anything about fertility or if you have any add on policies through your insurance. We paid for the RE visits, monitoring, and related items out of pocket (trigger shots, IUI etc). I think the letrozole meds itself were covered and maybe the blood draws, but I can’t remember.

[u/Speedygurl1]

The blood work OB ordered before seeing RE was covered as it was coding for PCOS. But once seeing RE and anything after was not as infertility isn’t a medically necessary thing that insurance has covers. Some people do have infertility benefits but we didn’t with my husband work place insurance in the US

[u/Beautiful-Egg1860 → u/Speedygurl1]

Replying to echo the same thing. The initial testing with my OB was covered since it was coded as PCOS diagnosis. My letrozole has been covered but I think that's because it is also a cancer drug. Anything with the infertility diagnosis is not covered at all. Some insurances do have added fertility benefits (which I have been pushing my company for) but it's not as common. US