clomid - when to take/cost

  1. You have chosen to ignore posts from stefani2. Show stefani2's posts

    clomid - when to take/cost

    does anyone know if one should take clomid in the AM, PM, or does it not matter, etc.?

    also, does anyone know how much clomid/iui is going to run me?  it's not covered by my insurance - ugh! 

    tia!
     
  2. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    Hi Stefani,

    I'm very surprised it's not covered by your insurance.  Are you in MA?  MA requires that fertility treatments be covered by insurance (there are minimum guidelines, so not all insurance is the same, but most things are covered to a certain extent).  Are you jumping straight to IUI or are you taking clomid alone for a few cycles first?

    I really don't remember if clomid had to be taken at a certain time of day.  That's a question a nurse at your RE's office should be able to answer for you though.
     
  3. You have chosen to ignore posts from stefani2. Show stefani2's posts

    Re: clomid - when to take/cost

    hmm, yes i am in MA... the dr seemed surprised it wasn't covered, too.  my insurance clearly states that fertility diagnosis and treatment is not covered... it's annoying!
     
  4. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    I think you should call your insurance company.  MA law requires insurance companies to provide coverage for infertility treatment.  The fact that your doctor was surprised is very telling.  Do they have a billing person that you can speak with?  They would know alot about submitting claims to insurance and what different policies will cover.  And of course, they can tell you how much the cost is if it isn't covered by insurance.

    Online, this is what I found about the law in MA:

    Mass. Gen. Laws Ann. ch. 175, § 47H, ch. 176A, § 8K, ch. 176B, § 4J, ch. 176G, § 4 and 211 Code of Massachusetts Regulations 37.00 (1987) require general insurance policies, non-profit hospital service corporations, medical service corporations and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization. The law defines "infertility" as the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year.

    2005 Mass. Acts, Chap. 111 expands MassHealth program to cover infertility-related costs for those eligible. (HB 4178)


    Since you've been diagnosed with PCOS, that should make you eligible for coverage.

    I'm really baffled about your insurance situation.  Let us know what you find out!

     
  5. You have chosen to ignore posts from stefani2. Show stefani2's posts

    Re: clomid - when to take/cost

    ooh - amrunner, i think you're right.  we are self-insured, i think.  (as you can see i generally tune out on this topic!)  sigh...

    (the other lovely benefit to this is that i think the HR and/or accounting dept know all about my issues!  :(  )
     
  6. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    Fwiw, I work for a large company that is self-insured and all of my infertility stuff was covered--so it's not a universal thing.  Amrunner--it sounds like you know about this stuff--why are ERISA plans not required to cover state-mandated benefits?  And I also read something somewhere about plans that cover pregnancy benefits HAVE TO cover fertility treatments...does their lack of infertility coverage indicate that they may not cover pregnancy benefits either?!

    Stefani--usually companies that are self-insured hire a company like BCBS or Harvard Pilgrim or Tufts to administer their plans since it would be such a major hassle to do it themselves.  I also don't think any company wants to get itself involved in HIPAA (patient privacy) issues with an HR or accounting employee knowing the intimate details of another employee's health issues.  I'd be surprised if they knew this information, unless, of course, you called them to complain about their lack of coverage for fertility issues! 

    Sorry if I'm sticking my nose into this too much.  I'm just really curious since I've never heard of anyone in MA not having coverage for this stuff. 


     
  7. You have chosen to ignore posts from stefani2. Show stefani2's posts

    Re: clomid - when to take/cost

    i appreciate your sticking your nose in! i 'm generally lazy about having to follow up with bureaucracies (i can't spell) but maybe it's worth a call.  my co has tufts/cigna.   i'm sure pregnancy treatment is covered.  i don't want to talk to anyone in HR at my firm b/c it's a small family business and i don't want everyone knowing my business (as much as i can help it).  i'll keep you posted!
     
  8. You have chosen to ignore posts from am1028. Show am1028's posts

    Re: clomid - when to take/cost

    If Stefani2 works for a large company that's based out of another state which has no mandates for coverage, then she might not have the coverage because the insurance plan of that state wouldn't include infertility coverage.  For instance, if her company is based in Georgia and they have a Georgia insurance carrier, then since Georgia has no mandates for infertility coverage, they wouldn't need to cover it.

    ETA: Just noticed that you work for a small company, not a large one and it's likely based in MA, so my thought is wrong.  I have no idea why you wouldn't have infertility coverage......
     
  9. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    am1028--it doesn't matter where the company is based.  If it OPERATES in MA, employees working in MA would have to have coverage of some sort.  (Although I'm sure there are some companies that just opt to pay the fine for not offering coverage, I don't think that's the norm.)  If people don't get it through work, it would be through one of the plans offered by the state--all of which are required to provide coverage for infertility treatment.  This is why Stefani's situation is so weird to me.  I'm SURE there are loopholes and exceptions, etc., but I've just never encountered anyone having this issue before.
     
  10. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    amrunner--thanks for the explanation.  I'm really disappointed that there are companies who do stuff like this, but I guess I'm not surprised.  In cases like this, I almost wish these companies would just pay the stupid fine and let their employees get coverage through the state (I say this from the perspective of not knowing any of the details about the plans offered by the state, so it's possible that wouldn't be better, but it sounds good for now).

    am1028--after reading amrunner's post, I did some more research.  Apparently you might be right.  Companies who operate in more than one state are allowed to self-insure and then offer the same plan to employees in all of those states w/o regard for each of those state's particular laws.

    Stefani--it sounds like your first step is to find out for sure if your company is self-insured.  I know self-insurance makes a lot of financial sense for larger companies, but as I understand it, it usually makes more sense for smaller companies to purchase insurance.  Then, regardless of the answer, put in a call to Tufts/Cigna to ask them about the infertility stuff.  They may cover some things but not others under specific circumstances, so it can't hurt to ask.  And then, call your company's HR again and tell them they're mean and stupid.  Ok...maybe don't do that, but it would be nice if there were a way you could complain and protect your privacy at the same time.  I'm not sure an anonymous letter would be taken seriously, but I'll let you know if I come up with anything.

    Let us know what you find out.
     
  11. You have chosen to ignore posts from Notanewbie. Show Notanewbie's posts

    Re: clomid - when to take/cost

    I really, really hate the self-insurance option.  I used to work for a small company based in MA that self-insured.  HIPAA be damned, not only did accounting and the HR person know about everyone's medical conditions so did most of the company since it affected our premiums the next year (after various employees had two hip replacements, a broken back and two pregnancies covered).
     
  12. You have chosen to ignore posts from Notanewbie. Show Notanewbie's posts

    Re: clomid - when to take/cost

    I don't think there's any way for your insurance to know how long you've been trying.  I'm sure there are codes and such that might affect billing and coverage, but I don't think they are specific to 6 mos vs. 1 yr of fertility problems.  You can mention it to your doctor when he makes the referral or the RE office when you make the appt to find out if there is an issue with coding.
     
  13. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: clomid - when to take/cost

    It'll depend on your insurance, but I would think the RE--a specialist--would be covered if you had a referral from your PCP.  The RE will then do some initial diagnostic testing like bloodwork and review any charts you have.  Then, IF the RE diagnoses you with a fertility issue, treatments for it SHOULD--SHOULD--be covered by insurance before the 1 year of trying mark.  Let me reiterate...it SHOULD be covered by insurance (grumble, grumble).  The RE might also do an HSG, and again, that should be covered as well.
     
  14. You have chosen to ignore posts from stefani2. Show stefani2's posts

    Re: clomid - when to take/cost

    ok - i called the insurance co. and they confirmed they do not cover any fertility treatments.  they will cover an underlying condition that causes fertility problems up until the point of infertility diagnosis.

    i can't decide if i think that's totally rotten or not.

    anyway - then i called the hospital to see if they could stop routing all of my fertility treatment bills through insurance, since it's not covered anyway, and instead just send them directly to me (thereby avoiding the HR woman and accounting department including COO knowing everything).  they said they were going to put the request in, but warned me that sometimes there's still a mix-up.  also, i called the obgyn dept. so DH's sp&rm deposits for the IUI will probably still go through insurance unless i call whatever dept. that is - but i'm not getting a warm fuzzy feeling that it's worth the trouble - think it's just going to cause confusion - so i don't think i'll bother.  :(
     
  15. You have chosen to ignore posts from whatawagSBNy. Show whatawagSBNy's posts

    Re: clomid - when to take/cost

    The generic of Clomid is on Walmart's list of fixed prices-  clomiphene, I think - on the walmart pharmacy prices pages, put in clomid, it will tell you which of the generics they cover.

      I believe a month of 5 50 mg is $9,   3 months is $24 or $25.  Some people end up taking two fifties if one does not work, and there is no separate plan - your costs would then be Max $18 for a month, $48-50 for 3.

    Should be this page, click Women's Health  for a pop up window.
    http://www.walmart.com/catalog/catalog.gsp?cat=546834

    No one ever should take clomid more than 5 months.

    So a maximum of $50 for 5 months single pill.  never more than $72  for the entire maximum length of treatment, because they never would up the dose without trying 2 months regular, first.
     
  16. You have chosen to ignore posts from whatawagSBNy. Show whatawagSBNy's posts

    Re: clomid - when to take/cost

    When to take :  Talk with your Dr.  Some people experience a little dizziness within an hour of taking it, others after several hours.  If you have some fixed thing like an hour commute to work,  then home,  you may have to schedule so you do not feel light headed doing that.
     

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