Monday, July 28, 2014

Vasectomy Reversal & An Update

We received awesome news last week! Mr. R called the urologist and asked them to check our insurance to make sure that they do not cover vasectomy reversals.  The kind nurse who has done a lot of digging through our insurance for us to discover that TESE was covered said, "We don't ever check with insurance companies for reversals, none of them cover them.  The cost is $5,000 and the best you can hope for is that they MIGHT cover the hospital portion for the surgery.  You will need to call them for this part."

Mr. R dutifully called our insurance and the woman he spoke with said, "Oh no, we definitely don't cover vasectomy reversals, but let me check on the hospital portion..."  She kept him on hold for what felt to him like an eternity before coming back on the line... "Um... so I looked into it and it seems that we WILL cover infertility reversal surgery 100% and since you've met your deductible that's $0 out of pocket."

Infertility reversal??

Mr. R checked with her several times and asked her to double check with a colleague to make certain that this meant vasectomy reversal.  She came back and confirmed that yes, vasectomy reversal is considered "infertility reversal" and yes, we are 100% covered.

Okay, so I am still well aware that the chance of a "natural" pregnancy -- I hate that term... (what's a better way to refer to an unassisted pregnancy?  I guess unassisted pregnancy sounds better already!) We know that the chance of an unassisted pregnancy is very very low... like tiny, miniscule chance, but at least it opens that door for us every month so we're doing it. Urologist consult is next week.

AF showed up yesterday at last.  I stopped progesterone and estrogen supplements on 11dp3dt.  I called it in to the triage line  yesterday and this morning received a call from my cycle nurse who said, "Okay, so you stopped progesterone 9dp5dt"... uhmmm... we didn't do a 5dt, we did 3dt?  "Oh you did? Okay then..."  HOW does my cycle nurse not know this?  Does anyone else ever feel like their cycle planning is all just a prefabricated sheet that they pull out of a filing cabinet under a tab that has your diagnosis?  Like "Over 35, DOR" and out comes a sheet with a basic plan for micro flare lupron.  Ugh... Well we're moving into uncharted territory now... or rather, we're moving into territory rarely charted by this clinic... so my hope is that now I will have to have an even more customized cycle plan.

She didn't sound enthused at the idea of a reversal and thought it was unnecessary, but advised me to discuss with my doctor. That's fine.  I know what they're all going to say, but we're doing this anyway.

She advised me that my RE can do a laparoscopy for me and that there is no need for me to go through my OB GYN for this.  Probably a better idea so that he can time it to match my cycling.  But their surgery facilities are out of network and so we will have to pay for that out of pocket -- whereas my OBGYN surgery is IN network and would be free.  (ALWAYS money isn't it...)   Strike this, see below... just had a call from our finance rep and we're pretty sure that we've met our out of network deductible too at this point, so there won't be any difference cost-wise.  Better then to do the lap with my RE so we can time it in with my cycling.

She says that I will need 6-8 weeks post laparoscopy for my lining to repair enough for transfer... but I mentioned that with banking embryos this was a non-issue, at least for 2-3 retrieval cycles.

She also said that we cannot do back-to-back retrievals as the risk for cysts is increased with the constant stimming.  I would need to do a stim cycle, rest cycle, stim cycle, rest cycle, stim & transfer cycle -- if we have any to transfer. So we're looking at transferring in or around January 2016... maybe.. depending on how much of the PGS stuff is out of pocket and how my 100% insurance coverage for IVF will work with stim-only cycling.  Back to money again... *Sigh*

So that's where we stand right now... will know more after WTF appointment on Wed about how we're going to proceed.  Mr. R has run out of sick/vacation/personal days at work and so he will be taking an early lunch to join us by phone for the consult... it sucks that he can't be there, but it's the best we can do without jeopardizing his crappy job that comes with awesome insurance.

That's another thing... Mr. R accepted this job as he transitioned out of law enforcement and completed studies for a new career.  The work is menial, the hourly wage is deplorably low, his colleagues are (mostly) insufferable... but as we've discovered the insurance kicks butt!  He will need to tough it out a bit longer until we can figure this out.

Just had a call back from my clinic's financial services:

IVF: We've now met in network deductible so this is free
Facility Fees:  We've met our out of network deductible (though it's not yet reflecting) so this SHOULD be free, but worst case $1,500 for each of us for retrieval and TESE
(PGS requires a medical review and approval on a case by case basis.) 
Biopsy: My clinic fees for biopsy - $2,750
3rd Party Lab:  $3,000-5,000 (Shady Grove Testing in Maryland)

My clinic will require $2,750 biopsy fee paid up front.  I deal directly with 3rd party lab on their costs.

Donor Eggs
IVF Me:  100% cover
Facility: Most likely free, but possibly $1,500
Donor Services (everything including meds):  Verbal confirmation that this is covered 100%.  My clinic requires confirmation in writing.  IF they don't get written confirmation this portion ALONE is $16,000 but it looks like everything for me and Mr. R is covered at this point. We can expect written confirmation or denial in 2-3 weeks.  Our financial rep is submitting the written request today.

Money. Money. Money. Money. 


  1. Holy crap, your donor egg cycle would be covered by insurance? What magical land do you live in that offers this coverage?? Anyway I hope you won't need it but it's good to know that it's an option. I'm sorry that this cycle didn't work for you.

    1. Apparently it has something to do with Blue Cross of Illinois, or rather the fact that the insurance company has to abide by the rules of the state of Illinois which has some kind of ruling about IVF. Weird how we're covered through Illinois because we live in deepest darkest Texas, but my husband's company has offices all over the country, including Illinois.

  2. This is awesome that you can get all this covered. Amazing! This crap is so expensive, but so great that it's covered. Now you just need to find that Western Union lady!

    1. I know. We cannot believe our luck! I wish everyone had this kind of cover. We have a medical issue, it SHOULD be covered across the board for everyone. Oh, if ONLY I could find her! haha But yesterday I think we may have found someone even better... :s