Intro and Questions about testing for RPL (Losses Mentioned)

[Deleted]

Hello Ladies
I am currently experiencing my second chemical pregnancy. Both this one and the one I had in September occurred at about 5 weeks. My doctor told me today that she is going to refer me to an RE for RPL testing. I am anxious to get some answers and maybe some solutions but I am about 90% sure my insurance does not cover even diagnostics for infertility. I can't really tell from looking at my plan. I know everyone's insurance is different but if you guys have any comments on this it is appreciated! Does having the referral from an OB help? Is testing for RPL vs. infertility with no pregnancies viewed differently by insurance companies? For those of you that have had this type of testing, what might I expect to pay if insurance doesn't cover it? Finally, what kinds of tests will they do? Thank you. 

[grneyes]

I'm so sorry for your losses. A lot of my RPL testing was billed under miscarriage, which might help you to have it coded that way if you do not have any infertility testing coverage. If you look at your plan brochure (like a 100 page pdf), they should have a section on maternity and infertility coverage, it should be on their website. I find if you call them you get that particular agent's interpretation of the policy which isn't always correct. Ask them to email you the plan brochure if you can't find it.

Typically, CPs are not considered to be a part of traditional RPL, but there still may be some things the RE wants to check out, especially if you have been trying for over a year. A typical RPL panel would be to check hormones (FSH, AMH, E2, Prolactin, 7 DPO Progesterone), Antiphospholipid Syndrome (there are several tests that check this), and things like thyroid (TSH, T3, T4, and thyroid antibodies), blood sugar levels, and Vitamin D should be checked too. A uterine structural assessment, such as saline infused sonohysterogram (SIS) is done to see if they are any polyps, fibroids, or other structural issues that could contribute to loss. If you have to pay OOP for that, it's cheaper than the HSG.

Genetic karyotyping is also done to see if you and your H have any chromosome issues that could also contribute to loss. It's expensive if your insurance won't cover, around $2-3k, so it's not typically done first if that would be an issue. Only about 5% couples have an issue there.

Inherited thrombophilias (blood clotting disorders) do not play a role in CPs, so they will not test you for that unless you have a family history of it. Most insurances will not pay for it if it's billed as RPL.

For my early losses, the RE recommended progesterone supplementation (vaginally) starting at 3 DPO, CoQ10, and baby aspirin to help improve blood flow to the uterus/establish a better initial blood supply to an embryo. If that doesn't work, they may recommend medicated cycles to produce a slightly better quality egg/ovulation/naturally higher progesterone levels, but again those cycles can be expensive if you do not have any IF coverage. A progesterone rx should be covered since it doesn't need to be billed as infertility.

Finally, see this google doc for RPL resources. Good luck, I hope your appointment with the RE goes well.

[sara20]

I'm sorry for your losses. Insurance is so confusing to sort out for this kind of thing. I would read your plan documents carefully and if you have it on a computer search for "infertility", including in the exclusions section. You could also call the number on your card and ask about coverage for diagnostics. When I got a referral to an RE, my primary care doctor volunteered to ordered tests if that would help with coverage. My insurance covers diagnostics though, so we didn't need to do that, but it might be something to try if it isn't covered by your plan.

Good luck.