A few testing and RE questions

[pinkcat]

Hi all,

We are on cycle 14 TTC and I met with my OB on Friday. She had previously told me she would run some tests herself, so that insurance would cover it, and then we would talk next steps.

She suggested CD 3 and CD 21 blood work, and an HSG. If all of those came back normal she suggested starting Clomid next month. I asked if it would be monitored and she said no, she didn't see the need for it. Based on many helpful threads here (even one on Friday, which was very timely and a good reminder!) I know that unmonitored Clomid is absolutely something I don't want. So, I will be asking her for a referral to an RE instead. But here are my questions....

1. I would like to do as much testing through her as I can since it will be covered by insurance that way. If I get the bloodwork and HSG through this OB, would the RE accept these results or do they typically want their own tests done, as well? Is it better to hold off and have the RE do the tests, and pay for them out of pocket?

2. What exactly is CD 21 blood work looking for? I am curious because I typically O on CD 20 or 21. Is this blood work done on CD 21 assuming a CD 14 ovulation? If so, should I get the blood work done on CD 27/28 instead, depending on O day?

3. I will be out of town for work on CD 3 most likely, as well as for the CD 21 blood work. Is it easy to get blood work like this done in labs not affiliated with your doctor? My doctor said I could just call around and find a lab in the city that I will be in. (Las Vegas) Just curious if anyone has experience with that or knows of a good website where I can find labs that will work?

Thank you in advance!!!

[notagoddess]

pinkcat, I started testing with my OB. He did an ultrasound and ordered CD 3/21 bloodwork for me and SA for MH. When my bloodwork came back abnormal he said time to go see RE. The RE accepted those results without any problem, but he had me do a lot more bloodwork as well as an HSG.

If tests ordered by your OB will save you money, you should go for it but expect you may need to do additional testing once you see the RE. The additional bloodwork was not CD-dependent, so it didn't delay too much.

When my OB did CD 21 bloodwork, it was to see if I had ovulated yet. It did not fall 7 DPO for me, more like 2 DPO, but progesterone levels confirmed ovulation. I'd ask your OB that question.

No advice on the last one but I know ladies here have done that.

Good luck!

[Rama]

May 23, 2016 9:07:37 GMT -5 pinkcat said:

1. I would like to do as much testing through her as I can since it will be covered by insurance that way. If I get the bloodwork and HSG through this OB, would the RE accept these results or do they typically want their own tests done, as well? Is it better to hold off and have the RE do the tests, and pay for them out of pocket?

My RE accepts stuff that I do through my provider, but I think this is dependant on the RE. Some will let you do it elsewhere, others prefer to be more in control.

2. What exactly is CD 21 blood work looking for? I am curious because I typically O on CD 20 or 21. Is this blood work done on CD 21 assuming a CD 14 ovulation? If so, should I get the blood work done on CD 27/28 instead, depending on O day?

CD21 bloodwork is so misleading. It should be 7DPO bloodwork. Primarily, it's a check for your progesterone (P4) levels to see if you've ovulated. This is also where people can find out if their P4 needs to be supplemented.

3. I will be out of town for work on CD 3 most likely, as well as for the CD 21 blood work. Is it easy to get blood work like this done in labs not affiliated with your doctor? My doctor said I could just call around and find a lab in the city that I will be in. (Las Vegas) Just curious if anyone has experience with that or knows of a good website where I can find labs that will work?

No experience with this, but as long as your doctor says it's okay, then go for it. It should be that hard to find a lab, but you might have to pay a tidy sum for your bloodwork. My RE will do "CD3 bloodwork" all the way out to CD5 and as early as CD2, so those might also be options for you to ask about.

[ironbaby]

My RE would have taken results from my OBGYN, but some will not. I would go ahead and find out who your RE will be and pose that question to them. In my case, I only had an US with my OB, and my RE accepted that result.

Definitely find an RE for monitoring.

CD21 is actually 7DPO bloodwork, so yes, you should schedule this when YOU are 7DPO. I know this tests progesterone, but not sure what else. My RE didn't ask for it, but I also have no losses. Not sure if that has anything to do with it.

Sorry I can't help with OOT labs. I know you can get it done from CD 2-4. Will that whole window be taken?

Good luck!!

[rooskie]

My RE took everything (CD3 bloodwork and HSG) from my GYN but they work in the same hospital and are besties the way they talk.

H has done his bloodwork offsite through La.b Cor.p and it went ok. The people were not as professional but if you can find one it will get the job done.

I would not take unmonitored Clomid.

Also, my GYN tried to get me to take Clomid because I was "normal" before we did our SA. Please get a SA done before paying to do Clomid and the monitoring. I would have been putting my body through that for nothing since our counts are so low. The OOP cost for my RE to do a SA is like $85 and well worth it before paying for Clomid and monitoring.

[pinkcat]

notagoddess Rama ironbaby Thank you! That is very helpful. I think I can make the blood work dates working knowing that it can be more like CD 2-4 or 5 and at 7DPO rather than CD 21. I will move forward with having her do the tests, knowing that it's possible I may have to re-do them with my RE.

Thanks again ladies!

[caer]

pinkcat - are you sure your insurance won't cover testing done by a RE? Mine did and I have a fairly crappy plan. It just depended on how the RE coded the tests. In my experience, REs are careful with their coding. Just a thought, if you're worried about a RE accepting the tests.

My RE doesn't do CD 21 testing but what everyone else said is my understanding of how it works.

My RE gave me a lab slip for the general blood work (not CD 3, all the other things like Vit D) and I was able to go to the lab of my choice. I did check with my insurance first to make sure I wasn't required to use a certain lab.

Good luck!!

[pinkcat]

May 23, 2016 9:27:19 GMT -5 rooskie said:

My RE took everything (CD3 bloodwork and HSG) from my GYN but they work in the same hospital and are besties the way they talk.

H has done his bloodwork offsite through La.b Cor.p and it went ok. The people were not as professional but if you can find one it will get the job done.

I would not take unmonitored Clomid.

Also, my GYN tried to get me to take Clomid because I was "normal" before we did our SA. Please get a SA done before paying to do Clomid and the monitoring. I would have been putting my body through that for nothing since our counts are so low. The OOP cost for my RE to do a SA is like $85 and well worth it before paying for Clomid and monitoring.

Thank you!! I forgot to mention in the tests she is doing the SA was also included. DH will be doing that in the next week or so.

I am so glad I found these boards way back when. I would not have known how to track my cycles without them, but I think now that I am starting IF testing it is even more helpful. I wouldn't have known that unmonitored Clomid was risky at all had I not seen it mentioned here so many times, and it's scary to think I could have been starting that next cycle. Glad to "know" all of you smart ladies

[pinkcat]

caer Good point- I am not positive that it wouldn't be covered, I was just assuming since I know IF isn't included in our coverage. I will look into this more and maybe the testing could be covered- thanks!!

[caer]

May 23, 2016 9:37:26 GMT -5 pinkcat said:

caer Good point- I am not positive that it wouldn't be covered, I was just assuming since I know IF isn't included in our coverage. I will look into this more and maybe the testing could be covered- thanks!!

FWIW, my insurance also doesn't cover infertility treatments at all. But it did cover the testing because of the coding. The RE's was able to check on it ahead of time for me, which was helpful.

[ironbaby]

IF is not covered by our insurance either, but IF testing IS covered. I would not have known without calling my insurance directly and asking.

[mustloveerica]

We had a lot of our testing done thru the RE just for convenience fake. A LOT of it was covered by insurance. I was surprised actually. So you may be pleasantly surprised as well.

[ohinvrtedworld]

May 23, 2016 9:39:51 GMT -5 caer said:

May 23, 2016 9:37:26 GMT -5 pinkcat said:

caer Good point- I am not positive that it wouldn't be covered, I was just assuming since I know IF isn't included in our coverage. I will look into this more and maybe the testing could be covered- thanks!!

FWIW, my insurance also doesn't cover infertility treatments at all. But it did cover the testing because of the coding. The RE's was able to check on it ahead of time for me, which was helpful.

+1 testing and treatment of "underlying causes" is covered for me. GL pinkcat! I hope that you find the most convenient and least expensive route for you to get testing done. 

[kayladawn91]

I'm in a similar spot as you pinkcat. So thankful for this community because I know what red flags to look for too!

[pinkcat]

May 23, 2016 9:54:28 GMT -5 kayladawn91 said:

I'm in a similar spot as you pinkcat . So thankful for this community because I know what red flags to look for too!

I'm sorry that you are here too, but glad we have this place to lean on!

[pinkcat]

Thanks for the insurance advice everyone- I am going to reach out to them today!

[thechickencoop]

So, you've gotten good answers so far so here's my two cents.

1. I think most REs accept bloodwork done elsewhere; however, they may need additional info. I had CD3 bw done through my ob but it didn't include an estrogen level so I just had it done again through our RE.

2. I'm positive your OB wants to check your progesterone at CD21. It should be done at 7DPO so you'll just need to figure out whenever that is for you.

3. My OB and RE both put in orders for either Quest or Labcorp for bw; they are all over the US so your Dr can order your tests electronically and you can have it drawn if you're OOT (depending on what labs are in your insurance network).

I second what everyone says about checking with your insurance. I would schedule with an RE and you can have them send in pre authorization for any appointments/services. You would know ahead of time what is covered and what's not.

Our insurance just switched in 2016 and we now have all our diagnostics covered but no treatments which is fine for now especially since my bw bill for the specific tests the RE wanted was almost 3 grand (yikes). I had my original testing done last year through the OB for this reason though.

Good luck lady

[thechickencoop]

I should also add that most of our testing was for repeat losses (three last year) so it's probably a little more than normal.

[aprilz81]

Another thing to think about with your insurance is how your plan is set up.

Even if a procedure/testing is covered you will still be paying out of pocket if you have to meet a deductible before your insurance kicks in. You will pay the negotiated insurance rate in that case (not the full out of pocket/cash price) but be prepared.

My plan has a $1,500 annual deductible and my insurance won't pay a penny until I spend that amount in a given year. After that, insurance covers 80% of all covered treatments (0% of anything coded infertility) and I still have to pay 20% until I hit my annual out of pocket max.

Also, RE's are experts at coding appointments to get insurance companies to cover as much as possible without breaking any laws. All of my CD3 appointments were coded in such a way that it counted towards my deductible even though I had to pay for the appointment since I hadn't hit my deductible. My mid-cycle monitoring and 7DPO blood work were usually coded infertility though... But it helped me hit my deductible early in the year. Now I only have to pay 20% of the insurance rate until the end of December.

[ldubhawksfan]

***Grad warning****

I would find out about RE referrals/network REs because my OB ran my IF bloodwork, and then ultimately my RE didn't accept it. that proved to be a PITA fighting with my insurance to cover the second round of it until after my daughter was born. It might not save you $ if you have to do it twice. Good for you for not taking clomid from your OB! Mine wanted to give me clomid too. I had my CD3 be done in a different city while I was traveling. Just make sure you find out what which lab your insurance goes through (i.e. Quest, labcorp) and you just bring your lab slips. My OB also ordered me to go in on CD 21, even when I reported back to him that I didn't O on CD14 (temping). That was when I was reassured in my decision not to take clomid from him. It was only because I was a pain that I convinced him to give me a second slip, which I went in on 7 dpi. It was my only real fluke cycle that I didn't O until CD21. When he called with those results that my progesterone was low, I said no kidding, because I hadn't ovulated! Low and behold my 2nd results looked normal. ::eye roll::

Good luck!

Eta: check with your insurance on everything. Don't just trust your dr. I know about the lab thing because my OB said I could do it elsewhere, but they gave me quest instead of labcorp because that nurse didn't check my insurance. I ended up with a $250 bill (about 20% for OON), when it should have been $0. I was pissed but learned about labs being in network. Costly lesson to learn.

[mikaela20]

1. My RE wanted her own tests with her own specific doctors to do them (lots of waiting for these to happen becuase of who I needed to see). So I would ask ahead if your RE would accept your ob's test reports. I'm sure for your circumstances , they will be more willing to work with you on what's best for you.

2. I've never had this bloodwork. They use U/S and bloodwork to check if ovulation is near or happened. So not sure about this one.

3. I think for bloodwork it should be ok to do it at another clinic and get the results faxed over to the RE. My RE just gives me the blood requisition forms and I can go anywhere for them. The only bloods I do at my RE are part of my u/s monitoring.

Good luck with sorting this all out!