Oh joy! I have to repeat the Clomid Challenge test

Joined: November 28th, 2012, 12:12 am

January 21st, 2014, 1:22 pm #1

I know I shouldn't bitch about anything insurance related since I'm lucky to live in MA with IF coverage mandated but dealing with it makes my blood boil. Before my FET I have to pass the clomid challenge test. This is totally ridiculous since I'm not cycling with my eggs, I won't be taking any FSH, etc. I guess it's nice way for them to deny my coverage if I fail. We IF sufferers of the world must have been warriors in another life. The battle for a THB never ends!
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Mrs. McIrish
Mrs. McIrish

January 21st, 2014, 2:13 pm #2

That is beyond stupid. It really makes you wonder what rocket scientist at the insurance co is reviewing this since it is logically "dumb"!! They are frozen embryos from donor eggs which they approved you for... Makes you think they have no concept of what the donor process is and they are in charge of your future.
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Joined: September 13th, 2008, 5:13 pm

January 21st, 2014, 4:15 pm #3

I know I shouldn't bitch about anything insurance related since I'm lucky to live in MA with IF coverage mandated but dealing with it makes my blood boil. Before my FET I have to pass the clomid challenge test. This is totally ridiculous since I'm not cycling with my eggs, I won't be taking any FSH, etc. I guess it's nice way for them to deny my coverage if I fail. We IF sufferers of the world must have been warriors in another life. The battle for a THB never ends!
So . . . they know you need DE, but they're going to pay for you to take a Clomid challenge just to . . . make sure you're not lying about needing DE? That is bizarre! {{{Hugs}}} Take care, Maggie (in VA)
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Anonymous
Anonymous

January 21st, 2014, 5:17 pm #4

I know I shouldn't bitch about anything insurance related since I'm lucky to live in MA with IF coverage mandated but dealing with it makes my blood boil. Before my FET I have to pass the clomid challenge test. This is totally ridiculous since I'm not cycling with my eggs, I won't be taking any FSH, etc. I guess it's nice way for them to deny my coverage if I fail. We IF sufferers of the world must have been warriors in another life. The battle for a THB never ends!
Isn't failing the CCCT when they recommend using DE since it indicates a poor response to stim drugs for OE IVF?

Just trying to understand the reasoning. Seems like an unfair bias against those with high FSH but a healthy uterus and cervix.

I would think most people using DE could not pass a CCCT without cheating.

Oh well, I'm sure you already know how to pass this, I'm sorry you have to go through the motions after all you have been through.

Does the state limit the number of attempts they will cover? Just wondering if you are allowed to pay yourself for the FET without going through insurance since FETs are relatively cheap, and save the CCCT and insurance try for fresh DE $$$ cycles.
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Mimi
Mimi

January 21st, 2014, 5:22 pm #5

I know I shouldn't bitch about anything insurance related since I'm lucky to live in MA with IF coverage mandated but dealing with it makes my blood boil. Before my FET I have to pass the clomid challenge test. This is totally ridiculous since I'm not cycling with my eggs, I won't be taking any FSH, etc. I guess it's nice way for them to deny my coverage if I fail. We IF sufferers of the world must have been warriors in another life. The battle for a THB never ends!
Have you looked into appealing the insurer's determination that you need to pass a Clomid challenge test, since you're not using your eggs?
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Joined: November 28th, 2012, 12:12 am

January 21st, 2014, 6:12 pm #6

Isn't failing the CCCT when they recommend using DE since it indicates a poor response to stim drugs for OE IVF?

Just trying to understand the reasoning. Seems like an unfair bias against those with high FSH but a healthy uterus and cervix.

I would think most people using DE could not pass a CCCT without cheating.

Oh well, I'm sure you already know how to pass this, I'm sorry you have to go through the motions after all you have been through.

Does the state limit the number of attempts they will cover? Just wondering if you are allowed to pay yourself for the FET without going through insurance since FETs are relatively cheap, and save the CCCT and insurance try for fresh DE $$$ cycles.
The CCCT is supposed to predict how you'll respond to IVF stim medications. If you fail the CCCT the ins. co. (and some doctors) feel it's predictive of a poor response to IVF stimulation drugs. If you don't pass you don't get any coverage for DE or OE IVF. For women over 40 passing the CCCT is challenging. The insurance companies claim that not passing over 40 indicates that you have a natural and expected age-related decline and so they don't have to cover it. The state of MA unfortunately agreed and put that into the coverage mandate.

Most MA insurance companies will only cover DE if you have premature ovarian failure (diagnosed before your 40), your missing your ovaries, of you've failed to respond to stimulation in an insurance authorized OE IVF cycle. I fell into that last bucket.

Some insurance companies put a cap on the total dollars for IF coverage. My insurance co puts a cap on the number of IVF cycles at 5. I just completed #4. FETs don't count toward that cap so thank God I have frosties.

My read on my DE authorization letter from them suggests that my DE IVF cycle isn't over until I either get PG or use all the embryos from that cycle. It's unclear if that is specified so that it's clear that FETs don't apply to the IVF cycle max only. The financial person at my clinic agrees that it reads that way but says they are regularly getting push back from the insurance provider citing out of date CCCT. It's shady. My clinic is pushing through the authorization for my FET without a new CCCT. Fingers crossed that it gets approved. My gut says I'll be dealing with it again.



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Joined: November 28th, 2012, 12:12 am

January 21st, 2014, 6:18 pm #7

Have you looked into appealing the insurer's determination that you need to pass a Clomid challenge test, since you're not using your eggs?
Waiting on feedback from the clinic. They requested authorization even though they expect it to get kicked back requiring the CCCT. It's such a racket.
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Anne
Anne

January 21st, 2014, 6:47 pm #8

So . . . they know you need DE, but they're going to pay for you to take a Clomid challenge just to . . . make sure you're not lying about needing DE? That is bizarre! {{{Hugs}}} Take care, Maggie (in VA)
The CCCT is just 2 blood draws and 5 clomid pills. If the clomid makes FSH skyrocket between blood draws due to the clomid, patient can be labeled a poor responder and disqualified from treatment coverage (there is always self-pay).

If you are under 40 and want to do DE, you need to fail the CCCT to show POF? And if you are over 40 and want to do DE you need to pass it to prove you are still theoretically fertile and deserving to have the state government pay for a child? Bizarre! Although I guess the RE has some discretion to still use DE for under-40s if they pass the CCCT?

I wonder if MA got these guidelines from countries with socialized medicine where fertility treatments are covered by the government if the patient meets strict guidelines?
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Joined: November 28th, 2012, 12:12 am

January 21st, 2014, 10:37 pm #9

With my insurance it's not as cut and dry as failing if under 40 and passing if over 40.

If you're under 40 and fail there is additional clinical criteria that you must meet to receive ANY IF coverage. Moving on to from OE to DE requires failed cycles and/or other clinical factors like missing ovaries, poor egg quality due to prior medical treatment (such as treatments for cancer that permanently damage eggs). It's a quagmire of documentation and red tape.

Over 40 you need to pass to prove that stimulation meds could assist your fertility. Unless you've got a health ins plan that gives you a dollar cap that you can use on any treatment you like, you need to have met other OE failure issues to get coverage.

The state government contributes nothing financially. Not sure how MA developed this policy. I know my policy inside and out at this point. Other MA insurance providers manage it differently. My clinic says my ins is really good an accommodating. Once you get the coverage doc from them it was much easier to carve a path forward. The ladies on the pink board were life savers helping me to sort it out and figure out how to advocate for myself with the clinic, ins co, etc.

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Anne
Anne

January 22nd, 2014, 1:22 am #10

I don't understand their requirement, but glad you can find a way to have this covered by insurance. Passing the CCCT shouldn't be difficult and will only set you back a month I guess, since the FET cannot be done in the same cycle. Good luck AC I am rooting for you and McIrish.
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