In which I, a know-nada newbie, solicit your advice in determining the correct allocation for flex spending, not knowing how many cycles I will go through, and whether I will be facing pregnancy & birth or a string of BFNs this coming year.
This is what I know:
Each visit to the RE is $40. This will be about $200 a cycle.
Each vial of jizz is $600 (Open donor, IUI).
We're going straight to injectibles, which are covered (but unclear whether I have the prescription co-pays which will be $35-50 per prescription per month).
How many cycles? Unknown. The way I look at it, I'm thinking well, we should at least spring for 6 cycles-- All my research says that after the third IUI chances of success drop dramatically from about 18-20% per cycle to about 5%, but this research was done on mostly straight couples with pre-existing (though not necessarily diagnosed) fertility issues, so may not apply AT ALL. BUT six cycles would mean we need 4 more vials-- and then there's the 200/month co-pays... That'll run us about $3400 just on jizz and co-pays for the first five cycles of 2010.
Not to mention the unknown prescription factor. For those who did injectibles: How many drugs is this a cycle?
Does 6 cycles sound about right? I mean, if we get nowhere with injectibles after 6 cycles, it may be time to consider other options (IVF? I said I wouldn'tgo there, but who the hell knows any more.)
And finally, what if I get a BFP?? For those who were recently there or about to get ther: How much in co-pays, hopsitals, etc. then? How much do you allocate for a possible BFP/birth?
Help? Anyone? Open enrollment ends Dec. 4.
Having never used FSA, take this w/ a grain of salt. Actually, make that a truckload of salt. We thought about signing up for FSA, but it was such an unknown, and not knowing how many we’d eventually buy, and since my insurance covers 100% of everything, including maternity/ birth, we didn’t. Blah blah. Anyway, our drs (the numerous ones we met with when we were at the first big fertility clinic), said try 3 (natual, clomid, injectables) of one thing, then move on. V’s injectables (Gonal F) was one pen per month (~$1400, but she paid a co-pay of $10). Actually, there was always some left over, so you can theoretically combine, if necessary. Like, one pen isn’t enough for two cycles, but maybe two pens would do two cycles (maybe).
ReplyDeleteIt's a tough call. GL!
xo
Oops, I meant to say maybe two pens would be enough for three cycles. I think there are diff’t sizes, but it seems like 1200iu is pretty standard, and if you start at the lowest dose, 75, and take it several days in a row, you will still have some left over that could contribute to the next cycle.
ReplyDeleteI'm ready to learn about the whole flex spending thing myself.
ReplyDeleteCan't anwser the injectibles portion of your questions, but I think there's $3,000 cap on medical FSAs so you'll hit the max no matter how you dice it.
ReplyDeleteAs for medical cost for pregnancy, assuming everything goes well you'll see an OB or midwife once a month from about 8 weeks until 30 weeks. Every other week from 30-37 weeks, and weekly from then on. Then there's the cost for any genetic screening you want (not sure what your insurance coverage for that will be). The actual delivery costs will vary greatly depending on your delivery. For me, a birth center birth with a midwife would have cost $7000 out of pocket including all prenatal care. My assisted vaginal delivery with epidural and 2 day hospital stay cost over $30,000 not including any prenatal care (this is before insurance, thank goodness!).
Good luck with the number crunching!
For my injectable cycle we did Lupron, Follistim and ended up needing progesterone in oil. But... all doctors are different. Are you able to call your doc and get his/her opinon??
ReplyDeleteThanks for your great input, everyone!
ReplyDeleteI did call the doctor to find out about # of visits per cycle (5).
I re-read the plan benefits and it does specifically state fertility drugs, oral and injectible, are covered 100%.
Hospital co-pay is $500.
It says nothing about birth center, so that remains the great unknown (and while HR woman is visibly pregnant while still attempting to hide it, I am not comfortable aking those questions of her.)
If we go with 3 visits, and budget in jizz, co-pays and a hospital visit (or, $500 toward whatever the birth center will be), we're at about $2100 for the year.
And if I shoot the moon? I guess I'll stock up on thermometers, baby tylenol and Pedialyte or whatever...
We took the max every year and have always used it with TTC'ing.
ReplyDeleteOur coverage also could be applied toward the sperm. Does yours? Something to consider.
I don't think you'll have a problem spending it all, but it's a gamble.
Personally, I'm voting for the Shoot The Moon option. So diapers it is!
ReplyDeleteAlso, can I please hire you as a consultant to setup my flex spending budget when the time comes? And are you sure you don't work as a freelance bookkeeper in your spare time? ;)
My doctor recommends no more than three cycles with injectables and I did a little research that basically wrote you plateau after three months on injectables. I am doing three cycles with letrizole and a little bit of injectables for three cycles then if not pregnant three cycles of injectables only. Hope this is helpful.
ReplyDeletei echo the comment about the cap. you will hit it no matter what -- pregnant or not -- within one year. the other thing to remember, if you dont hit it, i think I recall that most plans give you a grace period of 3-4 months to use your money after the plan year is over -- or is that grace period just to submit your reimbursements? I think I will end up losing about 100 dollars of my 750 deduction this year, and elected to take the maximum next year. also, maybe some providers will take partial payment in HSA funds and part of it in cash. I would elect for the total amount and then go for it!
ReplyDeleteHmmm. I checked with HR. The cap is $5K! I might go with 3, but 5 seems extreme, unless, of course, we're looking at IVF, which I swore I wouldn't...
ReplyDeleteNo advice. All I can say is your health insurance system is sooooooo complicated. I don't know how you navigate it.
ReplyDeleteI went with $5K for 2009 and am so glad I did as I went over that with out of pocket expenses this year. We did an IVF in Feb, had a D&C in March, did an FET in April, went out of network with my high-risk OB, and will have the birth on 12/21. I have excellent insurance coverage, too, and still had > $5K in out of pocket.
ReplyDeleteWe did know prior to signing up for FSA that we were going for IVF, so that made our decision easier. Good luck with whatever you decide!
I don't know a thing about the specifics of FSA since that's not offered where I work. I think 6 is a good number of cycles to plan for. They say that chances drop after 3 tries, but there are plenty of people in blogland who have gotten pregnant after IUI #3. I think most clinics start you at 75 for the injectables, and then move you up. In my experience, 5 is the max number of days they make you come in for monitoring at the clinic. Depending on how you respond to the meds, you may have fewer appointments per cycle. If it turns out that you don't have coverage for the injectables, I have an extra pen I can donate to the cause.
ReplyDeleteHI Keely!
ReplyDeleteI don't know about the old flex spending but with your helpful commenters and your brainy calculations I am sure you will figure it out. Good luck!
I had to pop over from J and DZ and tell you that BBC is Babycenter - and there is a GLBT section for TTC and one for pregancy ( which are the best sections of course) and some of us lezzie bloggers met over on the Babycenter message boards. There is a really cool group of women over there and very smart and unhysterical, unlike the women in the birth clubs sections which is I think a board for each month that your baby is due - so you can "bond" with other moms who are due when you are. According to Jand DZ and others it's a forum for ill-informed ridiculousness. So there you are -and if you want to come over to Babycenter GLBT fertility you are welcome. It's agreat place to get advice and share stories.
Thanks for your sweet and positive comments on my blog! I am looking forward to hearing about more of your journey:)
LOL @ the above description of BBC!! Very true assessment of what we all think of the Birth Boards - crazy women on there compared to the GLBT section!
ReplyDeleteI have no input on insurance but wanted to say that 6 cycles seems about right if you're going in with a strong plan for injectables/intervention.
Some people have gone into the the high teens without IVF but mixed in there is normally a time where the cycles have been unmedicated, or ici cycles at home. For example, we were going to go #10 before switching to IVF but did 3 unmedicated cycles and didn't try injectables until try #9. Therefore technically we fell into 6 medicate cycles and I wouldn't have gone further than that with switching to IVF.
Just a quick word about the hospital co-pay. That's for the hospital only. Not the OB and not the anesthesiologist if needed. The docs bill seperately. And you may have to pay that co-pay twice. Once for you and once for the baby. It also might not cover meds or testing done in the hospital. I was amazed that I got so many different bills for my birth. Birth center (before I transferred), midwife, hospital for me, hospital for the baby, OB for me, pediatrician for the baby, anesthesiologist, and anesthesia bills all came seperately.
ReplyDeleteHoly sh*t. This insurance business drives me crazy. What is wrong with this country?
ReplyDeleteDid you decide on the amount to put in? I think we're on the exact same schedule (cycles and FSA accounts!) since my cut-off date to sign up was Dec 4th also. Our cap was also 5k but we went with 3k. I figure even if we were to get knocked up early it will still cover classes, midwifes, meds, etc, etc if needed.
ReplyDelete