Confusing Coverage Questions (say that 10 times fast)

A few weeks ago when open enrollment started at work, I called the doctor. I wanted to ask her about a proposed "timeline" for the procedures and testing I faced next year so I could determine my "out of pocket" costs and load up the Salary Stretcher Plus account. Well, after 2 weeks and 3 calls to the doctor, I finally got some information. I don't really know how helpful it was. I was given a sheet entitled "Reproductive Medicine Testing Estimate Sheet." My favorite nurse circled the things that Dr. Dutta will want to do right away and then made some notes about what they expect Dr. Jeret (the specialist) to do if I am referred to him next spring.

Then today, armed with questions about what is actually covered by our plan at work, I contacted Health Alliance. I was on the phone from about 1:18pm until almost 2. I wasn't quite sure talking to the customer service representative. I felt a bit uneasy. She placed me on hold a few times and didn't seem to confident in her answers. She did assure me we have the "Enhanced Infertility" coverage and then rattled off a list of things covered. I asked her to fax me this list for reference. She did well and I grew more comfortable under the understanding that most everything we face next year will be covered with the exception of the expected office visit co-pay of $40. I'm pretty sure she even said invitro was listed. I'll have to do some research.

However, she also transferred me to one of the nicest ladies ever named Judy. She is the nurse that reviews and authorizes all the infertility testing. She was very helpful and even gave me her direct number. I also expressed my worry about switching the coverage from my name to Clay's through work but said we would still have the "Enhanced Infertility" coverage but just a different member number.

Now I am ready and waiting.....waiting for January, waiting for the insurance coverage to get switched, waiting for my wonderful nurse Stacie to send in the authorization request for infertility testing and treatment, waiting for the "good" drugs, waiting, waiting, waiting......

On a side note, that nice lady Judy thought Clay could go ahead and do his semen analysis immediately. She didn't think it would require pre-authorization. She said they usually just pay for those in full if request. So, when I call the doctor back in December to get the ball ready for January, I will have to ask about how to get that started.

I still don't know what to do about the Salary Stretcher Plus. I figure I will just put $500 in and use what I can. If I get pregnant right away great if not, we keep plugging away.