Insurance question - calculating one year of infertility

[Anonymous]

Our new insurance requires us to be unable to conceive after one year of unprotected sexual intercourse. We tried for over a year before conceiving our first child in 2011 with help from clomid and progesterone. DS was born 2012. We started trying again in 2012 and tried for 4 months naturally, then conceived in our second cycle of using progesterone. We miscarried. We have had 8 unsuccessful cycles since then. Does anyone know if I am considered infertile because of my year of infertility before DS? Or do I have to try for another year? If it's the latter, does the miscarriage restart the clock? In other words were we eligible in Novemver 2013 or are we not eligible until April 2014? I am really appreciative of any advice trying to get answers from insurance is a nightmare.

[Anonymous]

The way that I understand it, at least with my CareFirst HMO plan is that once you have a live birth then the clock starts over. If you were trying for 4 months and had a miscarriage, the miscarriage does not count as it was not a live birth.
With my fertility treatments I was allowed 6 IUI's per live birth. It didn't matter if those treatments resulted in a miscarriage, it was not a live birth and I could continue on to the next one.
I think you would be ok to call an RE. I actually found my insurance company very easy to deal with. I was also able to find all my coverage and benefits online.

[Anonymous]

OP here - thanks PP. I have not found the information about the miscarriage issue. But this gives me hope. Thanks again.

[Anonymous]

Is the miscarriage documented? Was there a heartbeat identified?

[Anonymous]

Yes it's documented. I had a d&c. There was never a heartbeat.

The more I think about it my situation seems dissimilar to the PP's above. She would have been diagnosed infertile after a year without conception, then had a miscarriage. I had a miscarriage before the year was up, meaning I did conceive within 1 year. Seems different. Anyone have a similar experience?

[Anonymous]

I remember discussing this issue with my re and he said if there was no documented heartbeat, he could argue it wasn't technically a pregnancy. I think it depends on your insurance. It can't hurt to talk to an re about this.

[Anonymous]

Ok. I have an RE. They're great and I'm sure will do what they can. This is a new insurance co for us with so many hoops to jump through. It's just frustrating because the RE thinks we need to move forward with more aggressive options. That's why we got different insurance in the first place. Now it seems we may have to wait until may for coverage to kick in. It's just frustrating.