To discuss something I know is excluded

[Icklepickle101]

I've just got authorisation from my healthcare insurance to see a gynaecologist and have several scans and blood tests as I have a suspected ovarian cyst. We have been ttc for 14 months and our appointment at the NHS fertility clinic isn't until October.

WIBU to discuss my infertility with the gynae and hope he refers me for ultrasounds/can prescribe clomid (fertility drug my GP has suggested I will need) and any scans. If the bill only states 'consultation' or 'ultrasound' these have been pre authorised by the insurer albeit for a different issue

I should add I know infertility is excluded from my cover

The bill will be more detailed than that - and my insurer needs to preauthorise all scans in advance so you'd never slip it through.

You could ask about the likely effect of the cyst on your fertility. Fwiw I had a cyst and needed 90% of my ovary surgically removed but still managed to conceive DC2 and DC3 on it: the consultant said it rarely affects fertility.

Good luck with the consultant and for October. You've waited this long: don't cause yourself unnecessary financial headache for the sake of four more months.

I doubt he will, and you will get a big bill after if he does and your insurance won't stump up. Plus you would have to pay for anything he prescribed for you privately which would be costly. He probably won't specialise in fertility anyway and he'd most likely refer you to the same clinic anyway but you wouldn't be private there so you wouldn't speed it up anyway. They'd just see you were a duplicate referral and not do anything.

I know it's horrible waiting, but it would be much better to wait until October and save your money for later on if you come to the point of needing IVF later.

Incidentally I expect you'll be advised to take a break from ttc while the cyst is sorted out, so there's no advantage to jumping the queue anyway.

im sure the insurance company have never heard of this scam before

Private docs are great at putting whatever they need to down on forms to get insurers to cough up.
Mine didn't cover infertility but could and did pay for lots of investigations of irregular periods, including prescribing Clomid to try to kick-start periods and a number of day 21 blood tests. I did have to pay for the prescription for Clomid myself, which was about £30 a throw.

I guess I kind of knew the answer

In usual circumstances I would even entertain the idea but ttc does horrible things to your sanity!

Your gynaecologist will undoubtedly ask about your fertility and pregnancy history as part of your initial consultation. A pelvic ultrasound will be required to confirm or exclude an ovarian cyst, and will give basic information about your uterus and ovaries that are also useful in the assessment of infertility.

As others have said- he/ she is unlikely to set in motion any fertility treatment, but the basic investigations will still be very useful and relevant. If it's going to be a different healthcare provider for the fertility side of things, try and get copies of ultrasound reports or blood tests, as hospitals rarely have easy access to each other's results unless they're the same NHS Trust.

Good luck with everything

Citrus that's interesting. My periods are 4 weeks late (apparently because of the cyst) so I wonder if it could be related in a legit way?

I used to work for a travel insurance company (not the same I know) and people used to try this all the time. For example they'd go to visit a doctor or hospital for an 'emergency' condition and have non essential investigations or treatments. They would be flagged up to the fraud team and this can invalidate your whole claim as per the T&Cs even though the rest would be covered.

It's fraud. Expect to pay for the investigations not covered by your insurance.

Sorry if that sounded harsh btw! Definitely not intended that way. You just get to notice these things working for insurance companies but I haven't worked in health so I can't be sure.

In my experience doctors and dentists are generally pretty decent about filling in the insurance forms so that you get the maximum benefit to the letter (if not the spirit!) of the T&Cs.

Talk it over with the consultant at the appointment.

When we last used our private health insurance, the consultant was really good at telling us what would be covered, getting the best treatment for us, and telling us what would be best to go back to the GP for. Good luck.

Do it! Relate it all to your current condition, the consultant will definitely hear where you're coming from and help you out !

oh dear, but dream on dear OP, those bastards wont pay for anything if they don't have to. How much would Clomid cost if they prescribed it? Good luck

If you are being investigated for a cyst then the issue of fertility will be one that will obviously come up. I don't see a problem with that.

THeres nonharm in asking/discussing this during the referral - you can ask about what private treatment is availavle - it doesn't mean you have to take it - just discuss likely options

Doctor will be fine about this and ime are always keen to help,

A pelvic ultrasound scan is essential in the diagnosis of an ovarian cyst. It will also look at the anatomy of the womb and lining thickness. These things would also be done as an initial investigation in infertility. So that at least, you will get without any question of fraud!

However most gynaecologists are not specialised in treatment of infertility, so they are unlikely to initiate any treatment. And indeed should not, until you've had other tests e.g. Sperm analysis and your hormone profile.

Headsup: when we say "scan" we mean "dildocam".

those bastards wont pay for anything if they don't have to

Insurance companies are like that. It's kind of the point.