Finding a certain kind of doctor

My health insurance kicks in on June 1, and this is the first time I'll have had insurance in SIX years! (so excited). So i really need to go to the doctor, needless to say.

I will have really good insurance. I work in a large medical clinic, all specialists ranging from ENT to Urology to Plastic Surgery, but no fertility specialists, like I think I may need.

Do I need it?

I ask b/c my husband and I want to get our fertility tested. We are NOT looking to have a child right now, but we want to know if we are even going to be able to (personally I'd rather not have them, as I've always wanted to adopt, but my husband doesn't want to adopt unless we KNOW we can't have one of our own). Anyway, we both want to get tested to see what our next step is (having a child is still a few years off, regardless).

How do I find one? I'm looking over the in-network doctors right now and find one in my area. Do I need to wait to visit a Gyno (June 14) and get a referral? How do referrals typically work? I'm so confused on it all, and this is my first time working in health care so I really still have no idea.

Also, how do I go about finding a primary care doctor? Just pick one in network? What am I looking for, exactly? Would a primary doctor be able to do a physical on me (I want my blood, cholesterol, heart, etc checked)? If not, what kind of doctor do I visit to find out if I'm healthy or not?

I've only ever looked for Gynos before when I had insurance before but I honest to god haven't been to a doctor since 2006 (no lectures please) so this is all so new to me. I feel like I should know this stuff but am so lost!

If it helps, I have BCBSFL BlueOptions insurance

You can call your insurance company to see what their restrictions are. I believe BlueOptions is a Preferred Provider type of policy (PPO). So you should select doctors in their network for the best coverage. Sometimes you need advance permission for certain things (and infertility treatment may fall under that). Give the insurance company a call to make sure you get the best coverage.

For a regular physical a primary care doctor can do everything you should need. Many insurance policies cover an annual physical at 100%. Then your primary doctor can refer you out to other specialists if you have specific needs.

It is a PPO, Avman. I don't know the difference between PPO and HMO though!

Is an annual physical different from a yearly gynecological exam? Or do most insurances cover both?

With an HMO you must select a primary doctor and then that doctor must refer you out to any other specialists. Otherwise they will not cover it. With a PPO you do not need your primary care doctors referral or permission to see a specialist. As long as you select a doctor in the network you'll be covered.

Many insurances will cover an annual gyno exam as part of the physical. Though with some policies it's consider a different type of visit. Call your insurance company to get the real story on what they'll cover for your policy. There's just too many variations in what all these companies sell for me to tell you for sure what they will cover.

Yeah I'm going to call them soon but their hours are closed right now.

It's all so confusing and they are SO difficult to deal with sometimes. In my job I have to call insurance companies sometimes and those calls are the WORST b/c they aren't very forthcoming...

Primary Care Doctors are usually listed as practicing "internal medicine" , "family medicine" or "primary care". You are better off choosing an "in network" doc if you can, as it will keep your costs down. Primary care doctors can give you a general check up, bloodwork, see you for a sick visit/cold, etc. Many also will do pap smears, etc if you don't have an ob-gyn. Personally, I always see a separate ob-gyn, as they are specialist with better credentials in female reproductive health, and do not leave that aspect of my health up to my primary care doc.

As for a fertility specialist, definitely double-check with your insurance company about the rules about that. Most couples are not referred to a fertility specialist unless they have tried conceiving for one year, unsuccessfully.

(personally I'd rather not have them, as I've always wanted to adopt, but my husband doesn't want to adopt unless we KNOW we can't have one of our own)

Do you think you will resent him if you end up getting pregnant? Pregnancy is not easy. Major changes happen to your body and mind before, during, and after the pregnancy. When you feel connected to the pregnancy and you really want a baby, all those changes are worth it. I just worry because the way you worded it seems as if the desire for a pregnancy/ biological baby is not mutual. If one partner feels they "sacrificed" for the other by having a child, that could be a problem that leads to resentment later.

Nope you've got that right. Dealing with insurance companies is really frustrating and you don't always get clear (or even accurate) information.

But it beats having no insurance at all.

Thanks Bella. Do a lot of places not even consider you if you just want to find out if you are fertile or not? How do they know if you've tried conceiving for one year or more?

The kid thing--it's basically up to God at this point. If it happens, we are fine with it. If it doesn't, we are fine with it. I've always been more childfree than anything and would like to keep it that way but I do think that, if I'm supposed to ahve a child, then I'd be a good mom and I will handle it all as it comes. Sounds kind of dumb to leave it up to faith and spirituality like that but it's what god and I have worked out (and as a result, waht my husband and I have worked out).

We are both of the mindset that we shouldn't feel resentful toward each other, whatever happens, b/c spirtually speaking, I'm of the belief that where I am is where God wants me to be, and my husband is of the belief that wahtever happens, we will accept it and be happy, no matter what. We definitely ahve that part of our relationship made up (vague as it may sound)

Usually you don't go to a fertility specialist unless you assess your level of fertility.

Basically, when you to go to your OBGYN, discuss your fears, and mention that you might be infertile. They then do a work up. If something comes up abnormal...THEN they refer you to a fertility specialist for further resting. Lol I know how confusing this all can be.

Fertility doctors are ALSO obgyns. So they will be in your manual under OBGYN most likely...however, they just specialize in fertility. Your obgyn will either be able to do the work up, or find someone who can

Usually you don't go to a fertility specialist unless you assess your level of fertility.

 

Basically, when you to go to your OBGYN, discuss your fears, and mention that you might be infertile. They then do a work up. If something comes up abnormal...THEN they refer you to a fertility specialist for further resting. Lol I know how confusing this all can be.

 

Fertility doctors are ALSO obgyns. So they will be in your manual under OBGYN most likely...however, they just specialize in fertility. Your obgyn will either be able to do the work up, or find someone who can

 

OH! Ok! THat makes sense!

 

Now, the next question--who would my husband see to get his sperm tested?

Now, the next question--who would my husband see to get his sperm tested?

A Urologist can do this.

Thanks Bella. Do a lot of places not even consider you if you just want to find out if you are fertile or not? How do they know if you've tried conceiving for one year or more?

That, I am not sure about. I'm not sure if they would refuse to see you or not (i.e. if you didn't have a particular (in)fertility issue you wanted addressed). See link removed I've only seen it framed that way: e.g. that they are a doc you see if you are having a problem with pregnancy history or trying to conceive.

If you see an ob-gyn, she/he should be able to give you more info on when and why to see a fertility specialist as well.

Thanks so much for your help, yall.

My husband needs to see a Urologist anyway, so I'll be sure he gets tested then too.

I actually think any doctor can presscribe a semen analysis. I have never had one done..since, you know...I'm a woman, and I get pregnant if you look at me the wrong way....

But...I believe that even your OBGYN can prescribe it. You take your prescription to a lab, where you do your thing in a cup after holding it for a few days. It gives you a semen count. Also blood work.

His primary care doctor can probably request it at his regular annual checkup, too!

His insurance hasn't kicked in yet. We don't know when it will (state worker sort of thing?) but we will be right back where i am when it does kick in...

If you are just looking for a sperm count, I think a PCP (primary care physician) can order one up. So he may not even need a urologist. If he needs to see a urologist for other issues though, then ask that guy. He may do it himself or tell you to go to your PCP. Fertility tests for dudes is really simple.

For fertility specialists, I would not be looking into one now. Get started with an OB-GYN and they will look into your fertility. If things are good, you likely will not need to see a fertility specialist. Those are mostly for women who have reduced fertility and are looking to get pregnant ASAP. If the OB-GYN wants additional testing/advising for you, then they may make the choice to refer you to a fertility specialist. But that's up to them.

I know your plan is not a HMO (my plan isn't either) but even so, I think it's good to check in with your PCP *before* seeing a specialist. Even if you don't NEED a referral, just check in with your PCP, even just over the phone. I say this because seeing your PCP in terms of co-pays and whatnot can be much, much cheaper for you (or even free) versus going to a specialist, which can have much higher fees, and your PCP may be able to do tests themselves and save you money. That's why it's good to check first instead of making the choice on your own to see a specialist. Otherwise, you could just be wasting money.

I don't mean to drag up stuff from old threads, but are you still looking into therapy? I just mention that because myself started seeing a NEW therapist back in my homecity and my insurance covers unlimited appointments as long as I pay a co-pay so if your insurance offers something similar, I think it's a great idea. You and Jared deserve to be the happiest you can be with each other and reach a higher level of peace and openness. If you do have child(ren) in the future, that will certainly be needed!

As far as I know, you don't need a referral to see an OBGYN because it falls under women's health. That's how it works over here anyway. I'm not sure about over there.

Made an appt with a primary care doctor for June 7. She said none of their doctors prescribe narcotics. If I ever need ambien or anything, will they at least prescribe me that? ThTs not a narcotic is it?

No ambien is not a narcotic. However if you are ever in serious pain what they will tell you take is tylenol or naproxin. I guess they are trying to avoid people being addicts. Narcotics are opiate based.

Hers, I would call to verify if they just don't prescribe narcotics specifically..or all controlled substances - sleeping meds, anxiety meds, ADHD meds, etc.

and I would think your obgyn would be able to do a fertility screening..if you run into issues, that's when they would refer you to a fertility specialist. Jared can either be worked up by a primary care doctor or a urologist.

The type of doctor that specifically checks your fertility is called a Reproductive Endocrinologist. So, this is actually a cross between an endocrinologist -- which is a doctor that focuses on hormonal issues -- and a gynecologist (but who is not dealing with the hands-on of usual gynecological work.)

I saw one in my mid-30's so that I could assess my fertility. He is an OB/GYN, but I would not look him up under "OB/GYN", because those listed as such usually will be regular practicing OB/GYNs. I was given his name by my OB/GYN, but now that I know who he is, I can make appointments with him on my insurance without anyone's permission. And I was not trying to conceive at the time -- I just wanted to know how much time I had left. Generally, gyns don't know this specialty well enough, hence there is this sub-specialty (RE's also follow other sex-hormone related issues besides fertility -- ovarian cysts, endometriosis, hirsutism [abnormal female hair growth], menstrual phase defects, etc. Lots of overlap with gynecology, but with more hormonal knowledge. They are not regular endocrinologists, who diagnose/treat other types of hormonal disease, unrelated to the sex hormones [like diabestes]).

I don't know if your insurance plan has listed Reproductive Endocrinologists, but if so, and you don't need a referral, that's something you might do on your own. I think they'd all be comparable as far as your chosen gyn would recommend, if they're all in network.

Just wanted to add, the RE can tell you through bloodwork that you are viable hormonally, and if there may be any problems on that biochemical front.

But infertility has many causes which include mechanical issues (such as scarring in/around the tubes) which to my understanding, they won't start to investigate unless you try for a child and are having problems conceiving, and have ruled out the other possible reasons (including things your ob/gyn has checked for). Fertility testing can become invasive, so some of it wouldn't be routinely done, or without the wish to conceive.

So would I be able to find out if I can even conceive? I mean, we aren't trying to have a kid but we also are lax about birth control. "not preventing" is the same as "not conceiving", right? Technically? Maybe?

So would I be able to find out if I can even conceive? I mean, we aren't trying to have a kid but we also are lax about birth control. "not preventing" is the same as "not conceiving", right? Technically? Maybe?

Well, "not preventing" means you're not doing anything to guard against an unwanted pregnancy. And I take it, a pregnancy now would not be "unwanted"? (that is, you'd welcome it?)

Whereas you could be lax and not take precautions, but that doesn't mean you'll conceive. So you could "not prevent" and still "not conceive".

While I'm obviously not an expert or doctor, I don't believe any doctor can tell you -- even with the most reliable and modern of methods -- whether you can conceive or not with any certainty. They can evaluate you for certain risk factors or conditions, and in some more rare cases, something quite significant may be known to make a woman almost completely unlikely to be able to conceive. But for the average woman with no known reproductive imbalances or abnormalities, I think it would be very hard even for the best science we have to know "I am not going to be able to conceive" or the opposite. I know of cases where a woman was sure she couldn't conceive after rigorous medical work-ups, and then got pregnant and carried a baby to term anyway. I know more than one woman who has named her child, "Miracle." I also know of the opposite -- that a woman was sure she was healthy and nothing was wrong, but could not conceive, with elusive reasons for that, even after lots of work-ups.

In the end, I think it's up to Mother Nature to give you an answer, because She's pulled a lot of surprises before. You can get some basic information from doctors, but it's going to come down to TRYING to conceive to know how it's working for you.

What this means for you is that if you want to know, you'll probably have to make concerted efforts to conceive -- having sex multiple times at the most fertile times of the month. Rinse and repeat for several months. IF then you don't conceive, and you've ruled out medical conditions at the outset, this means you may know you have trouble conceiving for some as-yet-unidentified reason, but it's still not a confirmed prognosis that you never can or will. Like I said, I know couples who have tried and tried, given up hope, and then gotten pregnant.

What I'm saying is that finding out one way or the other is not like taking a blood test and finding out you're positive or negative for something. And being lax about birth control is not the same as making a proactive, targeted effort to get pregnant. So you can't know your fertility status just by a series of hit-and-misses with "not trying to prevent pregnancy." You'd have to take "not preventing it" a step further, to "actively trying to make it happen" to start sensing whether you have problems conceiving or not. Even if you CAN conceive by medical tests (or nothing obvious is standing in the way), it doesn't mean you WILL, and that's when it starts getting complicated and the tests will demand more of you. There is no fertility doctor on earth that will pursue what your problems conceiving are if he asks you, "Are you and your husband trying?" and you say, "not really".

Medical tests can offer important information, but I'm saying, they aren't the be-all-end-all (and as I said, they become progressively more invasive the more information you want about your body's status -- laparascopic surgery is not something I think you'd want to do if you do not have a burning desire to find out if you can conceive, and feel thwarted in your plans to have biological children.)

I think it's important for you to assess why you're trying to get this information. If it's about your husband wanting to make sure you can't have children of your own in order to move on to the adoption route, I don't believe he's going to get that kind of answer with the current orientation you both have. If you're operating on "we're not TRYING to have a baby, but if it happens, it happens," you guys won't be making the effort to conceive that would lead to anything conclusive. And even with some preliminary medical evaluations, there would be no short-cut answers.

So in other words, you guys would have to get more gung-ho about trying for a biological child to know whether you can conceive or not and it sounds like the current MO is not in alignment with that. So you'd have to sort out the priorities.

I'd rather not "try" to conceieve a child in order to tell if we are fertile. That doesn't make sense to me. We aren't technically trying. We more or less just don't care.