SIRM and Aetna PPO?

Sorry for an off topic discussion ladies.... I am in a sheer panic.  My consultation is with SIRM on Oct 22, and I just got a letter from work that our insurance is switching to Aetna PPO as of January.  I am devastated!  I have no way of accessing particular info concerning coverage until January and I cannot mentally cycle this year.  It just isn't possible.  My other insurance covered a $10,000 max with no proof of infertility.  Ugh.  I am so upset.  Wondering if anyone else has this insurance and cycled with SIRM.

TIA!

Natalie

 It all depends on your individual insurance plan and your state.  I have seen people have BCBS (my insurance) get coverage yet my BCBS plan does not cover a dime.  I can't imagine that there isn't a way to call and ask them though.  I was able to call my insurance company before my husband even started his job to find out about certain coverage.

 ((Hugs)) I know you must be so frustrated. 

 

Can you talk to your HR reps about it?  Maybe SIRM has info about it themselves.  

 

I would say that that amount/extent of infertility coverage depends upon what plans the employer selects, but since you live in a state where it is mandated I'm not sure. 

 

Sending you a separate email about something off topic. 

Good question, although I am not sure how it all works - I too have insurance quetions and would appreciate any feedback anyone can provide. I know that our insurance through United Health Care covers 100% of infertility coverage up to a lifetime maximum of $20000 for procedures and $10000 for infertility related medications.  Does anybody know if this would include PGD?  I am in Dallas and SIRM is right down the road from me - I am not sure how to approach SIRM since I am fertile, but am considering IVF/PGD to rule out any chromosomal abnormalities and to ultimately get another daughter.  Or would they tell me to forget it since I am fertile?  Not even sure that we are going to go this route, but just trying to weigh out all of my options.

itsbabytime:

Does anybody know if this would include PGD?

No they do not cover it.  I don't know any insurance company that has covered it.

itsbabytime:

am in Dallas and SIRM is right down the road from me - I am not sure how to approach SIRM since I am fertile, but am considering IVF/PGD to rule out any chromosomal abnormalities and to ultimately get another daughter.

SIRM is very open about gender selection and there have been girls who have cycled at SIRM Dallas from this board. 

itsbabytime:

Or would they tell me to forget it since I am fertile?

No not at all.  They have free consults so you could always set one up and get all the information you need whether you cycle or not.  I had my consult in June (with Dr. Sher in Vegas) and when I found out I was not going to be able to cycle for 18 months they were more than helpful getting things together for me.  Dr. Sher was not pushy in his consult at all and it was the best decision I ever made.  SIRM is fantastic!

 

RNmomtothree:

Sorry for an off topic discussion ladies.... I am in a sheer panic.  My consultation is with SIRM on Oct 22, and I just got a letter from work that our insurance is switching to Aetna PPO as of January.  I am devastated!  I have no way of accessing particular info concerning coverage until January and I cannot mentally cycle this year.  It just isn't possible.  My other insurance covered a $10,000 max with no proof of infertility.  Ugh.  I am so upset.  Wondering if anyone else has this insurance and cycled with SIRM.

TIA!

Natalie

OH Natalie that is such a huge disappointment and I am sorry.  I will keep my fingers crossed that you get this all worked!  Very excited to cheer you on -- 2010 quickly approaching!   So glad to see you posting!  I miss you!

Thank you for all of the info Michaela :).  I really appreciate it.  Do you think my insurance will cover the meds and IVF if I paid for the PGD out of pocket - I would def want PGD to check for chromosomal abnomalities and for gender selection?  I will definitely look into the free consultation - it would be great if I could get my insurance to cover the majority of the expenses if we were to go this route.

Yes most insurance companies will still pay for infertility procedures/IVF even if you are doing PGD for genetic testing or GS.  They really don't look at it that way and if you are paying for it out of pocket your clinci probably won't bill anything like that.  It is also just billed/coded under PGD but not the reason.  You should be fine with that.  It would be great if you could get coverage!!  Every little bit helps!  I wish I was that lucky that is for sure!  I think I need to move :)  LOL!

Hey Natalie, I actually have Aetna PPO but doubt my info can help you - since it's all individualized (company to company state to state).  Just wanted to wish you the best and hope everything works out.

RNmomtothree:

insurance is switching to Aetna PPO as of January

I am looking at the open enrollment info through my husbands work website and it gives three options of coverage - one is Aetna PPO, the other is United Health Care and the other is Cigna and all 3 offer IVF coverage at 100% up to $20,000 and coverage of infertility meds up to $10,000 - I know it varies from company to company and state to state, but I would imagine that you can call the ins company to find out what it covers in regards to infertility for the upcoming year.  This is from the enrollment website that compares the three insurances.....

Aetna HMO - North Texas(EPO)	CIGNA EPO - North Texas	UnitedHealthcare EPO-N. Texas

Family Planning
Fertility drugs	Covered; limited to $10,000 per lifetime; check with Plan for details	Covered; limited to $10,000 per lifetime; check with Plan for details	Covered; limited to $10,000 per lifetime; check with Plan for details
Fertility services	$30 copay; limited to $20,000 per lifetime	Copay based on location of services rendered; $20,000 lifetime limit; check with Plan for details	$30 copay; benefits for infertility services are limited to $20,000 per lifetime per covered person

Keep in mind, even if you have infertility insurance coverage, your insurance may not pay out unless your clinic "codes you" as being infertile.  I've heard of other insurance requiring other hoops to be jumped through too - like "trying" for 12 months, at least 1 or 2 prior IUI attempts, etc.  So be sure to ask your insurance company what qualifies you to be able to use your coverage.

Michaela:

most insurance companies will still pay for infertility procedures/IVF even if you are doing PGD for genetic testing or GS

Do you think the insurance company will cover IVF even though I am fertile?  I expect to pay for PGD out of pocket, but I may have to pay for everything if insurance doesn't cover IVF when I am able to conceive naturally.  Or can I tell them that I had a daughter born with multiple anomolies and want to do IVF/PGD to test for chromosmal abnormalities and have them submit the IVF portion to my insurance company.  I am just trying to figure out how to approach the doctors and insurance company so I don't screw anything up.  Thanks for taking the time to answer my questions Michaela :)

Thak you Ilovemykids - that is what I was trying to figure out.  So I guess that I just cannot willie nilly go to the fertility clinic and ask for IVF/PGD, just because I want it and expect the insurance company to cover it.  I will give the ins co a call tomm and find out what constitutes being infertile in order to qualify for the ivf.

 Oh I am sorry I misunderstood what you were saying when you said that you had IVF coverage for X amount of dollars, etc.  Yes you will need to be considered infertile in order for your insurance to pay for it.  Some are able to get their docs to code you that way but it is usually pretty difficult.  Sorry for the misunderstanding.  If you are in a state that mandates coverage I can find out what they consider to be an infertility diagnosis.

Michaela:

wish I was that lucky that is for sure!  I think I need to move :)  LOL!

Does your state not provide insurance coverage for IVF or is it the employer that doesn't cover it?