Insurance? Is this good?

My dh has Aetna and right now we are not exactly sure what coverage will be as we are switching to a different plan but i just got some info from my work on their insurance plan Highmark Blue Shield. On the simple explanation of benefits sheet it says all basic diagnostic tests covered including bloodwork, diagnostic medical, standard imaging. Infertility Counseling, testing, and treatments covered but they consider treatments the correction of a physical or medical problem associated with infertility. They have a Premier Prescription drug Program Mandatory generic with 80% covered. It does say assisted fertilization procedures not covered. But I am guessing it would be covered if you did the tests and still had unexplained fertility? How do people get their insurance to cover IVF if so many plans say it is not covered right off the bat? Is there any plans that come right out and say it is covered? I am just trying to understand. Is it worth it for me to take my company's insurance? It seems they will at least pay for preliminary tests, bloodwork, meds? Does that save a lot of money? If anything I would not take it till next year around this point when they offer it again and hopefully the same plan. Thank you!

I had BCBS and it was covered. There were no pre-quals or anything.  The doctor has to be willing to bill under an unexplained infertility diagnosis though.  Some will not do it for obvious reasons.  The place I first cycled at was big and if you had insurace, they would bill for you.  My insurance also covers all diagnostic testing which has nothing to do with infertility.  My drugs would have cost around 7,000 if I had paid out of pocket so the drug policy is totally worth it IMO.  So, first you have to find out what your insurance covers and what they need from the doc and then you have to know if the doc will actually bill your insurance if you are not truly infertile.

What is BCBS? And you just handed your insurance card to to the receptionist at the place where you were actually doing IVF and they accepted it and submitted the bill to your insurance and they paid it because it came from an infertility clinic? So they took the "clinics word for it" that that meant you were infertile? Am I understanding it correctly or is there more to it than that? Do they need some sort of a special note from your ob or the fertility doctor you cycle with claiming you are infertile? Did you need to go through a battery of tests first before you were called infertile or your insurance would cover? Thanks!!

The insurance companies don't know about GS when it comes to infertility.  The billing department didn't know what I was there for anyway.  So, yes, the just asked for my insurance card, they make the call and get verification of benefits and as long as the clinic is OK billing them, that's it.  There ws no big red stamp on anything or notes passed...just like going to the regular doctor with insurance.

What insurance do you have? And did they state upfront that they would cover IVF if infertile?

BCBS PPO. I called and asked what the infertility coverage was.  I did have a lifetime $ amount for coverage.  That was it.

Hi.  I am covered under my husband's insurance Cigna (ppo).  I just found out that they cover IVF, with no documentation of infertility, no testing, etc!!  I was blown away!  It is an 80/20 plan.  So I will pay 20% of all the procedures involved in IVF.  All IVF meds are covered also through their pharmacy, Medco.  I was quoted $3000 for PGD (checking for gender only, with nothing else like chromosomal abnormalities.)  The grand total will be approximately $4500 out of my pocket for PGD and IVF.  But it depends on what plan you have. Also, it is up to (your husband's or your) employer to decide what they want to cover, like IVF.  The company decides what extra packages they want to purchase to offer their employees (IVF, etc.)  Hope that makes since.  In other words, someone else may have Cigna-ppo, and not have IVF covered, it is up to their employer.   To be honest, most insurance doesn't cover IVF without documentation of infertility, if at all.  Many only offer diagnostic testing to find out the "problem."  Some offer a couple rounds of IUI only with no IVF. Good luck!

Ours offers IVF coverage too, but did NOT in this case.  Be warned that most RE's will not file this for insurance purposes simply because it is an elective procedure.  My file had 'OUT OF POCKET' in large print on it.  They filed for my first ultrasound/bloodwork and that was about it.  Oh, and the HYS which was like $600 so that was good.  All of my pre-testing was covered. I had to pay $8,900 up-front for IVF/PGD.  OUCH!

For us, meds like Lupron were covered, but not Gonal-F and that is the expensive one!  We are Cigna.

HTH!  Kiki

We are in MA which mandates infertility coverage.  Our RE was sort of beating around the bush saying that IF we were experiencing difficulty getting pregnant (wink, wink, nudge, nudge.... who's really to say how hard you and DH have been trying to conceive), that insurance would probably cover the IVF portion.  Often there isn't an identifiable reason couples aren't able to conceive, so they just have to take your word that you've been "trying".  I need to check again, but I believe our insurance requires us to try 2 IUIs before going to IVF.  It's also sort of a scruples issue..... is it bad karma to lie to get IVF paid for?  I feel like the insurance company screws us in so many ways (my son has autism and they pay for NONE of his treatment ), so I'm more okay with it than my DH.  This is something we have been struggling with.  Slippery slope... still haven't decided which way to go.

I personally wouldn't feel bad about fudging the truth about trying.  Also wanted to add that I called the RE where I hope to cycle soon, last year, and the insurance person told me that the MD's at this practice usually put "unexplained infertility" in the notes of people wanting to do IVF-PGD, w/ no fertility issues.  It seems some MD's try to help out as much as they can, afterall they will get paid either way!  But, if the MD chooses to put "no fertility issues, etc" in your notes, but they still file insurance (hoping no questions will be asked and insurance therefore pay).  This may work, but if the insurance co. asks for documentation, the MD has no choice but to submit the actual notes...which say "no fertility probs."...BUT if you fudge it and say from the beginning that you have been trying for 1 year or so, how is anyone (MD/insurer) to know that's not true?  At least that would be in your chart that you have been trying for a while if insurance asks for notes.....Hope this helps...

nuthinbutpink:

The insurance companies don't know about GS when it comes to infertility.  The billing department didn't know what I was there for anyway. 

This wasn't true for my insurance company. My dr billed unexplained fertility but the insurance company did know it was also for GS. They (insurance co) also were sent all the dr. notes to make their final approval. I thought we were a go after verification went through, but to my surprise (just a few weeks before I was cycling) it had to go through another "final approval". We had Aetna PPO.