Specific question re BC/BS

[Anonymous]

Has anyone who is covered by BC/BS Federal plan Basic or Standard undergone an IUI or IVF and had BC/BS cover the monitoring (ultrasounds and blood work) and/or drugs? (I know BC/BS covers monitoring/drugs outside of IUI/IVF). If so, what process did you have to go through to get them to cover it? And, has anyone done this through Shady Grove? I have read all the old archives on this topic and I am just looking for an answer to this specific question. Thanks!

[Anonymous]

I have federal BCBS. It covered most of the cost of my IVF drugs and I only paid copays for bloodwork and montioring. Actual IVF and IUI services were not covered.

[Anonymous]

I'm the previous poster - forgot to add that Columbia Fertility took care of all the paperwork for me. I didn't have to do a thing. The clinic will have to prove that you've met the requirements BCBS has set - which is easily proved via the clinics initial visit with you. Read through BCBS rules though - I think you have to have been trying to get pregnant unsuccessfully for 9 months to a year, but I can't remember. You can find the BCBS rules booklet online.

[Anonymous]

Thank you!

[Anonymous]

Yes, they definitely cover meds and they should also cover bw/us. Don't let Shady Grove tell you otherwise (they try to, because they make much more money if you're self-pay). You will have to pay for the IUI or IVF procedures themselves though.

[Anonymous]

I was told at SG that I wouldn't be able to have the monitoring covered by BC/BS if the end result was IUI not timed intercourse. I'm not sure why that would be, why should BC/BS care if I'm willing pay the $375 for the IUI; I don't get why the monitoring isn't covered?

[Anonymous]

OP here and 14:00 - shady grove told me the same and I am about to call their financial person to discuss. I think you have to push them.

[Anonymous]

Poster at 14:00 here; let me know what they say.

[Anonymous]

I would be EXTREMELY interested in hearing the outcome, 14:08. I recently underwent an IVF cycle at Shady Grove and paid out of pocket 9,500 for everything (not including drugs, which I only paid a co-pay for-- for what it's worth, about $1200 in my case). It seemed to me likely that monitoring WOULD be covered even during the IVF cycle. Shady Grove told me no, but I have found them to be a little sketchy/disorganized on this front and would like confirmation.

[Anonymous]

PP - I forgot to say that I have BCBS, Basic (Federal Employee Program).

[Anonymous]

13:27, can you please articulate how you got the clarification and bills paid for monitoring and bloodwork from SG? I have BCBS federal (BASIC) and have suspected insurance might pay for monitoring and bloodwork (since the benefit brochure says "diagnostic") but SG told me no, it's considered part of the procedure. Now that I'm hearing what you are saying I'm really wondering if my insurance wuold have paid for things out side the actual procedure. When I call the insurance company no one will tell me anything besides reading me the plan over the phone (which is unclear to me).

Is the only way to get a real answer to submit bills to insurance? And if so, how so I get these for just the bloodwork and monitoring (since I already paid my full cycle)? Or does SG just jack up the costs of the actual IVF procedures to so it doesnt matter to my own costs if insurance pays something?

[Anonymous]

I think the issue with SG is that they break the IVF cycle into IVF Retrieval and IVF Transfer (and divide the costs in some fashion) for submission to insurance and do not break the monitoring out separately for submission to insurance. You should still ask if it can be done.

[Anonymous]

OP here and I still haven't heard back from SG financial. I did read somewhere that you can ask what CPT codes they use when they bill monitoring and blood work and then run those codes by BCBS to see if they'll cover it. But I am guessing 10:01 is right that they don't bill it under the diagnostic code so it isn't covered. And it may be their policy to bill it as an IUI or IVF procedure as a whole. I will update you when I hear back from them. But I would think they would/should work with you on getting these procedures covered if at all possible.

[Anonymous]

My understanding is that for IUI and IVF, once the clinics use the codes for IUI or IVF then BCBS won't cover anything related to the procedures because of the plan language excludes covering anything related to IUI/IVF. However, I do get coverage for drugs that are not exclusively used for IUI/IVF, such as clomid, progesterone and estrogen, and the various antibiotics I've needed. And BCBS always covers my betas.

I didn't know SG offers time intercourse monitoring - how does that work?

[Anonymous]

OP here and SG just told me again that BCBS will NOT cover monitoring or bloodwork once an IUI or IVF cycle begins.