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Do any federal non-HMO plans cover meds?
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Anonymous
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For fear of not passing the IVF criteria for MDIPA, we are considering sticking with a non-HMO plan if we can find any that cover some part of the meds. In 2010, we had decent luck with Fed Blue Cross Blue Shield (PPO) but of course, got a letter about a month ago stating they would no longer cover injectible meds in 2011 (it felt like an oddly-timed knee jerk reaction on their part!)
Anyone have any plans that are non-HMO that cover meds? Thanks so much for any input. |
Anonymous
| I've done basic research on this and the short answer seems to be no. A lot cover oral meds, but not injectables. |
Anonymous
| Carefirst covers IUI's and injectibles. |
Anonymous
That's true, but Carefirst is an HMO. The OP was looking for a PPO. |
Anonymous
| you should really cold call mdipa or aetna to see the chances of acceptance and talk to your RE office about it as well. The major fertility offices all deal with the federal plans all the time. I was so nervous about meeting the criteria, but my fertility office dealt with the insurance and there didnt seem to be a problem. it is in their interest to make sure that you have insurance and can proceed with fertility treatments! also, most just want you to be married and have tried for 6 months before they will approve certain testing and then treatments. |
Anonymous
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OP--do you have a diagnosis? I had MDIPA through 4 years of fertility treatment (including 3 rounds of IVF) and I didn't feel like they scrutinized the length of our marriage and the length that we were TTC at all. We were approved for IVF immediately (never did IUI) and we had been TTC for under a year and were honest about this with our RE. What MDIPA cared about in our case was that we had a diagnosis (in our case a crummy semen analysis). I believe "having a diagnosis" of infertility (as defined in their booklet) trumps all the other variables.
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Anonymous
| OP here - my diagnosis is anovulation. Husband has decent semen analysis. However, I was on the pill until August of 2009 (stupid me, thinking I needed it!), so fear they will tell me to wait until Aug. 2011 to proceed. We bit the bullet last night and signed up for shared risk. That's why I'm now trying to figure out if any of the non-HMO plans will cover meds... Alas BCBS is pulling the plug on us for that. |
Anonymous
OP, if you know you are going ahead and need meds in early 2011, I would call your RE's office, and get your cycle Rx before BCBS stops covering the meds. A lot of REs are hearing complaints about the changes, so you won't be the only one asking for an early Rx. That way, you make the change to another plan of your choosing, but you already have the meds on hand. |
Anonymous
| OP here -- thanks for the above suggestion, 09:34. I was actually planning on doing that. Definitely worth spending $1500 or so to save $4K (albeit a possible change in protocol). Does anyone know how long these drugs last in the fridge? |
Anonymous
Yes, ditto this! I have Federal BCBS and my doctor agreed to order all our meds for February. You're allowed up to a 90 day supply. |
Anonymous
| I have Fed BC/BS and just ordered a 90 day supply of IVF meds through the mail order pharmacy. Paid only $195 total. |
Anonymous
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oh my also fed bc/bs here, this changes on january 1st?
stupid question, but how did you know which meds to order throught the mail order pharmacy?? doesn't that depend on which protocol you're on? we did one round of ncivf in 2010 and meds were covered very well, however there was only one injection. needless to say, we may move to full ivf in 2011, but since it would be a first i have no idea about the meds we would need!? any advice? |
Anonymous
| I have Aetna Fed and they covered my meds. However I passed all protocols. Aetna has this mail order pharmacy and the doc office calls in the RX, the pharm calls you to confirm/bill, then meds are shipped. You get your doc to start the process by ordering meds. Do talk to doc office about insurance and all the ramifications - and consider switching practices or at least gettin a second opinion. When I went to SG, I was to my insurance wouldn't cover anything. True, b/c my FSH was one point too low (too high to conceive, too low for coverage, WTF). I went to another clinic who offered to re-test my FSH -- another FSH was covered. Turned out not to need it, but just shows some clinics really understand insurance. |
Anonymous
Unfortunately, if you don't have a cycle date or a protocol yet, I don't see how you could get meds before December 31. Of course, your doctor would have to order them but you'd have to meet with him/her first and decide very quickly how and when to proceed with a cycle. |
Anonymous
| To poster 20:21 who ordered via mail order pharmacy -- Which did you use? I think I read on another thread that Medco doesn't cover injectables.... Would love to know who you've used. Thanks! |