insurance for IVF for diagnosed infertility

[Anonymous]

I would be SO GRATEFUL for help. I’ve read through most of the thread on federal insurance and fertility coverage, but didn’t seem to find my question addressed. Here’s our situation: we have diagnosed female (tubal) factor infertility. I have one tube; the other was removed when it ruptured during an ectopic pregnancy. We tried for about a year before successfully trying IVF with Shady Grove; our baby is due in April. I’m 35.

We’d really like to try for another, likely in early-mid 2012, when we would do IVF again. At the moment we have BCBS/Federal, Basic. As we don’t plan on doing IVF in 2011 (although I could see starting in January 2012), we don’t plan to change coverage now. However, I wonder

1. Do any of these plans have limits in terms of either “pre-existing” conditions or “waiting” times?
2. Once we do change plans, are there any that stick out as particularly good for us? (i.e., near certain IVF treatment in 2012 with diagnosed infertility)?
3. Anything else I should be concerned about?

In case it’s relevant, we generally live overseas and would be in DC only for treatment. We already have one daughter who was conceived naturally before my ectopic (I mention this in case diagnosis would be contested).

Thank you SO much for help. The TTC has been a lifeline for me over the last year or and I’m grateful once again for suggestions.

[Anonymous]

First, since you say you have federal insurance, there is no such thing as a preexisting condition. Once you are hired by the feds, you can be covered by the insurance regardless of what ailments you have.

Second, I believe that you have infertility issues that would fall into the exceptions to the "must have 2 years of trying" general requirement. You can be covered immediately. You said that your first child was conceived via IVF. When I was going to get covered by the insurance we didn't have the 2 years, but we had done one round of IVF during which surfaced a MF issue. That took us out of the 2 years of trying. (I had a natural pregnancy (we had to terminate) that was less than 2 years from when we wanted to do IVF, so that's how the insurance knew that I hadn't been "trying" for two years.)

[Anonymous]

PP here. The only plans that cover infertility for the feds are MD IPA and Aetna, I think. MD IPA is the least expensive for IVF, but also the biggest PITA. Both plans cover 50% of the cost, but under the Aetna the drugs aren't really covered.

[Anonymous]

Thanks so much. I had wondered about the number of years trying... like I said, we'd only been trying a year (actually, a little less) so clearly it was less than 2... but went to OOP expense IVF first. Is there anyway I could find out for sure?

So, for planning purposes, only 50% of the costs would be covered-- at the most-- in 2012 assuming we decided to go with MD IPA (what does that stand for- do you have to be in Maryland)? We would definitely need drugs AND IVF, clearly, so I'm thinking Aetna wouldn't be a smart choice.

Why is MD IPA a pain? Can you think of reasons not to do it overseas? Does SG take MD IPA?

[Anonymous]

And would there be any reason not to start the BC portion in Dec 2011, if we wanted to get that early of a start on it? I'm not keen to have two kids back to back but age isn't on my side and I *almost* considered switching in case we wanted to start again in 2011 after birth in April...
THANKS!

[Anonymous]

You actually may not be eligible for MDIPA because it is a regional plan, local to the DC area. You will have to check with your agency. I wasn't covered to go up to Cornell under MDIPA.

MDIPA is an HMO, which means you need a primary care doctor to get referrals for everything. It is a PITA.

Also, the billing/reimbursement sucks. For example, the brochure states very clearly that they cover an annual mammogram over 40. I got the referral from my OB/Gyn and had my mammogram done. I'm now getting a bill from the radiologist b/c MDIPA hasn't paid due to lack of information or some such BS.

Aetna may be your only choice for IVF coverage.

Someone else correct me if I'm wrong.

[Anonymous]

Anonymous wrote:You actually may not be eligible for MDIPA because it is a regional plan, local to the DC area. You will have to check with your agency. I wasn't covered to go up to Cornell under MDIPA.

MDIPA is an HMO, which means you need a primary care doctor to get referrals for everything. It is a PITA.

Also, the billing/reimbursement sucks. For example, the brochure states very clearly that they cover an annual mammogram over 40. I got the referral from my OB/Gyn and had my mammogram done. I'm now getting a bill from the radiologist b/c MDIPA hasn't paid due to lack of information or some such BS.

Aetna may be your only choice for IVF coverage.

Someone else correct me if I'm wrong.

We've had MDIPA for 8 years and have NEVER had problems with billing. And we've billed some major, major things. 3 IVF cycles, 2 pregnancies, 10+ ER visits (including a complex one following a car accident), extensive dental surgery, many visits to specialists, countless peds visits, all sorts of expensive medications and they've never once messed up. You just HAVE to keep within the provider network for PCPs and specialists. All ERs take it, all academic medical centers and doctors take it.

[Anonymous]

I bet the folks at Shady Grove who handle the insurance and financial stuff would be an excellent resource for this question. You should call them and ask what Federal Plan they recommend based on their experience with them.

[Anonymous]

Just posting to say I did this very thing and was directed to each individual insurance plan; they could not offer advice about insurance.

[Anonymous]

I'm not sure but tubal issues might also take you out of the 2 years of trying, like having a MF issue. I'm not exactly sure but it might.