Fed Ins / Dr. Question/course of action advice

[Anonymous]

Anonymous wrote:- you have been unable to attain a successful pregnancy through a less costly treatment that is covered by the Plan

This is the language that allows them to require IUIs pre-IVF.

[Anonymous]

Anonymous wrote:
- you have been unable to attain a successful pregnancy through a less costly treatment that is covered by the Plan

This is the language that allows them to require IUIs pre-IVF.

Yes -- but it does not mention any particular number of rounds (ie. three, or six...) Right?

[Anonymous]

Anonymous wrote:Anonymous wrote:

Yes -- but it does not mention any particular number of rounds (ie. three, or six...) Right?

Right. That part is subjective, but I'm betting they won't let you get away with less than three IUIs before moving forward absent a more specific diagnosis that indicates IUIs won't work. MAYBE, if your doctor specifically recommended otherwise, but I still doubt it.

[Anonymous]

PP 13:00 here. We did 2 rounds of injectibles with TI and we had done one round of IVF out of pocket in which the eggs did not fertilize and we had to do rescue ICSI. I switched to MDIPA for 2010 because of the IVF coverage. I don't know if MDIPA requires IUIs but had we not had that MF issue in that first IVF we would have had to wait another 6 months because I had gotten pregnant naturally, but had to terminate that pregnancy, so it was documented that we hadn't been trying for 2 years unsuccessfully to get pregnant. I was 41 at the time so age was never a consideration.

[Anonymous]

OP here-one final question. I think I have decided to sign up for the BCBS HMO to get 100% coverage for some more IUIs since I have only done 1 instead of signing up for MD IPA and risking them say I need to get more IUIs done and having to pay 50%. Do you think there will be any issues with the fact that my DH's insurance which we have family coverage for is BCBS PPO and I would be signing up as an indvidual for BCBS HMO? Will they not let me do this for some reason? Thanks!

[Anonymous]

Anonymous wrote:OP here-one final question. I think I have decided to sign up for the BCBS HMO to get 100% coverage for some more IUIs since I have only done 1 instead of signing up for MD IPA and risking them say I need to get more IUIs done and having to pay 50%. Do you think there will be any issues with the fact that my DH's insurance which we have family coverage for is BCBS PPO and I would be signing up as an indvidual for BCBS HMO? Will they not let me do this for some reason? Thanks!

It won't be an issue. Your insurance through BCBS HMO will be your primary.

I have a similar situation, and I would say just make sure your docs offices are submitting things to your primary plan first, and that they follow through and submit any of the remaining expenses (once primary has paid) to the secondary. It can be a pain, but it might also save you some money here and there.

[Anonymous]

Thanks PP that helps alot!!