Federal Health Plans & IVF coverage

[Anonymous]

You might want to look at the United Health Care high deductible/health savings account plan. I had great private sector coverage for #1, but changed jobs to one with crap coverage. When we investigated federal options about this time last year, I thought United was the only one offering IVF coverage (but obviously I was wrong given the answers above).

The advantage of the high deductable account is you can put away a lot of money in the health savings plan (tax free like a FSA, but not use or lose) and use it any way you like. Plus, you get the insurance company negotiated rate for everything. Plus, because United actually covers IVF, if you spend up to your cap, then they start paying for the IVF.

We didn't actually test this b/c we actually are one of those awful people who had a "oops" after an IVF. But, the United coverage has been good for pregnancy too. If I had a chronic problem (ashma, etc) I would not recommend it.

[Anonymous]

Can someone please explain more about getting the insurance company negotiated rate? My plan has no coverage for treatment (just testing and meds), so we're looking at paying out of pocket for IVF or IUI. Will clinics give us the negotiated rate if we ask? FWIW, we are leaning towards using Shady Grove.

[Anonymous]

I have federal bcbs and they are not paying for bloodwork, IUI, IVF only the clomid. I just looked through Aetna and it looks like it is only the HMO that covers anything, not the PPO. Geha didnt look to cover anything either.

[Anonymous]

I had BC/BS, but switched to Aetna when I found out I had fertility problems b/c BC/BS doesn't cover IUI or IVF. I did one IVF cycle with Aetna. In total, cost $9K ($7K for cycle, $2K for freezing leftover eggs). Process was pretty seemless, although did get some bills 6 mo. after doing cycle, which might have been difficult if your first cycle doesn't work. I would definitely switch to a plan that offers coverage. Don't risk minimal coverage with BC/BS.

[Anonymous]

We currently live in Virgina and are on the Fed BC/BS plan. We just found out after all of the testing etc., that our options are a. IUI with a 1-5 percent chance or b. IVF with ICSI with a 40+ percent chance. Open enrollment is next week. Does anyone know if we do change to MDIPA (we used to be on this plan) and wait for our first attempt in January once the coverage begins....will we be covered? I realize that we'd have to call and get permission, etc...but just wondering if MDIPA would require a wait period or more testing, etc.?

[Anonymous]

I don't know, but don't forget that open season for flex spending accounts is here too, so you can shave a lot off your out of pocket costs if you can pay them with pre-tax money.

[Anonymous]

Yes...we are planning on putting the max in our flex account this time! We tried calling MDIPA to find out about the coverage. We were transfered to the UC customer service and can you believe that they asked who MDIPA was?? My husband said, "well it's one of the companies listed on your website," and they had no clue. Without a group number to give them which we don't have yet...they were completely lost.

[Anonymous]

We have MDIPA through the federal government and have no problems getting infertility testing/treatment covered. Under the federal MPIPA plan, everything is covered at 50%. This is different than most insurance plans that cover testing at 100% and treatment at 0% so you may end up paying more for testing (hsg, etc.) under MDIPA but the IVF coverage is the best among the federal plans.

Our first cycle was back in 2006 and our 50% was about 4.5K at Shady Grove. Meds were covered in full. We just recently did a FET with our left over embryos and it cost us 2K after MDIPA payed their half. Again, meds were covered.
MDIPA requires both a referral from your PCP to see a RE and a infertility "pre-authorization" which is a special form that your PCP will need to fill out. Then the RE will need to submit another pre-authorization for IVF. However, we had NO problems getting either. I'm pleased to say that MDIPA has been quite orderly and efficient. Shady Grove is very familiar with them and had our authorization for IVF approved within 5 days of our consult visit without us doing a thing.


I should add that MDIPA required us to be married (for a year, two?--can't remember??) and have some sort of documented fertility (ours was Male Factor which was very obvious on a semen analysis). I believe they require those with unexplained infertility to vouch that they have been TTC for 2 years. Lastly, when I checked in 2006, MDIPA was not paying anything towards IUIs. Certainly this may have changed but it was the case at that time.

Good luck!

[Anonymous]

Thanks for the info! I wonder how it will work for us...we have already been through the testing phase. We are now ready to start IUI or IVF. I just wonder if we start MDIPA in January if they will accept the referals we already have, etc. We have a referal from DH's PCP to the Urologist who referred us to the RE. Or...would I need to get a referal from my PCP even though I don't have any issues. I've already had all of the the tests (HSG, Hysteroscopy, Day # Ultrasound and the Sonohystogram), so we're just ready to start!

[Anonymous]

I just spoke with MDIPA and asked if we switched to them during open season whether they would accept our existing diagnostics, test results (SA, Day 3 bloodwork, HSG, etc...) all of which were completed this past summer. The answer is NO. They REQUIRE that you start from scratch and do all of the diagnostics again. And they only cover 50% of the costs of the diagnostics. They have great coverage for medication, but if we have to basically start over and pay 50% to diagnose ourselves again, we decided we're better off elsewhere. Aetna HMO and Coventry Health also cover IVF and meds at 50% so we are looking at them.

Now that it is open season for federal employees all of the insurance companies should be willing to answer any questions about coverage before you make a decision.

[Anonymous]

When we switched to MD IPA 4 years ago (after successful IVF under Kaiser), I got the referral to Shady Grove when we decided to try for number 2 with no problem (i.e., an initial consult). Then my doc at Shady Grove provided MDIPA with my previous test results and diagnosis and MDIPA approved us for IVF. The only tests/procedures I needed to undergo again were the blood tests (i.e., day 3, STD), seman analysis, and the moc embryo transfer. Day 3 is standard for all IVF cycles. The seman analysis and moc embryo are standard when you are starting up IVF (we were starting up again after having given birth a year earlier). The STD tests are required anually.

[Anonymous]

What Virginia-based federal plan is best to cover IVF? I'm with B/C/B/S and the don't cover anything but the testing and the meds. And now instead of 10% they upped it to pay 15% (on everything, not just IVF)

[Anonymous]

Does Fed BC/BS pay for Ultrasounds and Bloodwork during clomid treatments? The financial advisor at Shadygrove said no. I found this shocking as the BC/BS brochure seems to suggest that this would be covered. I would really appreciate any help on this. I really don' t need the added stress on top of just dealing with infertility issues in gerenral.

[Anonymous]

Does BC/BS federal cover U/S and B/W with clomid? Shady grove told me no.

[Anonymous]

If you're doing an IUI, I believe the answer is no. If timed intercourse, then yes.