BCBS federal coverage

[Anonymous]

I am on BCBS Basic and have had very good coverage for all diagnostics and even some monitoring, bloodwork, and medications as part of a "treatment cycle" including IUI. The monitoring and bloodwork appointments have been $40 each, a hysteroscopy I just had was $100 copay, and a hysterosalpingogram at a hospital was fully covered. It has even covered some medications involved in treatment at different points (e.g., estradiol) but only the ones that don't require prior authorization. Given that the monitoring and bloodwork was covered, we only paid $350 for the IUIs at an out-of-state clinic.

One thing that benefited me for a while was to do a cycle with timed intercourse and get some prescriptions going that way for fertility meds like Clomid and Femara and Crinone. The fine print says that medications aren't covered "when used in conjunction with ART procedures like IUI and IVF." But with timed intercourse, they're covered. So you could try that once and then get refills covered for a while once the prior authorization is already in place.

We are now about to start IVF and I have taken on an extra Aetna policy through my husband's school. My meds were all covered and I paid $195 in copay. The Aetna Fed plan brochure says that 100% of meds are covered. But yet I have read on these forums that people with Aetna still end up paying thousands in meds. I'm not sure how this can be the case at 100% coverage. This makes sense if the coverage were 50% or something else, because their prices are really high at the Specialty Pharmacy. I'm wondering if the Aetna fed coverage changed over the last couple of years from some other percentage to 100%. Are the stories of people paying thousands on Aetna just not current? One important thing to note about Aetna is that your Day 3 FSH has to stay below 19 or they won't cover IVF.

One other Fed insurance that has some infertility coverage is the Carefirst Blue Cross. It covers IUI only, though.

It will not take you a year to do diagnostics. You can basically learn everything you need to know in a month or two if you can get the timing of all bloodwork, HSG, and semen analysis to work out. Definitely use your BCBS to the fullest right now to get that stuff done, and if you learn that you need something like IVF, you can switch at open season. IUIs aren't that expensive on BCBS. If you decide to stay on BCBS, consider switching to Basic from Standard. The premiums are way less, there's no deductible, the network is the same and there's really no disadvantage to the coverage.

[Anonymous]

Anonymous wrote:I am currently going through diagnostic testing at SG and have FEPBlue. I wanted to share my costs thus far in hopes it can help you.

1. Initial visit with Dr. Doyle-Billed my insurance $230.00 for the consult. Insurance agreement was $118.67 which they paid. My cost was a $20.00 co-pay.
2. Day 3 labs and ultrasound. SG billed BCBS $670.00 of which they paid $165.15 and I have a balance of $126.25.
3. HSG had two separate charges. One for $500.00 which insurance paid $378.25 per agreement with SG and my cost is $66.75. Second charge for that day is $1,170.00 of which BCBS pays $187.42 and my cost is $33.06. HUGE savings here for this test.
4. I used the pharmacy on the first floor in Rockville with the coupon given in the initial packet for prenatal vitamins. Cost to insurance was $138.20 of which they paid $76.01. My cost was $62.19 but after the coupon it was only $22.19.

It is CLEAR that the agreement BCBS FED has with SG is to our advantage and saves a lot of money. The suggestions to use that plan while going through diagnostics is sound.

Thank you. Very helpful, it's great to see real costs.

And thanks to everyone who responded. I feel like I have a better handle on this stuff now.

[Anonymous]

PP here. I just wanted to add that the new Aetna I'm on did not care how many IUIs I had done or that I did them while not on Aetna coverage as mentioned by another poster. I am 40 and they are letting me go right to IVF. They have a requirement of 2 year history of infertility, but a financial person at a fertility center told me that Aetna usually only uses that requirement for those age 37 and under. If you are 38-39 it goes down to 1 year.

[Anonymous]

Which Aetna plan do you recommend (i.e. HDHP or CDHP)?

[Anonymous]

IMO, the Open Access HMO is the best plan for the feds...the Aetna rep agreed it was the best bang for the buck
SG honors Aetna's negotiated rate, which provides a steep discount. I don't think that is true of other clinics?
best of luck.