DC Government insurance coverage options for IVF

[Anonymous]

I’m a DC government employee and used IVF for both kids. I used United Healthcare until I exhausted my limits and then switched to Aetna PPO. United Healthcare was great! I hit the OOP max after the first cycle in March so I had no copays the rest of the year, including for my delivery and hospital stay.
At the time (not sure if this has changed) Aetna’s coverage wasn’t as generous. It covered 50% of charges So we decided to get secondary insurance from my spouse’s employer that covered the gaps (fwiw, the secondary insurance had NO fertility coverage but it covered the diagnostic and lab tests under the regular coverage at 100%.) That was a little more complicated with billing but it worked fine.

[Anonymous]

PP above, I forgot to add. I was able to do 2 cycles (2 each of retrieval and transfer) before maxing out my United Healthcare benefits. Only the actual retrieval/transfer procedures fell under fertility, all the diagnostics and monitoring procedures fell under the broader healthcare coverage.

[Anonymous]

OP here - thank you, PP!!! That is really awesome information. It makes me feel much more confident about switching to United. Did you do fresh or frozen transfers with your two United cycles? If you remember, do you know which pharmacy you used for meds and how much they were (and what protocol you did)?

[Anonymous]

Anonymous wrote:OP here - thank you, PP!!! That is really awesome information. It makes me feel much more confident about switching to United. Did you do fresh or frozen transfers with your two United cycles? If you remember, do you know which pharmacy you used for meds and how much they were (and what protocol you did)?

If I remember correctly, I used Freedom Fertility for my meds.
I was on an OCP antagonist cycle.
Both of my UHS covered cycles were fresh cycles. I had a frozen cycle with 2 transfers with the Aetna PPO.

[Anonymous]

OP again - confirmed verbally with Aetna yesterday that the coverage was what I stated above. 3 cycles of IVF covered at 50%, does not cover meds, freezing, cryo, and does not count toward the OOP maximum. They couldn't confirm how the policy defined a cycle, but I'm 99% sure a FET is counted separately from a freeze all cycle. Based on that, I'm switching over to UHC for the IVF benefits this year. Good luck to all!