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Infertility Support and Discussion
MD IPA (fed plan) - HCG trigger not covered under plan
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Anonymous
In Baltimore, MD: http://www.essexrx.com They ship nationwide. |
Anonymous
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Just an FYI - I'm currently doing IVF with shady grove - and MDIPA as of May 5th (I was told) no longer covers injectables at all. No notice or anything was given to me. I called to try to refill my meds because I'm in the middle of a cycle and need more meds to continue and was told i was not covered. It's a terrible decision and has left me, and many other women I'm sure, in the lurch.
Also, there plan for 2010 explicitly states they cover injectables for IVF, so this decision in my opinion is bad will at the very least on their part. When I am done this year, I'm definately changing plans. |
Anonymous
Is this MDIPA through the FEDs? Yikes -this is unbelievable. I could understand if they changed the plan from one year to the next, but in the middle of the year??? The reason why I picked this crappy insurance to begin with was for the IVF coverage. GRUMBLE. |
Anonymous
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I was very disturbed at the idea that my meds would not be covered for the next round. I just called MD IPA (feds) and I was told that if you get the authorization for your IVF round then the meds are a covered benefit on the policy. The representative that I spoke to didn't know where the pp was getting her info.
As an aside, I would be really surprised if MD IPA (feds) could change something like that in the middle of the year. OPM keeps an eye on the insurance stuff pretty closely. I also think that changing benefits in the middle of a calendar year would amount to a breach of contract. Someone else might want to call the customer service number and check to see if you get the same answer I did. I agree, this insurance sucks. I only switched for the IVF benefits too. I can't wait to go back to BCBS or a new insurance plan if/when my husband gets a new job. |
Anonymous
| PP 8:54 here. I also just looked at my benefits book and it specifically says that they cover the injectibles for covered IVF cycles. I don't know what is going on with the other PP's coverage but I don't think anything has changed with MD IPA federal for this year. |
Anonymous
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Update: I was the one who previously posted about MDIPA not covering injectables. I was on the phone with United healthcare, freedom fertility and shady grove back and forth all day that day (about 8 hours) when I was denied. I kept escalating it, but allI was told was that it was no longer covered due to a change made to the plan in May. It was a very emotional day to say the least.
They are still not covering it for me. The only answer I get is that the tiers changed in May, and the injectables menopur and gonal f are no longer covered. I ordered what I needed and had to pay out of pocket. I sent in appeals forms for the drugs. It is federal, and I contacted my HR, but they are terrible. I've had issues with them before, and they have not called me back in 2 weeks. I may have to escalate this in my HR dept. |
Anonymous
| Update: Also, I know it explicitly states in the benefit book that it covers it, and I photocopied that and sent it in with my appeal. No one on the phone really cared - they just said the plan changed. |
Anonymous
I would be shocked if this was true! I just switched to MD IPA for the med coverage so I cannot see how they can change it mid year with no notice. Please keep up updated on what you find out. I am sorry you are having to go through this! |
Anonymous
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Injectable are covered under your medical benefits and not under the prescription benefits. If you go through medco (MD IPA/United pharmacy) they won't cover them but any other pharmacy will (though you do need the authorization).
I don't think you can change benefits mid year and if this did indeed do this them OPM needs to be informed and those on the plan should be given the option to switch plans. |
Anonymous
| I have UHC (but not fed) and they kept telling me that injectibles were not covered. I spoke with EVERYONE at UHC and at MEDCO, who handles the prescription coverage and they kept saying injectables are not covered for IUI - only IVF. It wasn't until my fertility clinic called them to order the drugs (after telling them I already checked my coverage) when they told me the gonal IS covered. But, only thru approved pharmacies (Freedom was the one we use). Have your clinic call and check - they have ways of working around thise issues. You can also call Freedom and have them check - they are also very good at nailing down coverage rules. |
Anonymous
| I used Freedom too and it was covered. The medco and MD IPA folks didn't know a thing and were very frustrating to work with! |
Anonymous
| FYI - just ordered my injectable from Freedom with no problem... |
Anonymous
| I also switched to MDIPA during the open season for the IVF/med coverage. I ordered injectables for an IVF cycle in April, and all meds were covered (including Follistim). My cycle was canceled prior to the start of the meds, so I never picked them up. I started a new cycle at the beginning of June and the pharmacy informed me that everything is covered except the Follistim. MDIPA keeps saying it IS covered, MEDCO says the insurance company changed the plan in May. I'm looking at $1500 out of pocket for this one drug...so frustrating! I use Prosperity - should I have my nurse call it in to Freedom? |
Anonymous
| Injectibles aren't an issue for me, but there has to be some means of reporting this BS change to OPM. I wonder if OPM even knows about it. It's ridiculous. |