Federal Health Plans & IVF coverage

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

They only cover 50% of ART treatments, this is unrelated to diagonistics. So if you are still trying to figure out what is going on, you can get that cover like normal doctor's visits.

no, NOT true. MDIPA pays 50% beginning at the diagnosis stage. They pay 50% of the first visit to the RE, the hsg, bloodwork, etc. Blue Cross will pay these visits at 100%.

I guess I should clarify that we had Aetna, I don't know anything about MDIPA. When I went to my RE for visits that did not involve treatment, I just had to pay my co-pay. All of my blood work (as long as it went through Quest) and my husbands SA were paid at 100%. I did not have a HSG or a saline sono while on Aetna, so I can't speak to those. The plan summary is a little unclear, so if someone is thinking about Aetna they might want to get clarification on what would be covered before you start an ART cycle.

MDIPA here---
so in this way Aetna and MDIPA differ. MDIPA pays 50% of any visits to the RE and all testing and treatment ordered by the RE---from visit #1 onward. So as a previous poster mentioned, the most economical way to proceed with infertility testing and IVF when using the federal plans is to have BCBS (or Aetna per your post) for testing and then MDIPA for IVF (because although the cost of IVF is the same as with Aetna, the drugs are cheaper with MDIPA). If you can manage to switch plans at just the right point in the calendar year, this would be the cheapest.

Yes, except Aetna covers IUI at only 50%, whereas CareFirst HMO covers it fully (plus the drugs).

[Anonymous]

Anyone have AETNA Open Access and use Columbia Fertility?

[Anonymous]

This thread is so useful! I'd like to share my recent experience with the CareFirst BlueChoice plan, and also ask for people's input on a question.

I currently have CareFirst BlueChoice for 2010. I had 4 IUI cycles using injectable medications at Shady Grove Fertility Clinic. I paid $35 copy at each monitoring visit, and same copay amount for HSG and consultation appointment with my RE doctor. Other than the typical co-pays, CareFirst BlueChoice covered ALL COSTS for both the procedures and the injectable medications. It is a great plan if you are undergoing various diagnosis tests and IUI treatments. On top of that, you don't need a referral. The drawback is that they do not cover anything with IVF.

I haven't had much luck with IUIs, and I now need to step up to IVF. I recently signed up for Shady Grove's Shared Risk program, and I would like to choose a plan that may offer the best coverage for IVF medications. Is there anyone out there who have gone through a similar experience? *** Do you know which plan works with the Shared Risk program in terms of covering for the most of IVF medications? ***

By looking at the information posted on this thread, it seems like Aetna and MD-IPA offers IVF medication coverage. I am still confused at how much Aetna covers for IVF Meds...

One thread said:
>> 11/09/2010 21:01 -- I did cycles with both aetna 2009 and mdipa 2010. the drug cost is a huge difference for me 3500 v. 150.

Another thread said:
>> 11/11/2010 14:30 -- If it cost you 6K then Kaiser is a lot higher then MDIPA (really double the cost). My total cost with MDIPA was 3500 and about 150 for meds. Aetna was 3500 and about the same for meds.

*** If you have used either plans, could you please share your experience with the IVF medication coverage? Thanks! ***

[Anonymous]

Aetna IVF meds - 3 - 4K (depending on how high a dose of gonal f etc you are on).

MDIPA meds 150.00 co-pay

[Anonymous]

I also am looking for FEHB plan selection help. Currently going to Columbia Fertility. No luck so far with clomid, IUIs, etc.... I would like to start IVF in January and need to switch insurance plans since my current plan does not cover ART. If I switch to MD IPA, do I have to go back to a primary physician to get a referral back to Columbia? If so, anyone have any physician suggestions to make sure I can get the referral back to Columbia ASAP. I am over 40 and would like to get pregnant ASAP. I also have never used an HMO before, so I am a little nervous.

[Anonymous]

I had to go back to my PCP with MDIPA and get the referral. It was an extra step and thus a hassle but I kept telling myself I was saving 3-4K a cycle by doing this! I go to SG and once they got the referral they took care of everything else.

[Anonymous]

mdipa was my first experience having to get referrals. find yourself a good pcp. i ended up finding someone extremely responsive and was able to get quick referral back to sg where i already had been going. i am over 40 and was definitely worried about the doctor being opinionated about referring me, but in the end it was easy and i am glad that i did it. the fact that i paid 150 instead of 3500 with aetna was a huge stress reliever.

[Anonymous]

23:20 -- if you don't mind - who was your PCP?

[Anonymous]

If I am just beginning IUI treatment in January -- would you suggest switching to BCBS Carefirst that covers 6 IUI's completely except for copays or switching to MDIPA that covers both IUI's and IVF at 50%? BCBS is a better deal for the IUI's but I am afraid I will regret not doing MDIPA if IUI doesn't work b/c then I will have to wait until 2012 for IVF.

[Anonymous]

The CareFirst brochure doesn't say how they define infertility. Does anyone know if I'll have trouble getting my IUIs covered -- I'm in a same-sex relationship.

[Anonymous]

Anonymous wrote:If I am just beginning IUI treatment in January -- would you suggest switching to BCBS Carefirst that covers 6 IUI's completely except for copays or switching to MDIPA that covers both IUI's and IVF at 50%? BCBS is a better deal for the IUI's but I am afraid I will regret not doing MDIPA if IUI doesn't work b/c then I will have to wait until 2012 for IVF.

For me, it would depend on my age and how likely my RE thinks we would stick with IUI. I only ended up doing one cycle with IUI and then switch to IVF. Can you get a sense from the RE how many they would try before moving to IVF?

[Anonymous]

Anonymous wrote:If I am just beginning IUI treatment in January -- would you suggest switching to BCBS Carefirst that covers 6 IUI's completely except for copays or switching to MDIPA that covers both IUI's and IVF at 50%? BCBS is a better deal for the IUI's but I am afraid I will regret not doing MDIPA if IUI doesn't work b/c then I will have to wait until 2012 for IVF.

I agree with PP that age is important. Also, what's your diagnosis? Some problems are much more responsive to IUI than others. If you're unexplained or if it's just a matter of not ovulating regularly, I might stick to IUI's for a year but if you have Endo or severe PCOS, I wouldn't want to waste much time before moving to IVF.

[Anonymous]

Anonymous wrote:The CareFirst brochure doesn't say how they define infertility. Does anyone know if I'll have trouble getting my IUIs covered -- I'm in a same-sex relationship.

I wish I had a definitive answer for you on this but I don't. I know a woman in my Federal office did IUI's with her partner a few years ago and was unable to get it covered, although I'm not sure which insurance she had. If I had to guess, I'd bet they'd be a**holes about it and say no, but why not just call and ask them straight up? You can do it anonymously.

[Anonymous]

Dumb question, but I've never had an HMO and I'm switching to MDIPA for my IVF. Would I get the initial referral from my primary care doc or ob/gyn? I want to make that appt for Jan. 3 to get that ball rolling. It sucks because I've already been with SG for a year and have done three IUIs already. This referral seems like an unnecessary step.

Also, wondering how long it takes to get approval to proceed with the procedure from MDIPA. The financial person at SG told me to plan on not starting until March!! Ugh.

[Anonymous]

Have you asked SG -- they should be able to give you info on the process. I've heard it's really just a phone call between doctors not an actual visit.