Federal Health Plans & IVF coverage
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Anonymous
My experience with MDIPA is that my primary care doctor made the referral (to my RE whom I had already been seeing for some time) and I had a letter within a few days from MDIPA...this was only for a consult with the RE. Then, once that took place, the RE had to send the infertility team a diagnosis and treatment plan. Mid year, they said it can take up to ten days, but I have heard that things take longer at the beginning of the year when everyone has just switched insurance. Be forewarned -MDIPA saves you a lot of money, but they can be a hassle to deal with. Their regular phone reps are not equipped to handle infertiltiy treatment questions, and the infertility team is only reachable via fax. |
Anonymous
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This thread has been so helpful! I was torn between BXBS Carefirst and Aetna and didn't even consider MD IPA. Now I don't think I am considering Aetna anymore. I have a few questions and if anyone out there can help me with the answers, I would most appreciate it!
I am 35 y/o (and staring at 36) with no children. My husband and I have been trying for 18 months. We started going to SG a few months ago. b/c i am on BXBS Basic, we just did timed intercourse with drugs. No luck. I originally was planning on electing Carefirst so I can have the IUIs covered at 100%, but now I am really looking at IVF if IUI doesn't help after 3 tries. Here are my questions: 1. Does anyone know how many IUI cycles MD IPA makes you go through before it will approve IVF? I spoke to the finance person at SG about this and she said she didn't know about MD IPA, but with Aetna it is usually 3. I just don't want it to be 6. 2. Can anyone recommend a PCP in MD IPA that would give me a referral back to SG without a huge hassle? Thank you all so much. It is great to have such a support network! |
Anonymous
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I am trying to figure out what plan, if any, can work for us. My fiance had a vasectomy yeawrs ago and the urologist suggested that since I am 35, IVF (or IUI) would be a better way to go than a reversal. We'd need an extraction and IUI (or IVF).
It appears that MD IPA, Kaiser and Aetna do not cover anything if either partner had a voluntary sterilization. I called HR and (as I expected) they were absolutely no help. I see that CareFirst has IUI benefits, but I can't figure out if they will exclude coverage b/c of the vasectomy. I called CareFirst and the customer service 'specialist', who was reading from her book, couldn't tell me anything. I can't seem to pull up the plan brochure online. I also called Shady Grove and they told me to call HR and the insurer. Does anyone have any answers? Fortunately, the wedding is next month and so I will have another opportunity to set this straight after our "life changing event." Thanks!!! |
Anonymous
| I have BCBS Care First. We are on a plan that covers 100%: unlimited IUI, 3 IVF. So if you can switch to that plan in january, its awesome! Also I believe their definition of infertility is having unprotected sex for one year and not getting pregnant. So if you are in a same sex relationship, they'll probably deny. But you can try! I think one round of IUI at SGF is around $1800. |
Anonymous
| I did IVF and IUI on FEderal Blue Cross when I had my daughter some years back. Diagnosis of infertility ...tests, etc. were all covered. The drugs-follistim were covered back then. THe actual procedures..IUI and IVF were not covered. I think it is still this way, but check to make sure. |
Anonymous
| Fed BCBS covers all the diagnostics but none of the procedures. BCBS has stopped covering the drugs if they are used in connection with any ART procedure for 2011. |
Anonymous
| Anyone know what you need to establish a two year history of infertility? I only sought infertility treatment around one year ago. Prior to that, my husband and I tried to get pregnant for a number of years. During that time, I did not see any doctors. Also, I was not on any birth control. Keep in mind, the policy does not say "documented history of infertility." |
Anonymous
In most cases, your verbal statement to that effect will be sufficient. |
Anonymous
| Agree with PP. If you see an RE it is whatever you report on your intake form. |
Anonymous
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Ladies,
a little off topic but... I read a few threads here saying that some HMOs are not covering the meds for IVF cycles only covering the procedure portion of IVF. You can file a complaint with Maryland Insurance Commission (if you reside in MD). Or at least threaten them to file a complaint and specify that Maryland code of regulations binds them to cover all meds at 50% co-pay. They are supposed to cover 50% of your medication cost per Maryland Mandate on infertility coverage. In addition, for those of you considering Kaiser as your HMO during next open season. I have Kaiser right now, and getting a refferal to SG fertility was a breeze. Your OB at Kaiser refers you , and after that your RE can do whatever she wants. Kaiser pays 50% of medication cost. Also, I have a two year old and getting care for him through Kaiser has been absolutely wonderful. For example, our wait to see an ENT surgeon was 3 days!!! With Aetna, last year we waited over a month to get an appointment with ENT. |
Anonymous
| Bumping this thread, since I am looking at this issue right now. Live in VA. |
Anonymous
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For this year, we could choose between Kaiser, Aetna, and MDIPA. Kaiser was out immediately because I don't like to be so limited in my doctor choices. Aetna covers meds only at 50% percent. MDIPA was our best option. They covered the meds in full, approved everything relatively quickly, and have not caused us trouble so far.
Only drawback is that you need to get a referral for specialist visits, but if you have a nice PCP, those can be faxed over without visiting PCP first. I also don't like the fact that your radiology facility depends on the state your PCP is in. My PCP was in MD, and that meant I had to go to Community Radiology for ultrasounds, which I did not like. So I switched PCPs to someone in DC, and now I can go to Washington Radiology, but only to the K St location, although I am much closer to their Chevy Chase location. A drawback with MDIPA that ended up not mattering to us (because I got pregnant on first attempt) is that they count an IVF cycle as started once you begin injections, so if you don't respond well to a protocol and have to cancel, that was one of your three tries. Aetna, on the other hand, is said to only count it once you make it to retrieval (I'm not 100% sure about this). Another good thing about MDIPA is that you only have one copay for your prenatal care, and that pediatrician visits have no copays until your kid is 17 or so. |
Anonymous
OK I've been looking at this all morning, and it is pretty grim for VA. MD is one of the few states that has good coverage. Seems like the VA General Assembly must have really done a number on this, limiting coverage for the type of services I need. |
Anonymous
Look into Aetna. My DH is a fed employee and we live in VA. Sure we had some to pay out of pocket but their negotiated rates with SG were good so between drugs and IVF/ICSI it was about $5000. |
Anonymous
I live in DC and could use MDIPA. Are Virginians not able to use that insurance, even if they are federal employees? The 50% drug copay with Aetna would easily have cost us an additional $2,500. |