IVF with UnitedHealthcare MDIPA & referals with MDIPA in general
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Anonymous
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We switched to MDIPA this year in part to receive benefits for IVF. We did IVF in 2010 (out of pocket) after 9 months of trying and post an ectopic pregnancy/tube removal. Can anyone give any general hints about working with them? We plan to use Shady Grove again.
I'm particularly interested in hearing from people who have done IVF outside of MDIPA in the past for tubal issues. I'm assuming I don't need to have been 'trying' for a number of months yet again and can resort to IVF directly? When I called to ask about how authorization for IVFworked, I was surprised to hear that my RE could send over information and they would review it and approve/deny. I was really surprised I didn't need some sort of referal from my regular OB to a specialist since that's what I had understood the plan entailed in general. (I had thought, say, I wanted to see a dermatologist I would need to see my PCP and then get an appt with a dermatologist... but apparently that's not the case?!) Thanks! |
Anonymous
| This is the OP here with another question. Looking at my plan brochure, it says 50% of office visits to "other plan physicians or health care practioners" are covered. Does this mean that I don't pay the normal $40 co-pay to see my RE and that this visit is out of pocket?? |
Anonymous
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If you're seeing your RE for a specific procedure (e.g., IVF), the RE's office will get your authorization (including submitting your marriage certificate) from MDIPA. So you don't technically need a referral from your PCP. Once the procedure is authorized, you pay 50% of the IVF costs and you don't have a co-pay each time you go in for bloodwork, sono, etc.
If you want to have a consult with the RE, you would need to get a referral (and authorization) from your PCP. Does that distinction make sense? It can be a bit frustrating sometimes to wait for authorizations, but once things are authorized, everything runs smoothly. I've had no complaints. |
Anonymous
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This is really helpful, thank you. Speaking with the SG folks gives me the impression that the consult, and not the actual procedures, are what require a referal. Speaking with insurance, that's not the case. Anyway, it's definitely better safe than sorry!
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Anonymous
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I am United Health Care MDIPA in the middle of a IVF cycle at Shady Grove. I just had my ET today.
I switched to them also because of the IVF coverage. I had 3 failed IUI cycles in the fall under CareFirst, I have done no IUIs with MDIPA. I thought I would need a referral from my PCP, but I just had to have a PCP set and Shady Grove handled the rest. I had to provide a copy of our marriage license and a current sperm analysis for my husband. Once they got all of that the approval happened right away, very easy on my part. My portion for the SG charges was about 3300$. I had to go to 3 different pharmacies, each one had to provide certain of the medications to use the insurance coverage(Freedom, Medco Specialty Pharmacy and 1 local) but the meds were covered except for a pretty small co-pay. Good luck! |
Anonymous
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Thank you SO MUCH 1442. This is super useful.
So did you order your meds by mail, then? How did you figure out what you would get where? Your advice is so appreciated. |
Anonymous
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My SG nurse sent all of the prescriptions to Medco, who then contacted me and said the Medco Specialty Pharmacy could only fill one of them (the trigger shot) and Freedom Phamacy would have to fill the Menopur, gonal-F and prometrium suppositories. AND another pharmacy would have to fill the rest. I chose to get the rest filled at the phamacy in the Rockville SG building, Ambulatory Care, they are wonderful. Ultimately it was my SG nurse who then sent the prescriptions to the correct pharmacies and I spoke to them by phone to arrange delivery and copays. They have a lot of experience with these pharmacies so do that all the time. |
Anonymous
| We have MD IPA and are at GWU. Waiting for the approval wasn't too bad, but I do recommend letting the clinic handle it. I tried to follow up myself during the approval process and it was very kafka-esque. We are able to get all our prescriptions (hormones/antibiotics/steroids/supplies covered through Freedom Fertility Pharmacy. It's very convenient! |
Anonymous
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I finished an IVF cycle with SG earlier this year. You don't have to wait 2 years if you have a tubal factor but you do have to be married.
Here's a summary of what is required in terms of referrals and pre-authorizaiton 1. For a Consultation a pre-authorization has to be submitted by your PCP or ob. I was authorized for 1 consultation visit. (cost-$130) 2. After the consult, SG will send in the pre-authorization paper work for your day 3 blood work, baseline sonogram, and any other testing you need (HSG, etc.) 3. HOWEVER, and this is where I got frustrated, in addition to a pre-authorization, a referral from your PCP has to be on file at SG. Some PCP's will manage this in advance when they get the pre-authroization letter from SG. My PCP's office did not since it was not very familiar with sending patients to SG. Once your PCP submits the first referral, SG will take over and submit subsequent referrals. 4. If you don't have both an authorization and referral on file, SG will charge you the cash price and then refund your money once the insurance authorization is accepted or referral with the date of your appointment is on file (~$695). However, the alternative of waiting another month is not appealing either so I ended up doing my Day 3 blood work on Day 4 since my referral was not in place on day 3 and my PCP couldn't fax it to SG the morning of Day 3. I didn't want to wait another month and I didn't want to pay $695 and hope that I get my money back (SG will have you sign a waiver). 5. MD IPA requires a pre-authorization for each procedure. SSG will submit the pre-authorizations for IUI or IVF once your treatment plan is estblished with yoru RE. |
Anonymous
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I had already been a patient at SG when I switched to MDIPA last fall in order to do IVF in the new year. I did not need a referral to SG (like you, I was already an established patient there), but I did not have another consultation.
SG submitted the request for IVF preauthorization first thing in January, and we got approved in February. I think approvals are quicker when it's not the beginning of the year. I had to have my PCP registered with MDIPA before SG could file for preauthorization, but I did not need a referral (my PCP was never involved in the process). We got all our medications from Freedom Fertility Pharmacy. I have endometriosis and we had done several unsuccessful cycles of timed intercourse with injectibles (since IUI was not covered by previous insurance). I was worried MDIPA would make me do IUI first, but they didn't. SG also got authorization for the gestational ultrasounds after I got pregnant. No referrals were involved in the whole process. |
Anonymous
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pp13:42 here: @16:05-I don't understand why MDIPA didn't require you to get a PCP referral for SG. I only needed the referral once. Maybe your doctor automatically submitted it once they received a copy of your pre-authorization letter for SG. When I received my authorization letter it was good for one consultation. To get my bloodwork, etc. I had to have a referral on file.
After getting pregnant by SG IVF, I had to also get a referral to a perinatologist (maternal and fetal medicine) from my PCP since I was referred to MFM since I'm over 35. OP I suggest you check with SG because you don't want a surprise on the day you show up for your treatment. |
Anonymous
| Does anyone know how long it takes for the pre-authorization to happen with MDIPA once your PCP submits the request for it? I can't even make an appointment with Shady Grove yet until I get the pre authorization number. |
Anonymous
In my case, it was SG who submitted the request for pre-approval, my PCP had nothing to do with it. I don't think you need pre-approval for a consultation. |
Anonymous
No I am not talking about pre approval once you are already at SG. That's a step after initial consultation. I am talking about the pre-authorization your PCP will have to get and that you will need to go for your first consultation with SG using Federal MDIPA. I wanted to know how long that takes. |
Anonymous
Sorry, can't help with that, I had a different insurance when I first became a patient at SG. Isn't it enough for your PCP to refer you? I didn't know this was different than referral to any other specialist. |