Federal Health Plans & IVF coverage

[Anonymous]

If you have MDIPA just go through Freedom Fertility. No need for appeals. If your authorization hasn't came in yet, you can pay with cash and then they will appeal the amount for you and follow up with MDIPA. It is easier if you let the pharmacy do all the work or you will be on the phone for hours with United Healthcare...Lesson Learned.

[Anonymous]

MDIPA is now using Medco instead of Freedom Fertility, right? Is there a difference in out of pocket costs or service?

[Anonymous]

Medco still uses fertility freedom for the specialty fertility meds.

[Anonymous]

Thank you. I didn't know that.

[Anonymous]

Paid 2750 for I've with kaiser

[Anonymous]

Just donated remaining meds to Shady Grove! It feels great to give back.

[Anonymous]

Going into open season 2013, have read entire thread, cannot use MDIPA or Kaiser due to other specialist needs - is there any other good IVF coverage in FEHBP? Cigna offers nothing. Thanks

[Anonymous]

Look at Aetna - doesn't cover meds but should cover 50 percent of the rest of ivf

[Anonymous]

Anonymous wrote:Going into open season 2013, have read entire thread, cannot use MDIPA or Kaiser due to other specialist needs - is there any other good IVF coverage in FEHBP? Cigna offers nothing. Thanks

That's unfortunate because MD IPA is fantastic - or has been so far. Maybe someone who needs other specialists can share their experiences?

I know Aetna does but I have yet to see anyone post here about being happy with them.

That said, I think the clinic you pick has a lot to do with how happy you are with your coverage - a poor billing/finance office and nurses (i.e. a nurse who knows there are better prices on meds elsewhere, for example) can make all the difference regardless of coverage

[Anonymous]

Thanks for that info, using SG, not thrilled with their folks re. info about money or help with keeping costs down - first round ivf drugs were $6500 at the DC pharmacy. Aetna may be the way unless there's something new this year (I understand they've added 10 plans) Odd that none of the OPM info services actually help you find IVF/Reproductive coverage information unless you go and read the plan pdfs

[Anonymous]

It appears AETNA no longer covers IVF or drugs - this is from their plan brochure - am I reading it wrong?

Infertility services
Infertility is defined as the inability to conceive after 12 months of
unprotected intravaginal sexual relations (or 12 cycles of artificial
insemination) for women under age 35, and 6 months of unprotected
intravaginal sexual relations (or 6 cycles of artificial insemination) for
women age 35 and over.
• Artificial insemination and monitoring of ovulation:
- Intravaginal insemination (IVI)
- Intracervical insemination (ICI)
- Intrauterine insemination (IUI)
Note: Coverage is only for 3 cycles (per lifetime). In-network benefits
requires members to 1) access care from Aetna's select network of Plan
Infertility providers and 2) obtain preauthorization from the Plan prior to
services. Otherwise, out-of-network benefits will apply. You must
contact the Infertility Case Manager at 1-888/238-6240.
• Testing for diagnosis and surgical treatment of the underlying cause of
infertility.
Note: We cover oral fertility drugs under the prescription drug benefit.
In-network: 15% of our Plan allowance
Out-of-network: 40% of our Plan allowance
and any difference between our allowance and
the billed amount.
Not covered:
• Assisted reproductive technology (ART) procedures, such as:
- In vitro fertilization
- Embryo transfer including, but not limited to, gamete GIFT and
zygote ZIFT
- Services provided in the setting of ovulation induction such as
ultrasounds, laboratory studies, and physician services.
- Services and supplies related to the above mentioned services,
including sperm processing
• Reversal of voluntary, surgically-induced sterility.
• Treatment for infertility when the cause of the infertility was a
previous sterilization with or without surgical reversal
• Injectable fertility drugs
• Infertility treatment when the FSH level is 19 mIU/ml or greater on
day 3 of menstrual cycle.
All charges
I

[Anonymous]

Anonymous wrote:Going into open season 2013, have read entire thread, cannot use MDIPA or Kaiser due to other specialist needs - is there any other good IVF coverage in FEHBP? Cigna offers nothing. Thanks

Unfortunately most plans do not fully cover Ivf. Your best bet is set aside money into your flexible spending account. It is before tax dollars and can be considerable depending on your marginal tax rate and other factors. Bottom line, you will have to foot most of the cost. It is an elective procedure after all.

[Anonymous]

Anonymous wrote: Bottom line, you will have to foot most of the cost. It is an elective procedure after all.

so is sterilization yet there is decent coverage for that, interestingly enough

[Anonymous]

Anonymous wrote:It appears AETNA no longer covers IVF or drugs - this is from their plan brochure - am I reading it wrong?

Infertility services
Infertility is defined as the inability to conceive after 12 months of
unprotected intravaginal sexual relations (or 12 cycles of artificial
insemination) for women under age 35, and 6 months of unprotected
intravaginal sexual relations (or 6 cycles of artificial insemination) for
women age 35 and over.
• Artificial insemination and monitoring of ovulation:
- Intravaginal insemination (IVI)
- Intracervical insemination (ICI)
- Intrauterine insemination (IUI)
Note: Coverage is only for 3 cycles (per lifetime). In-network benefits
requires members to 1) access care from Aetna's select network of Plan
Infertility providers and 2) obtain preauthorization from the Plan prior to
services. Otherwise, out-of-network benefits will apply. You must
contact the Infertility Case Manager at 1-888/238-6240.
• Testing for diagnosis and surgical treatment of the underlying cause of
infertility.
Note: We cover oral fertility drugs under the prescription drug benefit.
In-network: 15% of our Plan allowance
Out-of-network: 40% of our Plan allowance
and any difference between our allowance and
the billed amount.
Not covered:
• Assisted reproductive technology (ART) procedures, such as:
- In vitro fertilization
- Embryo transfer including, but not limited to, gamete GIFT and
zygote ZIFT
- Services provided in the setting of ovulation induction such as
ultrasounds, laboratory studies, and physician services.
- Services and supplies related to the above mentioned services,
including sperm processing
• Reversal of voluntary, surgically-induced sterility.
• Treatment for infertility when the cause of the infertility was a
previous sterilization with or without surgical reversal
• Injectable fertility drugs
• Infertility treatment when the FSH level is 19 mIU/ml or greater on
day 3 of menstrual cycle.
All charges
I

is this from Aetna Health Fund or Aetna Open Access? I think Open Access is the only plan that covers it.

[Anonymous]

Ah, so the Aetna coverage is through an HMO as well. I guess this makes some sense. Unfortunately after a quick search not one of my specialists is included in their HMO either. As far as the FSA suggestion - it's been reduced to $2,500, and even at the old 5k, that wouldn't put much of a dent in what is looking like a $30k bill to go through SG's multi-cycle plus drugs ($17.5k +13k in drugs. The only thing I have going it seems is deducting the $30k (or more if the first two rounds don't work) under the tax code - ie. unreimbursed medical expenses over $10k, not that it amounts to much.