MDIPA and out-of-pocket and IVF

[Anonymous]

I thought I was going to be out of pocket around 4K for the procedure and around $150 for meds.
But I am seeing that I have an out-of-pocket max per individual of something like 1,800. Did I miss something? Is this going to be less expensive than I had assumed?

[Anonymous]

The 50% co-pay for fertility treatments does not count toward the $1800 out-of-pocket max. Nor do prescription co-pays. Much of the monitoring, however, is not billed as IF treatment and so does count toward your max out-of-pocket.

[Anonymous]

Same experience here. Expect around $2500

[Anonymous]

I did a few cycles of IVF with ICSI with MDIPA and it was $4500ish each time.

[Anonymous]

Wait- 2,500 and 4,500 are really different, at least to my pocket book. Which one is it?

[Anonymous]

Not 22:57, but for me cryopreservation (which isn't covered at all) was $2600. So the difference in costs between cycles could be driven by whether you have embryos to freeze.

[Anonymous]

SG charged us $4K on an IVF cycle with MDIPA as well. No freezing involved, just ICSI and AH. Did we pay too much?? Why do some people just pay $2,500?

[Anonymous]

I think the ICSI is extra... as is AH? Would that come out to 1500, though? Was this in this calendar year?

[Anonymous]

I paid around $600 for AH out of pocket 2 years ago at SG.

[Anonymous]

I did ivf with icsi in January and paid about $150 for drugs and about $2000 for the procedure. I anticipated paying more, but I all of the monitoring ended up being covered and since the clinic was in-network the procedures themselves were discounted.

[Anonymous]

Anonymous wrote:Wait- 2,500 and 4,500 are really different, at least to my pocket book. Which one is it?

The original fee was around $4500. However, with MDIPA, many of the ivf procedures DO count against your $1800 annual maximum. When we got to around $2500 in IVF treatments, we hit the $1800 threshold and then everything else was covered 100%

[Anonymous]

PP, how did this work for you? When we started the cycle at SG this spring, they made us pay a deposit of around $4K. We never got anything back, and I assumed we owed what we paid. Would they need to reimburse us, or do I contact the insurance? Thanks!

[Anonymous]

^contact your financial counselor. I had an ivf cycle, none to freeze, no isci or AH. I had to put down a 3200 deposit to start and ultimately received a $900 refund (after a few months...I also called to ask and followed my claims on myuhc dot com).

The fee really depends on how long you stim( I stimmed until day 11) and other factors ( I had to get a cyst aspirated at the beginning of the cycle w/ ~$140 copayment). I was pleasantly surprised but now I'm stuck with trying to spend my flex account (a good problem to have). Btw, my cycle looked sucky.... 6 retrieved, 3 fertilized, 2 transferred, none frozen, 1stuck ( I have pcos so only 6eggs was a bit of let down)! Good luck to all...use that extra $$ towards your next cycle, if needed!!! Don't give up!

[Anonymous]

Thank you for the information, PP, I will contact them. I looked up my benefits, though (I have a federal plan), and it says that the out-of-pocket max excludes (among other things) IVF. So I'm not sure that I have a case.

[Anonymous]

Anonymous wrote:PP, how did this work for you? When we started the cycle at SG this spring, they made us pay a deposit of around $4K. We never got anything back, and I assumed we owed what we paid. Would they need to reimburse us, or do I contact the insurance? Thanks!

17:39 here.

Go to my uhc.com and look up all your claims. SG has to submit each procedure as a separate claim--they don't bill the insurance a global fee. Each claim will show you the amount that you owe. You should also get a monthly statement from SG to help you. Add up what you owe from the EOB and compare that to the deposit you made. If you're owed money, give them a call and they will need to send you a check.

One thing though--it takes a long time for all the claims to go through so be patient.