Information on MDIPA Costs at SG- 50% Co-Pay- Federal HMO

[Anonymous]

Hi, I alway see people asking about IVF out of pocket costs here, so I thought I'd paste the official version from SGFC regarding MDIPA costs (patient co-pay) for 2012 as they were sent to me. The formatting is a bit funky but hopefully it will save others some trouble and digging around. Good luck.

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Prescreening
Authorization required from healthplan
Day 3 Blood work $142.77
Clomid Challenge Test Day 10 $ 6.22
Endometrial Biopsy $ 95.82
Semen Analysis $ 4.72
Mock Embryo Transfer/Fluid Sonogram $534.89
Injection Class $17.98
Hysterosalpingogram (HSG) $ 685.96
Hysterosalpingogram (HSG) at GBMC $ 451.91
(Facility Fee and Interpretation billed separately by GBMC Hospital)
Follow Up Visits (Range) $31.27-99.34

Estimated IUI Cycle Costs*
Authorization required from health plan.
Pre-Med $119.16
Monitoring Cost Per Visit $129.66
IUI/Sperm Wash Visit $370.21
Post Cycle Labs (Beta) $6.22

Estimated IVF Cycle Costs*
Authorization required from health plan. Deposit due 10 days prior to starting cycle.
IVF Treatment Cycle Deposit $3,026
(Includes LE and 5 days Monitoring)
IVF Treatment Cycle Deposit at GBMC $2,760
(Includes LE and 5 days Monitoring)
(Facility Fee and Anesthesia billed separately by GBMC Hospital)

Possible Additional Charges
ICSI $ 463.75
Assisted Hatching $ 265.00
Cryopreservation of Embryo or Egg $1500.00 (Not Covered)
Cryopreservation of Embryo and Egg $2000.00 (Not Covered)
Embryo Storage $ 360.00 (Not Covered)
PGD Biopsy $1500.00 (Not Covered)
PGD Lab Test-Billed by Actual Lab

Frozen Embryo Transfer Cycle*
FET Treatment Cycle Deposit $1726

Possible Additional Charges
Extended Culture $200.00

[Anonymous]

What does "LE" stand for? And why only 5 days of monitoring? (Or is that 10 days since it's usually every other day?)

[Anonymous]

wow, i paid twice that as a single woman fed using coventry healthcare of delaware. my cycle with icsi and ah was 7k.

[Anonymous]

As a single woman you wouldn't be eligible for these rates since insurance makes you prove you have been married a certain amt of time and you need your spouse's sperm.

Ridiculous.

[Anonymous]

yea, i know that. thanks for posting the rates though.

[Anonymous]

what do these mean?


Cryopreservation of Embryo or Egg $1500.00 (Not Covered)
Cryopreservation of Embryo and Egg $2000.00 (Not Covered)

is that per embryo? for how long? why is there and OR and an AND option?

[Anonymous]

Anonymous wrote:what do these mean?


Cryopreservation of Embryo or Egg $1500.00 (Not Covered)
Cryopreservation of Embryo and Egg $2000.00 (Not Covered)

is that per embryo? for how long? why is there and OR and an AND option?

Regardless MDIPA doesn't pay for freezing eggs or embryos - it is all out of pocket

[Anonymous]

Why is that? It seems strange for me that they'd rather pay more for a more complicated procedure (ie another fresh cycle) instead of using the embryos that are leftover.

[Anonymous]

Anonymous wrote:what do these mean?


Cryopreservation of Embryo or Egg $1500.00 (Not Covered)
Cryopreservation of Embryo and Egg $2000.00 (Not Covered)

is that per embryo? for how long? why is there and OR and an AND option?

No, it's per cycle. You then pay an annual storage fee of $360 per year.

[Anonymous]

17:18, it's because cryopreservation is considered an experimental procedure (and it actually still is, there isn't adequate data on its effectiveness/success). Most insurance companies don't pay for anything experimental.

[Anonymous]

Thanks, 730- that's really helpful. I thought maybe they were concerned people would switch to their insurance just to get their embryos frozen or whatever...

Having said that, does anyone have a sense of when it will no longer be considered experimental? Or if it's possible to appeal this given a particular person's situation? I know with other things sometimes insurance can be ask to cover experimental procedurse.As I understand, SG success rates for instance are actually slightly higher for FET vs. fresh transfers.

[Anonymous]

NP here. I am so mystified by the insurance company coverage of IVF. I live in VA, have access to the federal insurance plans. They all seem to include the same exclusionary language regarding certain specific ART procedures. I'm wondering if this is due to a state law???

Also I'm just getting into the referral process for infertility testing now, after trying and charting for a year with some family history indication that there may be a problem. Despite what it says on paper on the insurance company coverage, I wonder how the guidelines will be interpreted at each company?? Are some more generous in approvals?

[Anonymous]

You should be able to do MDIPA and they should cover IVF. I'm not in Virginia, but I know of other Virginians that used it.

[Anonymous]

10:51, I have MDIPA-Federal and live in VA and all of our ART have been covered. I am not aware of any restrictions on their coverage that apply to VA residents only (though my RE is in DC).

In our case MDIPA waived the 2 year history of TTC because our dx is male factor which has very low odds. I think this is pretty normal, and as far as I know all of the insurance companies that offer ART coverage would have done so in our case.

As far as ATB restrictions, I think most insurance doesn't cover treatments using donor egg or donor sperm. This isn't state specific but may have something to do with the fact that while MD mandates that insurance companies cover ART, they only do so for couples using their own eggs and sperm. In addition, to get our coverage we had to fax them our marriage certificate. I think this is standard as well.

[Anonymous]

I'm a married woman suing husband sperm with mdipa in va. N problem getting ivf covered. I had diagnostics user another insurane