Federal Health Plans & IVF coverage
![[Post New]](/jforum/templates/default/images/icon_minipost_new.gif){kind=icon}
Anonymous
| What are your specialist needs? Would it make sense for one year to switch to a plan that covers IVF and pay for your out-of-network specialist out of pocket? |
Anonymous
| Has anyone had experience with SG and Aetna? We did IVF three years ago with a different carrier and are now trying to switch to Aetna because SG says they have a fixed rate FET with them. But when I try to talk to Aetna they say they don't do FET and can't give me information because we aren't current members. Argh!! |
Anonymous
| Aetna does not cover FET. That is true. |
Anonymous
| But has anyone who has Aetna received the reduced rate FET through shady grove? For $1850? Before we switch insurance I would love to hear from someone who actually did it! |
Anonymous
|
The Federal Gov, has 2 plans that have IVF coverage.
MD IPA and Aetna HMO. I have Aetna and found that my out of pocket cost was about $8000.00. I switched Centers and was told by their insurance coordinator, that MD IPA was less out of pocket and found that the same cycle with Aetna cost me $2000.00 with MD IPA. I found that they have rigid rules but it was worth it. Thank you "Partners for Fertility" for saving me $$$. |
Anonymous
| I have Aetna and had a FET for that price this year at SG, after a failed IVF cycle. I didn't understand how, since Aetna flat out denied coverage. It's just what I was billed without explanation. |
Anonymous
|
I need help everyone. DH and I have been TTC since 4/2013. We are with BCBS Federal. I just had my first work up with the RE and everything turned up normal, except for low progesterone. They suggest I try clomid with a trigger for a few months. Would this be covered by BCBS Federal?
Say, come 4/2013, we still have had no luck with Clomid and trigger and need to progress further. Would IUI be the next thing to use? And if so, would BCBS cover it? If not, should I use the current open season to switch to another carrier? If so, which one would you all suggest? We are currently working with Dominion. Thanks. |
Anonymous
I can only speak about 2011, which is when I had BCBS federal. They covered all diagnostics in full, unlike some of the other plans that cover ARTs at 50% but only cover 50% of the diagnostics as well. BCBS also covered all meds, if they were NOT used in conjunction with any ARTs (assisted reproductive technologies). They consider IUI an ART, so no, they don't cover it. They would have covered the Clomid + trigger with timed intercourse. They would even cover injectables for a TI cycle. However, if you need anything beyond that, you'd have to switch to MDIPA or Aetna (I recommend MDIPA, because they cover meds in full). So basically, especially if you have all diagnostics done, I'd switch to MDIPA now. |
Anonymous
Well, we are still young (I'm 31 and he's 33) and all my tests (except progesterone) turned up normal. And we have only been TTC since 4/2013, so I wonder if we should stay with BCBS for this coming year (do the clomid + trigger for a few months), and then next year switch to MDIPA. I don't want to jump the gun (but I also don't want to get stuck next year with health insurance that won't cover what I need). Having never gone through the process, I just don't know what to expect 6 months from now. Too early to switch to MDIPA? |
Anonymous
| PP here. I also want to clarify that by testing I mean all bloodwork, a U/S, the HSG, genetic testing, and DH's SA test. Not sure if there's other testing involved in the RE process. |
Anonymous
|
Great thread, I've learned a lot, thanks gals (and guys)!
I'm on Aetna, and have generally been pleased with their coverage, but the service can be a bit of a PITA. My (federal) coverage doesn't cover (as was pointed out previously) injectables for timed intercourse/IUI-- OK, fine, but not having memorized the plan, I spent an ENTIRE day (i.e., I actually had to put in for leave) trying to deal with SG, Aetna, specialty pharmacies, etc! The request had just been sitting with Aetna for a week before my nurse fast tracked it two days before trigger- everybody thought that everything would just move forward, but after calling (6 times, no kidding) to make sure I would get it on time I finally was told that it was denied....no indication that they would ever communicate that to me. SG was able to get a local pharmacy to fill the trigger meds, but DEFINITELY get your nurse to follow up-- they told me it would be 2-3 days to fill, which is just absurd with these timed situations. |
Anonymous
| For those that are on MDIPA, how do you feel about the non-fertility coverage? I'm tempted to switch because the fertility benefits are better, but I want to consider the full range of our health needs. |
Anonymous
The two things I found annoying: 1) getting referrals for every specialist visit 2) having to use a particular radiology place depending on PCP location (I switched PCPs just to avoid a radiology place I didn't like) After two years with MDIPA (only used IF benefits the first year), we are switching back to BCBS. But it was totally worth it for our IVF cycle, which cost us only around $2K. |
Anonymous
| I thought MDIPA was great even apart from fertility. Referrals were a snap. I have other health issues and was worried about being on an HMO but I was very pleased all around. |
Anonymous
I have had MDIPA for almost 10 years. They were much easier to deal with before they were bought/taken over by United Healthcare. They are very prickly about referrals and pre-auths. And, no, it isn't just getting a referral from the PCP. For some procedures, you need a referral AND a pre-auth. They aren't exactly timely with the pre-auths. I had a situation where my doctor submitted all of the paperwork for an outpatient procedure a month in advance of the procedure, and one day before it was scheduled to take place, they still had not authorized it, saying they needed more information. I spent a day on the phone -- lots of phone calls. I finally got a manager to rush through a pre-auth and I went ahead with the procedure the next day. Well, they still denied coverage, and it took 2 months back and forth with the doctor to finally get them to cover it. More recently (like 2 weeks ago), I had another outpatient procedure. The doctor's office got a preauthorization. But even though they will pay the claim for the doctor and facility, they are denying the anesthesiologist and giving "no precert" as the reason. Well, I would assume if a procedure is pre-authorized, then that means the entire procedure. I have an inquiry in with them. Their game is to make the entire pre-auth process complicated and not at all transparent. That is how they deny things, and you have to keep at it to get them to cover it. I'll bold this because it is important: Just because you get a procedure pre-authorized with MDIPA doesn't mean they're going to cover it. And I am very good at getting referrals from my PCP. The other thing another PP mentioned is that LOCATION matters with radiology. It isn't enough to use a facility they are contracted with; you have to use a facility in the same county as your PCP. But this isn't spelled out in the documentation. There's just this "RAD: [County]" on your card that you are supposed to understand means you have to stay in that county. So that means it isn't enough to call the radiology place and ask if they are in network for MDIPA. And their premiums have gone up significantly for next year. I'm seriously considering making a switch. |