Federal Health Plans & IVF coverage

[Anonymous]

15:59 here again. Both procedures were for NON-fertility related health procedures (i.e. procedures that most insurance plans cover without issue).

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

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.

22:20 here. Ugh, that sounds horrible! We're definitely switching back to BCBS. Will also save us almost $300/month. I will say, we have not had too much trouble getting pre-authorizations (for ultrasounds at RE, and labwork at specialty lab) with MDIPA. Everything worked smoothly for us these two years. But they are just expensive, and the referral requirement and radiology restrictions really bother me.

[Anonymous]

Has anyone with MDIPA had a transfer canceled (postponed one cycle) because of a high progesterone level before trigger? This will likely happen to me, and I'm wondering if MDIPA will count next month's transfer of the frozen embryos from this month's fresh cycle as the first or second attempt.

[Anonymous]

I have MD IPA as well. I heard that once you start injections they count it as a cycle, even if it gets canceled. I am also interested in hearing other responses.

[Anonymous]

Thanks for your response. I'm still learning about the FET process, but I think there won't be injections before the transfer, so I would have only done them this month. If that's the case, my fingers are crossed that they won't interpret this as two cycles. I'll attempt to call them, but getting answers from them about the coverage has been more painful than all the shots!

[Anonymous]

18:30 - they will count the first cycle as a cycle since you started injections. The second FET would be better covered out of pocket.

[Anonymous]

I am getting ready to sign up for an FEHB plan (I just got married to my federally employed spouse). I went straight to MDIPA because of all of the recommendations here. The MDIPA for Washington DC has a note in the Infertility Services section: "Note: This benefit is available to members under age 43." This is a problem, as I am 43. I don't remember seeing that when I researched plans previously -- is it new? Kaiser and Aetna Open Access are the only other options for IUI/IVF coverage. None of my doctors are in Kaiser's network, but they are in Aetna's (including my doctor at Shady Grove). We have already done all of the diagnostic work under my current insurance (Carefirst BC/BS), although it's been about 1-1/2 years since it was done. I was hoping to hit the ground running at SG with my new coverage. Any advice would be appreciated!

[Anonymous]

Don't pick mdipa if you aren't under 43.

[Anonymous]

MD IPA wanted my day 3 bloodwork to be within the last 6 months, and my husbands report within the past 12 months to process the IVF preauthorization. I don't know about the age limit though.

[Anonymous]

Just found this thread and checked out Aetna Open Access coverage based on the information above. If I'm reading it correctly, there is no coverage for IVF for those of us without male partners.

In vitro fertilization is a covered benefit when the
following criteria are met:
• You have been unable to attain a successful
pregnancy through a less costly treatment that is
covered by the Plan; and
• Your oocytes are fertilized with your spouse’s sperm;
and
• You and your spouse have a history of infertility of at
least 2 years duration; or your infertility is associated
with endometriosis, exposure in-utero to
diethylstilbestrol (DES), blockage of, or surgical
removal of, one or both fallopian tubes, or abnormal
male factors, including oligospermia contributing to
the infertility.

[Anonymous]

That is true, unfortunately. Some sort of shared risk program is probably your best bet.

[Anonymous]

You still want to watch for good negotiated rates. Makes a big difference in price.

[Anonymous]

Shared risk programs won't take anyone over 39, so for older women who cannot use a partner's sperm it sounds like there are no options other than out of pocket.

[Anonymous]

Hello all,
Newly hired federal employee here, your comments have been very useful.

Deciding on switching from husband's plan into an FEHB plan (most likely MD-IPA) and wanted to compare costs for IVF. He currently has 90% coverage with CFA BC/BS at $325/month.

On average, how much does an IVF cycle cost, total with insurance negotiated rates? I know it can vary, but a range would be useful.

Thanks everyone!

[Anonymous]

I have MD IPA and am at SGF.
The plan will not cover PGS, embryo freezing or embryo biopsy. These are all OOP.
We are doing IVF+ICSI with assisted hatching. The IVF deposit was about $4000, and covers all labs, ultrasounds, retrieval, transfer and one follow up visit with the RE.
Medications have to be processed only through Freedom Pharmacy, and were a copay of about $200 in my case. This may vary upon individual protocols and levels of dosing.
FET will count as one of the three attempts,even if the fresh cycle results in a freeze-all. In the event we need this, we will pay OOP in order the preserve the fresh attempts.
Embryo freezing costs $1750.
Embryo biopsy is $1500.
Ivigen, the company for PGS, charges about $2500 for up to 8 embryos, then a separate fee for each embryo beyond that.
If you need a mock transfer, it is treated as a separate procedure and has it's own copay, about $500 in my case.