Federal Health Plans & IVF coverage

[Anonymous]

Aetna has great negotiated rates for those without a male partner. Not great drug benefits but very good negotiated rates.

[Anonymous]

Hi all! I was wondering if anyone has recent experience with the Federal Kaiser Permanente coverage and costs? I see that it says: Infertility, 50% cost share; IVF 50% cost share ($100,000 Lifetime Max-3 Attempts/Live Birth.

What about all the blood work and tests? Does that fall under the 50% cost share? Or is that covered under regular copays?

Any other advice using KP? I've had a hard time just getting to an RE with them.

[Anonymous]

Anonymous wrote:Hi all! I was wondering if anyone has recent experience with the Federal Kaiser Permanente coverage and costs? I see that it says: Infertility, 50% cost share; IVF 50% cost share ($100,000 Lifetime Max-3 Attempts/Live Birth.

What about all the blood work and tests? Does that fall under the 50% cost share? Or is that covered under regular copays?

Any other advice using KP? I've had a hard time just getting to an RE with them.

I don't have Kaiser, but I have the federal MDIPA, which has similar coverage. It really depends on how your doctor's office codes it. For me (at GW), the diagnostic testings were billed as regular lab work/office visits, so it wasn't subject to the 50% (just regular copays), but once I started with my IVF cycle, the monitoring visits and lab work was coded as fertility and subject to the 50% cost share. The finance department at your doctor's office should be able to confirm. I had heard that Kaiser refers out to SG, but I might be mistaken on that.

[Anonymous]

I use Kaiser. All diagnostics and treatments have been at 50% (except for things like TSH monitoring which goes through my regular endocrinologist). I did not have a problem getting referred from Kaiser (to shady grove). I had been trying naturally for over a year and had actually done some testing at Shady Grove out of pocket before changing my insurance to Kaiser in order to get coverage for infertility. Kaiser will require that you do diagnostic tests that they can do through them. For example I needed to do my HSG at Kaiser. Overall I have been pretty happy with the process. I also have been getting the 50% coverage for all IVF and IUI meds. I have found it somewhat cheaper to get these drugs through Grubbs specialty pharmacy in Dupont (with my kaiser coverage) than through the Kaiser pharmacy itself.

[Anonymous]

Does anyone know if either MDIPA or Aetna will waive the two year wait and lower cost options for known issues? We have known male factor issues that will require IVF + ICSI to give us any chance. I don't want to deal with an insurance company telling me we have to waste our time and money on IUI before they'll cover IVF if the docs tell us that IUI won't do anything for us.

Also, does anyone who has MDIPA have experience with non-fertility chronic health issues being covered? My husband takes an injectible weekly for RA and I need to make sure that any insurance we switch to will still cover it.

[Anonymous]

I had Aetna, though it wasn't a federal plan.

For me we only had to wait a year before being accepted to the infertility program. But they take your word for it. Unless you've recently had a live birth, you could tell them you've been trying for however you like really.

Second they do have a list of conditions where ivf is considered medically necessary. I believe severe mf is one. I'm on mobile so cant do a link, but google Aetna infertility bulletin and it will give you their entire policy/procedure sheet for infertility.

[Anonymous]

Anonymous wrote:Does anyone know if either MDIPA or Aetna will waive the two year wait and lower cost options for known issues? We have known male factor issues that will require IVF + ICSI to give us any chance. I don't want to deal with an insurance company telling me we have to waste our time and money on IUI before they'll cover IVF if the docs tell us that IUI won't do anything for us.

Also, does anyone who has MDIPA have experience with non-fertility chronic health issues being covered? My husband takes an injectible weekly for RA and I need to make sure that any insurance we switch to will still cover it.

We have male factor and AMA. We went straight to IVF+ICSI with Md IPA.

[Anonymous]

Thanks! AMA is over 35, right? I'm 35 now, so I guess we've got male factor and AMA too, so that sounds promising for being able to go straight to IVF+ICSI!

[Anonymous]

Anonymous wrote:I am on the Fed plan and looked into this a couple of years ago and wish I remembered more.

I think MD/IPA covers IVF under some circumstances. I don't think Aetna and Blue Cross cover IVF, although they do cover IUI. All have caps. Check into how much coverage each has for meds. I recall the BCBS coverage was good.

More details here ..

https://www.opm.gov/insure/08/planinfo/dc.asp

what is md/ipa????

[Anonymous]

New poster. We did IVF for #1 (dx is unexplained infertility) with MDIPA. Child is going to be 2 in May and we'll be ready to start trying again then using ART procedures. In fact we have one frostie that we will start with. What documentation if any will we need for MDIPA? Since we've haven't been on bcps at all during this time frame - will that be sufficient or is the fact that we had to do IVF for number 1 sufficient in and of itself?

[Anonymous]

Anonymous wrote:I use Kaiser. All diagnostics and treatments have been at 50% (except for things like TSH monitoring which goes through my regular endocrinologist). I did not have a problem getting referred from Kaiser (to shady grove). I had been trying naturally for over a year and had actually done some testing at Shady Grove out of pocket before changing my insurance to Kaiser in order to get coverage for infertility. Kaiser will require that you do diagnostic tests that they can do through them. For example I needed to do my HSG at Kaiser. Overall I have been pretty happy with the process. I also have been getting the 50% coverage for all IVF and IUI meds. I have found it somewhat cheaper to get these drugs through Grubbs specialty pharmacy in Dupont (with my kaiser coverage) than through the Kaiser pharmacy itself.

Who did you use for your PCP for the referral to SG? We will likely switch to Kaiser from BCBS this coming year, and I'd like to line up a PCP. Also, aside from the HSG, does Kaiser require any additional testing? Trying to figure out what testing I can get done this coming year for nearly free through BCBS. Thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I use Kaiser. All diagnostics and treatments have been at 50% (except for things like TSH monitoring which goes through my regular endocrinologist). I did not have a problem getting referred from Kaiser (to shady grove). I had been trying naturally for over a year and had actually done some testing at Shady Grove out of pocket before changing my insurance to Kaiser in order to get coverage for infertility. Kaiser will require that you do diagnostic tests that they can do through them. For example I needed to do my HSG at Kaiser. Overall I have been pretty happy with the process. I also have been getting the 50% coverage for all IVF and IUI meds. I have found it somewhat cheaper to get these drugs through Grubbs specialty pharmacy in Dupont (with my kaiser coverage) than through the Kaiser pharmacy itself.

Who did you use for your PCP for the referral to SG? We will likely switch to Kaiser from BCBS this coming year, and I'd like to line up a PCP. Also, aside from the HSG, does Kaiser require any additional testing? Trying to figure out what testing I can get done this coming year for nearly free through BCBS. Thanks.

Problem is I heard Kaiser makes you redo all of your testing. Can anyone confirm? I'm terrified of having an HSG done at kaiser!

[Anonymous]

l've found everything easy at Kaiser but I was in process with SG when I became a Kaiser member. At Kaiser, everything is very doctor driven vs insurance driven. I just asked my doc for a referral after sending her my SG file and she put it in and I continued on with what I was doing.

I had my HSG pre-Kaiser so I don't know about that. But Kaiser has surgical centers that do loads of surgeries, whereas SG (where I had my HSG and hysteroscopy) just do very limited procedures.

Because it's for your health insurance overall, and fertility at not be all that happens to you healthwise, during the period you are trying, be sure to look for a good health plan overall.

[Anonymous]

Oh and I didn't have to redo any of my testing when I switched to Kaiser.

[Anonymous]

Anonymous wrote:Oh and I didn't have to redo any of my testing when I switched to Kaiser.

Had it been over a year since your testing?