Kaiser - Infertility Services DO count toward OOP Max
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Anonymous
It is DEFINITELY the cheapest. Theoretically, you can do 3 rounds for $2500 TOTAL. No other plan comes close to that amount in the federal government. |
Anonymous
Why are you focusing on meds? Isn't the 2,500 oop max for everything infertility, including meds? |
Anonymous
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Meds come first in the process before monitoring and retrieval, which is why I asked about them specifically. But you'll see in my follow-up question that I'm really asking the same point you're making--do other parts of the infertility process count toward OOP max? Somebody in another thread had said meds count but retrieval doesn't so I wanted to hear from others who might have updated info.
I'm also wondering if there are any coverage restrictions on Kaiser? For example, Aetna has rules about FSH being below 19 and no coverage for infertility that is age-related. Does Kaiser have any similar rules/situations that could mean a person's cycle wouldn't be covered after all? |
Anonymous
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So we got our meds today, and it did show up as counting against the OOP maximum. Our OOP now shows as $0. Shady Grove said after the retrieval, they will verify with Kaiser the OOP. Also, if doing Frozen. ICSI is only covered if you have two abnormal sperm samples. So for us it wasn't covered. It basically broke down like this for us.
$2300-Meds Kaiser Pharmacy (counted online towards OOP) $2750 IVF (covered, Will be reduced to $0, since the meds counted towards the OOP of $2250 in Mid Atlantic) $2000 ICSI (Not covered for us) $1500 PGD Biopsy (Not covered by Kaiser) $2000 (PGD Testing Lab fee, not paid to SG, not covered under insurance) $1800 Cryopreservation and first year storage (Not covered by insurance) So real out of pocket. $2250+2000+1500+2000+1800= $5300+4250= $9550 We have two FSA's so we are waiting for those to reimburse us the $5100. Which means we still owe $4450 outside the FSA. Then we are waiting until next year to do the actual FET. Which will be $2500+ Meds. Which will be reduced down to the OOP for 2017 Do you have to do frozen? No, but when we looked at it, the success rates were higher, than Fresh. Do you have to do PGD? No, but this ensures you don't implant embroyo's that don't have a good chance of making it. Hope this helps, it was like going through a maze to find our final costs. |
Anonymous
Are you sure about this? Meds did not come first for me with SG. SG filed for approval with my insurance and I had to pay a deposit for the upcoming retrieval. Once this was approved I could order meds. I'm not certain there are many places that will have you order meds before you've made a deposit and your insurance has approved. |
Anonymous
| I was the PP inquiring on this older thread. True that you have to pay a deposit up front for the retrieval and other stuff and then get meds approved. I had forgotten it worked that way since when I did my first cycle so long ago. And many thanks to the PP for the detailed cost breakdown! So helpful! |
Anonymous
| 16:24 here. So our Deposit we paid first, but Kaiser processed the claim for the meds at the time we picked up from the Kaiser Pharmacy. The claim for retrieval, doesn't happen until after the meds for the frozen. So our claim for the IVF will be processed after the claim for the meds, if that makes any sense. At least thats how it worked for us. |
Anonymous
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I thought the FET was more expensive under Kaiser than $2500 if OOP?
There was a recent post that FET OOP cost is $7100. Aetna is the only plan with a negotiated rate for FET that you get even if not covered by the plan |
Anonymous
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The actual FET Transfer is only $2500, but you have to do the retrieval of the eggs $2750, and the initial meds $2300, and then there is the meds before and after the actual FET, which I don't have the cost on yet.
So if you did the FET all the in same year, you would be at: $2750+2300+2500= $7800 but it should be reduced down to $2250 as that is your out of pocket maximum. I am not sure about Aetna, as I have Kaiser, and I am under the Kaiser High Plan, which covers IVF. Kaiser seems to be way cheaper than Aetna. |
Anonymous
| Does anyone have any idea if the coverage for kaiser is going to change for next year. We are deciding between doing the shared risk option with SGF or waiting until open enrollment so that I can get on his federal Kaiser plan. But I am worried that we will wait the 4 months and the coverage will have changed. Also, does anyone know if there is a waiting period for fertility treatment with Kaiser once you get on the plan in the new calendar year. Any advice/help would be appreciated. Thanks! |
Anonymous
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The new FEHB Plans are not out yet, and probably won't be out until the end of September/Early October No one can say if they will change or not.
There is not a waiting period per say, you need to have been trying to conceive for at least a year. Keep in mind, you have to wait for your Hubby and you to get in the Kaiser System. Which takes a couple weeks from the first federal pay period. Then you have to schedule an appointment with your physician (another couple of weeks) then you need to get the referral to shady grove (another couple of weeks after you drop off paperwork) Also, since you and hubby will be on a shared family plan, the Out of Pocket Maximum will be $4500 not $2250 (if kaiser midatlantic) I think you need to figure out what your treatment plan is before you decide if shared risk vs insurance is better. I can tell you, it is/was much much cheaper to do Kaiser and Freeze the Embroyos vs the Frozen Embroyo Shared Risk Program. It was almost half the cost of the shared program for 3 shots at it. Might have been a little less than half. Also, if you do shared risk, make sure they give you FSA receipts, also if your hubby isn't enrolling in that, he should. It saves you about $800 since that money is pretax. |
Anonymous
| Thanks for all the info! I am hoping that since we have already had all the testing and already done several iuis it will move faster for us. My husband is already on Kaiser so I am hoping that will also make it a little easier. Maybe too much wishful thinking. I was hoping that I could call and make an appointment with the gynocologist before I was on the plan for the beginning of the year, but I am doubtful they will let me do that. I am just so mad at myself for not switching last year, but I thought you had to be trying for 2 years, not 1 (as per the brochure) and my current insurance fully covers up to 6 iuis so I thought it was smarter to stay on that. Guess is was wrong. I'm just hoping that nothing changes for next year and that we can get it going quicker. We were all set to do shared risk, but then I saw this thread and it seems like switching to Kaiser would result in major savings. The quote I got from freedom pharmacy for the drugs alone for one round would pay for almost all 3 rounds on Kaiser! |
Anonymous
| It was always my understanding that because the OOP max for an individual is 2250, if that individual spends 2250, everything after that for that person will be covered 100% even though you may be on a family plan. But the other person still has to meet their OOP max before they get anything covered at 100%. As a family you would not pay more than 4500 for any care received. Even though husband is on the plan, you do not need him to meet his OOP max before you get your own services covered if you have already met yours. This is the way it was when I was on Aetna this year. Is this not correct for Kaiser? Otherwise, you would be penalized for having a family, which does not make sense. |
Anonymous
| It is also my understanding that the oop max that you have to meet is just the $2250, not the full amount for your entire family. Is there anyone out there that switched to Kaiser and do they know how long it took to get things started. We are already waiting several months to switch insurances, so having to wait another couple of months once we switch seems horrible. Also, does anyone know of the oop max for the standard option counts towards infertility stuff? So far, I have only heard about the high option. Thanks. |
Anonymous
Can you explain why you added the 4250 after the 5300? Also, I thought that the IVF through Kaiser is covered at 50%? Or is that until you meet your OOP? |