Costs of infertility treatment; Adoptions, surrogacy etc.

[Anonymous]

OP, prob too late to add, but also consider embryo adoption. I’m not sure exactly of the cost but from the medical standpoint it would be a cost of FET ($4500 approx) + legal fees, which can be far lower than adopting an infant or child.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here - Thank you to those who responded and helped to provide a few data points for the discussion. I just finished typing up my notes and will transfer them to my slide templates this evening before the session. For those who asked about the broker and the MD infertility Mandate:

I didn't end up speaking to a broker today because I was busy at work. I think they must be easy to reach as at least 4 called me today. I did speak with Kaiser directly however and while I wasn't able to get someone well versed on the infertility benefits and how much things would cost, they did assure me that you would not pay more than your oop maximum in any calendar year and that includes medication coverage. Both Kaiser and BCBS cover up to 3 IVFs per live birth up to a maximum of $100,000 per the MD infertility mandate. I saw a few plans on the Kaiser site (Kaiser platinum for example) where for monthly individual premiums of $470 or so, the max oop was about $6-$7K for the year. The particular plan I looked at had no deductibles and so I am not quite certain how one's copays would work for the various IVF procedures/charges but at least its a start. Of note, MD open season runs from November 1st to December 15th so I wanted to get this topic in during that time.

West Virginia is also an Infertility mandated state near us. I just didn't have any time to research their plans.

The last thing I stumbled on was a website that had some additional info on the infertility mandate and also provided info. on some private companies (like UPS and starbucks) which offer good infertility coverage. Here's the link to that site: https://yourfertilityfriend.com/state-laws-related-to-insurance-coverage-for-infertility-treatment/

Again - this is just a quick and dirty summary.

I've actually been researching this today and I'm surprised to hear that. My understanding was that Kaiser made infertility treatment an exclusion from the OOP maximum in 2017. I would just double check the explanation of benefits before choosing coverage based on that assumption.

Op here - so I just looked at the plan brochure again and didn't see anything that indicates that for the Kaiser Maryland Plan on the exchange that infertility did not count towards the oop max. Page CS8 which lists oop maximum exclusions only lists three things: eye glass lenses, frames, etc.; adult routine eye exams and dental services. If you can point me in the direction where you heard or read this I would appreciate it. My session starts in the next few minutes so I will leave the oop max issue out for now until I hear back from you.

Hi OP, sorry just checking this thread now. I read that in my plan's 2018 evidence of coverage document. I'm not a fed employee though, and am checking with my HR now, so it may not be relevant to you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Op here - so I just looked at the plan brochure again and didn't see anything that indicates that for the Kaiser Maryland Plan on the exchange that infertility did not count towards the oop max. Page CS8 which lists oop maximum exclusions only lists three things: eye glass lenses, frames, etc.; adult routine eye exams and dental services. If you can point me in the direction where you heard or read this I would appreciate it. My session starts in the next few minutes so I will leave the oop max issue out for now until I hear back from you.

Hi OP, sorry just checking this thread now. I read that in my plan's 2018 evidence of coverage document. I'm not a fed employee though, and am checking with my HR now, so it may not be relevant to you.

I have Kaiser through my non-Fed employer and the evidence of coverage document specifically excludes infertility treatment and prescriptions from the OOP maximum.

[Anonymous]

Anonymous wrote:I have Kaiser. With Kaiser, you need to do initial diagnostic testing through Kaiser, then they refer you to Shady Grove Fertility for treatment. Our plan covered 50%. Below are 2018 costs for diagnostic tests and IUIs. I put in total costs and then our costs in parentheses. It is a little confusing because the providers charge a certain amount, but then the insurance has a lower negotiated rate and that's what actual costs below are based on.

2018 diagnostic and IUI costs through Kaiser and Shady Grove Fertility
Initial consult with OB for infertility through Kaiser: $80 (our costs: $40)
Day 3 bloodwork through Kaiser: $450 (our costs: $225)
Semen analysis through Kaiser: $40 (our costs: $15)
HSG through Kaiser: $200 (our costs: $100) – this seemed very low to me, I think Shady Grove’s price list had something like $1,600 for the HSG, but it is what they charged
Consult with Shady Grove Fertility RE: $100 (our costs: $50)
Genetic disease carrier testing: $350 (for each partner)
Clomid IUI cycle through Shady Grove Fertility including meds, initial monitoring appointment and two follow-up monitoring appointments: $1,200 (our costs: $600, but note that I believe this does not include the costs of hormonal support for some reason these were fully covered)
Hybrid Femara and Gonal-F IUI cycle through Shady Grove Fertility including meds, initial monitoring appointment and one follow up monitoring appointment: $1,500 (our costs: $750, we lucked out on this cycle because I was ready to trigger after first follow up monitoring appointment so we didn’t need another monitoring appointment, also this time I think the estrace was fully covered by insurance but the prometrium was not).

This is so helpful! Thank you for sharing these numbers!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Op here - so I just looked at the plan brochure again and didn't see anything that indicates that for the Kaiser Maryland Plan on the exchange that infertility did not count towards the oop max. Page CS8 which lists oop maximum exclusions only lists three things: eye glass lenses, frames, etc.; adult routine eye exams and dental services. If you can point me in the direction where you heard or read this I would appreciate it. My session starts in the next few minutes so I will leave the oop max issue out for now until I hear back from you.

Hi OP, sorry just checking this thread now. I read that in my plan's 2018 evidence of coverage document. I'm not a fed employee though, and am checking with my HR now, so it may not be relevant to you.

I have Kaiser through my non-Fed employer and the evidence of coverage document specifically excludes infertility treatment and prescriptions from the OOP maximum.

PP here - yes, same language in mine. I think it's standard for Kaiser now. My Aetna policy had the same exclusion. Are there any companies left without it? It seems so unfair to pay $500+ a month for a policy then have IVF cost $7-10k per cycle (after meds, ICSI, PGD, storage).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Op here - so I just looked at the plan brochure again and didn't see anything that indicates that for the Kaiser Maryland Plan on the exchange that infertility did not count towards the oop max. Page CS8 which lists oop maximum exclusions only lists three things: eye glass lenses, frames, etc.; adult routine eye exams and dental services. If you can point me in the direction where you heard or read this I would appreciate it. My session starts in the next few minutes so I will leave the oop max issue out for now until I hear back from you.

Hi OP, sorry just checking this thread now. I read that in my plan's 2018 evidence of coverage document. I'm not a fed employee though, and am checking with my HR now, so it may not be relevant to you.

I have Kaiser through my non-Fed employer and the evidence of coverage document specifically excludes infertility treatment and prescriptions from the OOP maximum.

PP here - yes, same language in mine. I think it's standard for Kaiser now. My Aetna policy had the same exclusion. Are there any companies left without it? It seems so unfair to pay $500+ a month for a policy then have IVF cost $7-10k per cycle (after meds, ICSI, PGD, storage).

Op here - so this is why it's so important to specify what insurance plan one is quoting. What I was quoting was the Kaiser policy for maryland on the opem exchange (also possible to purchase directly through them). This isn't the federal policy or a company sponsored plan. I haven't had a chance to call them back today but here is a link to the plan brochure that I referenced: http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/pdf/2019/KPIF-On-Exchange/KP_MD_Platinum_0-5-Dental_Embedded.pdf

Do a search for the page I quoted earlier or "exclusions"

I'll post back once I call them again but this is the plan under Maryland infertility mandated requirements for policies written in the state of maryland (which is not the same apparently as a plan that might just cover someone who lives in Maryland) which might differ from the plans you all have. If you can specify who your plan is with and whether it is employer sponsored or not that would be helpful.

[Anonymous]

Anonymous wrote:OP, prob too late to add, but also consider embryo adoption. I’m not sure exactly of the cost but from the medical standpoint it would be a cost of FET ($4500 approx) + legal fees, which can be far lower than adopting an infant or child.

Thank you for this rec. I included a price range for donor embryos that I found on shady groves website.

[Anonymous]

2013 paid about 15k out of pocket for one IVF cycle and that was with insurance coverage that paid for "50%" of the procedure. We later learned that "procedure" is very narrowly defined. and did not include the meds which were almost 6k.