Federal Health Plans & IVF coverage

[Anonymous]

Anonymous wrote:

Anonymous wrote:We've had Aetna open access for several years. Apart from the dropping IVF thing, I have no complaints. Good network. Claims paid quickly and correctly, and they stepped in and handled all those "your hospital is in network but the random doctor isn't" situations quickly. Has a decent preventive dental benefit (I found it best to call and select the PPO). For 2017 they are covering 3 days inpatient for childbirth (more for c section) w no copay - good news for the pp who got pregnant in june.

Biggest complaint is that there is no out of network reimbursement benefit at all (except for dental). So if you see someone not in their plan, they won't pay anything.

For those considering choosing Aetna for the SG discount, it is not a bad choice.

Thanks! I only saw two days in patient delivery covered on the website though!

Just kidding, I see it on the plan brochure. That is awesome! I'm switching from BCBS fed basic, hoping I have a baby in 2017 to get hose better maternity benefits.

[Anonymous]

We are also in the same boat - were planning to switch from BCBS (FEP) to Aetna or Kaiser for IVF coverage next year.... shocked to find out what's happened. We'll talk to SG about the potential Aetna negotiated rate. But we're also wondering about the Maryland health exchange options. Anyone have recommendations for those that are good generally, and in terms of coverage?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We've had Aetna open access for several years. Apart from the dropping IVF thing, I have no complaints. Good network. Claims paid quickly and correctly, and they stepped in and handled all those "your hospital is in network but the random doctor isn't" situations quickly. Has a decent preventive dental benefit (I found it best to call and select the PPO). For 2017 they are covering 3 days inpatient for childbirth (more for c section) w no copay - good news for the pp who got pregnant in june.

Biggest complaint is that there is no out of network reimbursement benefit at all (except for dental). So if you see someone not in their plan, they won't pay anything.

For those considering choosing Aetna for the SG discount, it is not a bad choice.

Thanks! I only saw two days in patient delivery covered on the website though!

Just kidding, I see it on the plan brochure. That is awesome! I'm switching from BCBS fed basic, hoping I have a baby in 2017 to get hose better maternity benefits.

It is a little weird, because in one place it says three days, and in another it says 48 hours. That discrepancy was in the 2016 brochure too; I called them a few months ago and they said it was an error and it should be three days in both places. The 2016 brochure also specifically called out the three days in the "what is changing" section, and that section for 2017 doesn't say they are changing it back. So seems reasonable to assume they just never fixed the error but are covering three days.

The no copay part is new for 2017.

[Anonymous]

I confirmed today through my financial advisor with SG if you keep the Aetna Open Access HMO they will indeed keep the single IVF rates for as many cycles as you would like, but this does not include the medication discounts previously obtained. Also, be cautious of extra fees they may add in for single IVF. From the numbers I received the multi and shared risk seem to be cheaper in the long run if you have to do more than one.

[Anonymous]

I confirmed today through my financial advisor with SG if you keep the Aetna Open Access HMO they will indeed keep the single IVF rates for as many cycles as you would like, but this does not include the medication discounts previously obtained. Also, be cautious of extra fees they may add in for single IVF. From the numbers I received the multi and shared risk seem to be cheaper in the long run if you have to do more than one.

[Anonymous]

Thanks, I talked to SG as well and you are correct - they will honor the Aetna rate but FETs, meds, etc. are extra -- so the multi-cycle may still be a better option depending on how things go.

I'm also trying to get some information about Maryland health exchange options - I talked to CareFirst today about their plans, but they say only that up to 3 attempts per live birth are covered, once deductible is met and if doctors authorize. The sales department won't say more about what's actually covered - I'm assuming it's just the standard IVF cycle and nothing else, but does anyone know?

[Anonymous]

Anonymous wrote:I confirmed today through my financial advisor with SG if you keep the Aetna Open Access HMO they will indeed keep the single IVF rates for as many cycles as you would like, but this does not include the medication discounts previously obtained.

If you are self pay at SG but getting the negotiated rate because you have Aetna open access HMO, there's not a discount for meds that I've heard of - you can order from discount pharmacies like Freedom Fertility, but that's not a SG related discount. Am I missing something?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I confirmed today through my financial advisor with SG if you keep the Aetna Open Access HMO they will indeed keep the single IVF rates for as many cycles as you would like, but this does not include the medication discounts previously obtained.

If you are self pay at SG but getting the negotiated rate because you have Aetna open access HMO, there's not a discount for meds that I've heard of - you can order from discount pharmacies like Freedom Fertility, but that's not a SG related discount. Am I missing something?

I'm not aware of any shady Grove Aetna meds discount. Maybe pp is taking about the insurer rate on fertility drugs generally. But if that's the case, the consensus on this board was that given the Aetna Specialty Pharmacy prices and auth procedures, it was cheaper and more convenient to self-pay with rebates anyway.

[Anonymous]

First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

[Anonymous]

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

[Anonymous]

Anonymous wrote:

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

My coworker is doing this. She's the fed and keeping fed ins with her husband on it , and is getting the carefirst as a supplemental ins.Even with an additional few grand a year premium it's still cheaper than one round of ivf.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

My coworker is doing this. She's the fed and keeping fed ins with her husband on it , and is getting the carefirst as a supplemental ins.Even with an additional few grand a year premium it's still cheaper than one round of ivf.

Awesome to hear that others are doing this. I wasn't sure if there was some sort of stipulation about having two health care plans or if I had to be on the private insurance plan as well. I think we are going to go with the Blue Choice HMO 3500 plan where it lists AI/IVF costs as "no cost, no deductible" so that seems like we would just be able to schedule an appointment and begin the cycle. The only thing I'm worried about now is if I have to be on the plan as well (as the husband) and if there is some sort of waiting period to begin the process. I read that the requirements are that we have to have been trying to conceive for at least 2 years. We have been, but I'm not sure if they make you prove that somehow.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

My coworker is doing this. She's the fed and keeping fed ins with her husband on it , and is getting the carefirst as a supplemental ins.Even with an additional few grand a year premium it's still cheaper than one round of ivf.

Awesome to hear that others are doing this. I wasn't sure if there was some sort of stipulation about having two health care plans or if I had to be on the private insurance plan as well. I think we are going to go with the Blue Choice HMO 3500 plan where it lists AI/IVF costs as "no cost, no deductible" so that seems like we would just be able to schedule an appointment and begin the cycle. The only thing I'm worried about now is if I have to be on the plan as well (as the husband) and if there is some sort of waiting period to begin the process. I read that the requirements are that we have to have been trying to conceive for at least 2 years. We have been, but I'm not sure if they make you prove that somehow.

That's the exact plan she's getting! I'm not sure I understand your question. You don't have to be on the supple gal plan unless you want coverage. She can get the MD plan herself and be the policy holder is my understanding.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

My coworker is doing this. She's the fed and keeping fed ins with her husband on it , and is getting the carefirst as a supplemental ins.Even with an additional few grand a year premium it's still cheaper than one round of ivf.

Awesome to hear that others are doing this. I wasn't sure if there was some sort of stipulation about having two health care plans or if I had to be on the private insurance plan as well. I think we are going to go with the Blue Choice HMO 3500 plan where it lists AI/IVF costs as "no cost, no deductible" so that seems like we would just be able to schedule an appointment and begin the cycle. The only thing I'm worried about now is if I have to be on the plan as well (as the husband) and if there is some sort of waiting period to begin the process. I read that the requirements are that we have to have been trying to conceive for at least 2 years. We have been, but I'm not sure if they make you prove that somehow.

That's the exact plan she's getting! I'm not sure I understand your question. You don't have to be on the supple gal plan unless you want coverage. She can get the MD plan herself and be the policy holder is my understanding.

I read a little more about the Blue Choice HMO 3500 and it I do not have to be on the plan with my wife in order to start the IVF cycle, however, the Blue Choice plan only pays for semen collection (sperm wash) if I am also a plan member. Since I won't be, that will be something that we'll have to pay for out-of-pocket. The only thing I need to know now is how do we prove that we have been trying to conceive for 2 years. Do we need to have been married for 2 years or do we just say that we've been trying for 2 years.. Does anybody know the answer to that?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:First time poster here and really glad to have found this discussion forum. Thanks to everyone who has shared their experiences & advice.

I was wondering if anyone else has considered purchasing an individual plan or are currently using the Carefirst BlueChoie or HealthyBlue options? In this case, would you drop the FEHB coverage altogether (I'm guessing so)?

I've been using Aetna Open Access this past year and started my first IVF cycle with SGF in the fall, so I was also really disappointed that they're getting rid of IVF coverage. So far, the plan has been pretty good except for the ridiculously high costs of the injectable meds through Aetna Specialty Pharmacy and their authorization/refill procedures. I'm now self-paying for meds. Wanted to see if it would be worth switching to a Carefirst Maryland plan, if coverage for IVF, FET, and meds are decent.

Thanks

I'm in the same boat as you. I am currently a FED and I have Aetna open access. I'm wondering if I can keep my Aetna open access plan and keep my wife on it and just have my wife sign up for a private plan through CareFirst to take advantage of the Maryland mandate?

My coworker is doing this. She's the fed and keeping fed ins with her husband on it , and is getting the carefirst as a supplemental ins.Even with an additional few grand a year premium it's still cheaper than one round of ivf.

Awesome to hear that others are doing this. I wasn't sure if there was some sort of stipulation about having two health care plans or if I had to be on the private insurance plan as well. I think we are going to go with the Blue Choice HMO 3500 plan where it lists AI/IVF costs as "no cost, no deductible" so that seems like we would just be able to schedule an appointment and begin the cycle. The only thing I'm worried about now is if I have to be on the plan as well (as the husband) and if there is some sort of waiting period to begin the process. I read that the requirements are that we have to have been trying to conceive for at least 2 years. We have been, but I'm not sure if they make you prove that somehow.

That's the exact plan she's getting! I'm not sure I understand your question. You don't have to be on the supple gal plan unless you want coverage. She can get the MD plan herself and be the policy holder is my understanding.

I read a little more about the Blue Choice HMO 3500 and it I do not have to be on the plan with my wife in order to start the IVF cycle, however, the Blue Choice plan only pays for semen collection (sperm wash) if I am also a plan member. Since I won't be, that will be something that we'll have to pay for out-of-pocket. The only thing I need to know now is how do we prove that we have been trying to conceive for 2 years. Do we need to have been married for 2 years or do we just say that we've been trying for 2 years.. Does anybody know the answer to that?

PP here. I know shady grove and many other RE define trying as having unprotected sex. This doesn't mean temping, or using opk, or checking fertile mucus or keeping record of charts. So, if they ask (and no one ever asked me to prove it) they usually just ask how long have you been trying.