CareFirst BlueChoice - any chance they'll cover IVF?

[Anonymous]

The CareFirst website says IVF is not covered, but I've been told that some insurance companies, in some cases, will cover up to three cycles. I was also told they're more likely to do this if the case can be made for infertility. We are able to conceive and sometimes carry, but we have lost or had to end all of our pregnancies due to a (likely- waiting on test results) genetic issue, so we are now exploring IVF with PGD.

Anyone have the same insurance and had luck getting at least some of this covered?

And/or, if anyone without coverage has worked with GW Fertility, did they adjust the cost for you since you were paying out of pocket?

[Anonymous]

Are you getting your plan thru a company headquartered in Maryland? If so, some IVF coverage is mandatory.

Otherwise - most policies will cover testing to determine cause of infertility. If you have already selected a clinic - contact them and have their insurance specialist find out what your level of coverage is. They deal with this stuff all the time.

[Anonymous]

Unless they have changed since 2009-2010, I believe the answer is "no." But, if your infertility is caused by a medical condition - i.e. not unexplained infertility - then they might cover something. They didn't cover the drugs for IVF either.

[Anonymous]

OP here - it just doesn't make sense to me - as I understand it, we would be more likely to get coverage if we were unable to conceive at all on our own. But if we have this genetic condition that causes us to conceive unhealthy babies - who, if born, would require hundreds of thousands of dollars in medical care - they won't help us pay for IVF to ensure that we get a healthy child. It boggles the mind.

[Anonymous]

I was unable to get any coverage for IVF through CareFirst, though they did cover three IUI cycles (unsuccessful for us). This was in late 2012 into 2013. Hope you're able to work something out. Best of luck!

[Anonymous]

Anonymous wrote:OP here - it just doesn't make sense to me - as I understand it, we would be more likely to get coverage if we were unable to conceive at all on our own. But if we have this genetic condition that causes us to conceive unhealthy babies - who, if born, would require hundreds of thousands of dollars in medical care - they won't help us pay for IVF to ensure that we get a healthy child. It boggles the mind.

If, as stated in your original post, ivf is not covered then you are just as unlikely to get ivf coverage for any reason - fertility, genetic or otherwise.

[Anonymous]

Hi OP, I get where you're coming from. I'm a carrier of hemophilia with no fertility issues and it was a long appeal process to get Kaiser to cover IVF-PGD. Unfortunately the prevention/cost savings argument is a tough one to make--our health care system is built around care and treatment, not prevention.

It's possible to win an appeal, but as PPs have noted you have to have IVF coverage in the first place. I ended up switching insurance to get coverage.

Good luck.

[Anonymous]

My only option is IVF due to a medical condition.

BCBS would not cover it - no way, no how.

[Anonymous]

Honestly, I wouldn't waste your time, OP. Seeking special permission would be a huge headache and I think your chances are pretty much nil.

[Anonymous]

NP here. I have Cigna and it doesn't cover IVF. I called and asked them if they cover PGD as my RE suspects genetically abnormal embryos that fail to implant. They asked me if I had repeated miscarriages and I said no. I have never been pregnant after several IVF attempts. Cigna told me that if I had repeated miscarriages and if then the RE would have recommended PGD, they would have covered the PGD biopsy costs (not the IVF cycle costs). You can call your insurance and ask them if they can at least cover the PGD costs if not the IVF costs, since you had to terminate your pregnancies.

[Anonymous]

Anonymous wrote:NP here. I have Cigna and it doesn't cover IVF. I called and asked them if they cover PGD as my RE suspects genetically abnormal embryos that fail to implant. They asked me if I had repeated miscarriages and I said no. I have never been pregnant after several IVF attempts. Cigna told me that if I had repeated miscarriages and if then the RE would have recommended PGD, they would have covered the PGD biopsy costs (not the IVF cycle costs). You can call your insurance and ask them if they can at least cover the PGD costs if not the IVF costs, since you had to terminate your pregnancies.

OP here, thank you, this is super helpful and I will definitely look into it. I understand the pgd costs about $5k and having that covered would be a huge help.

[Anonymous]

I was told that an employer has to chose to cover it otherwise just the testing is covered. Be sure to download the 20+ page fertility treatment policy from the website because you need to jump through medical hoops first (incl some tests) before IVF is even considered.

[Anonymous]

I have BCBS with %100 coverage for three cycles but PGD is not covered so who knows what your insurance will cover. Just need to have the clinic submit the information and find out or call the insurance company directly.

[Anonymous]

I'm a new poster here - I'm not going through IVF, however I am about to go through egg freezing in a couple of months. Has CareFirst covered any of the costs of medications? I know the procedures are never covered but thought maybe I'd get some help on the meds.

Thanks!

[Anonymous]

Hi, I just want to chime in bc I work in insurance. some of what is allowed vs not is generally determined by the states at some level. MD is a little different than say VA.
beyond that your employer is purchasing a plan.
in most cases employers chose cheaper plans that exclude fertility. I know it seems unfair, but they do it to keep costs down and cover other stuff seen as more necessary.
there are some employers that chose to cover fertility, but not many. it's a fairly standard exclusion. again, not saying it's fair, but I would avoid making blanket statements about certain insurers bc it does vary a lot even with one company. most sell some policies to employers that cover fertility, your employer just doesn't chose to cover it.