Federal Health Plans & IVF coverage
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Anonymous
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Previous poster is correct.
With MDIPA, my IVF with Shady Grove cost $3900 (with ICSI---without is maybe $400 cheaper). Meds were a total of about $200 in co-pays (and I was on large doses of stims. Out of pocket it would have been close to $6K from Freedom Drug). |
Anonymous
| I think I recall that MDIPA and Aetna count cycles differently as well. I believe Aetna says it's a cycle if you start meds and MDIPA only counts it if you get to ER? Is that right? |
Anonymous
16:18 - I am also a Fed employee going to DiMatina and am trying to figure out which plan to go with. Would you mind sharing which one you decided on? I am about to start IUI and expect maybe to have to do IVF. Thanks! |
Anonymous
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Dominion fertility does not take MDIPA (which happens to have the best federal benefits for IUI and IVF (50%)). MDIPA is an HMO and Dominion is not among their providers and so they pay $0 if you go to Dominion. We have MDIPA and payed out of pocket for a Dominion consult (about $300--which was a gigantic waste because Dimattina was such an ass---but that is another post). We did our IVF cycle at SG. They're an contracted provider for MDIPA federal and so MDIPA pays 50% of the contracted rates for IUI and IVF.
I have no idea what federal employees who go to Dominion do (I imagine they all just pay out of pocket?) I would call Dominion and ask their financial person. |
Anonymous
| I have Aetna Open Access HMO and overall was very pleased with the coverage. I did 2 IVF cycles last year, the last one being successful. I had one "possibly" blocked tube and DH had 1% morphology and Aetna preauthorized IVF w/o requiring IUI. I remember dreading the preauth because I thought they'd jack us around and make us do IUI--nope. As mentoned by PPs, their specialty pharmacy is not well priced and the 50% you pay is almost what you'd pay buying elsewhere. We saved big on the rest, though--negotiated rates with the RE and 50% responsibility. Aetna paid 100% of the anasthesiology for the egg retrievals. |
Anonymous
| I have MDIPA. I initially went to SG but didn't like the way things were going so I then went to Washington Fertility Care in Alexandria. SG wanted to charge $3100 and some change for regular IVF with no ICSI, etc. That was my portion to pay. My new clinic is charging me $1300 for the procedure and $150 for the drugs..MDIPA has the best IF coverage for fed employees. I researched all of them thoroughly... |
Anonymous
| aetna is very nice to work with, too bad meds are so expensive. md ipa, however, considers starting medication as a cycle, and aetna doesnt consider a cycle until retrieval. this is important if the cycle looks bad early on and you want to postpone. |
Anonymous
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We live in D.C., my husband is a federal employee, and we are going through open season to switch plans from CareFirst BlueChoice to another plan. CFBC covers 100% IUI but no IVF; we've already done 4 IUI cycles, unsuccessfully, so I'm ready to move on to IVF sometime next year. But, our infertility is definitely because of me, not him, and it's due to unknown factors - I'm just not producing the right hormones & I don't ovulate on my own.
I've been looking at Aetna, Kaiser, and MD-IPA, but my impression is that both Aetna and MDIPA cover IVF only under a pretty limited set of circumstances - endometriosis, exposure to DES, trouble w/ fallopian tubes, or male factor infertility. I just talked to someone at MDIPA, who said that the doctor could submit a request for coverage if there's some other underlying reason, but she couldn't give me any explanation of how or why the insurance co. would agree to cover it for a ground that's not listed. (Aetna's brochure has exactly the same language; they're just not open on the weekend, so I haven't talked to someone there today.) Kaiser potentially seems to have better coverage - depending on how they define "a history of infertility of at least 2 years duration" - but I'm just wary of switching to Kaiser. So... does anyone in the District have experience with a federal health plan covering (or not covering) IVF for infertility due to unknown causes? Many thanks in advance! |
Anonymous
| PP right above me, I was told by MDIPA that you do NOT have to meet all of the requirements, such as having a known cause for your infertility but if you plan to use your partner's sperm and have been trying for 2 years and your doctor writes that down when requesting the authorization for IVF, you will be approved for it. The key is all in what the Doc writes down on the request. I recommend that you stay away from Kaiser for IVF..Aetna I heard is good but their prices went up quite a bit for the next year and the drugs are too high for IVF..MD IPA's IVF drug benefit will only cost you $150-200 per cycle, whereas with Aetna, you could pay thousands per cycle... |
Anonymous
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and to the 10:46 Poster, here is what MD IPA says for why they will cover IVF:
In-vitro fertilization is covered for married members when the following criteria is met: - your oocytes are fertilized with your spouse’s sperm - you and your spouse have a history of infertility of at least 2 years, OR your infertility is associated with endometriosis, or exposure in- utero to diethylstilbestrol (DES), or blockage of, or surgical removal of one or both fallopian tubes (not due to voluntary sterilization), or abnormal male factors, including oligospermia, contributing to the infertility - you have been unable to attain a successful pregnancy through a less costly treatment that is covered by the Plan The "OR" in that explanation covers you, IMO..MD IPA is highly recommended and the cheapest way you can go... |
Anonymous
| To the 11:56 and 12:03 poster above: Thanks so much! The input re: MD-IPA & Aetna is very helpful. And of course you are exactly right about the language in the MDIPA brochure. The Aetna brochure has that exact same language but with an "and" between the oocytes sentence and the endometriosis, etc., sentence; when I read the same language in the MDIPA brochure, I skimmed it too fast, and assumed it was also conjunctive, but you are right, there's an "or" there! Yeesh - you'd think I could focus on rather important things like that. In any event, thanks again - I think that probably makes the decision for us. |
Anonymous
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The above thought is smart and doesn’t require any further addition.
It’s perfect thought from my side. adren ______________ Department Of Health |
Anonymous
Overall, how are Washington Fertility Care's true success rates? Part of the reason why Shady Grove, Columbia, and Dominion can charge so much is that they have decent success rates. When I checked WFC's website, it looks like they only do a handful of IVF procedures every year. Makes me wonder how many cycles they cancel. |
Anonymous
I think Shady Grove must be wrong, unless this is state specific. We are in VA and Federal BC/BS covered all monitoring, ultrasounds, HSG, labs, doctor's visitis, drugs and workup (save for copays, so several 100 dollars come up for copays/deductables a few times) during ART, just the ART procedures itself -retrievals/transfers/ICSI-, whether IVF or another form - they do not cover at all. |
Anonymous
| What kind of federal government BC/BS do you have? I'm almost done with my first IVF and I find it amazing that I can't tell definitively if any parts of the monitoring during the cycles (BW and ultrasounds) are covered. We paid the full 9,500 for IVF which includes all monitoring but I really wonder if this is necessary and since this a major expense it's frustratign to me. I don't really trust the guy at SG's financial office in DC who told me that monitoring is considered treatment... he doesn't really seem so great at his job in general. |