Question about IVF coverage under MDIPA

[Anonymous]

I am a federal employee and am thinking about switching to MDIPA during open season. The language of the plan says IVF is covered if I have a history of infertility of at least 2 years, and I have been unable to attain a successful pregnancy through a less costly treatment that is covered by the plan. Under the plan, infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse. Here is my situation. I am able to get a positive pregnancy test, but have a history of chemical pregnancy loss, with one clear miscarriage. Specifically, two years ago, I had a clear miscarriage and a D&C was performed. Since that D&C two years ago, I have had 1 chemical pregnancy and one presumed ectopic (not seen on ultrasound). For my presumed ectopic, my RE believes it may have been a chemical pregnancy with fluctuating HCG values, but which warranted Methotrexate just in case. I know the aetna plan defines infertility more strictly, as the inability to conceive. As you can see, I have no problem conceiving. After a battery of tests, my RE believes IVF may be the only option left to assure no more pregnancy loss.

Do folks around here know if MDIPA would probably cover IVF treatment based on my history? Would they be difficult about it (ie deny and require appeals, etc)?

Secondly, do you think they would require me to undergo the less costly procedures first? Do I have to do IUI, etc before IVF, even if my RE says that won't make a difference for miscarriage/pregnancy loss purposes?

Any advice you all can provide would be greatly appreciated. Thanks.

[Anonymous]

Honestly, I think you're probably fine with regards to whether you would get coverage, but I'm less certain about being able to skip the less costly options (IUI). I suppose it is always possible that your RE could try to justify why IUI would not work when the pre-authorization for IVF is requested.

I'm not sure how old you are and I don't want to assume you have all the time in the world, but I will say that generally IUIs are not time consuming (one cycle if you have regular ones) so if you have to do one or two before moving on to IVF it still may be worth it to switch to MDIPA.

With regards to whether you would be covered at all, I'd encourage you to call them. You can just say you are considering switching during open season but have some questions about coverage and see what they say. I called with lots of questions before officially making the switch and always found the people I spoke with to be helpful.

[Anonymous]

I'm under MDIPA and had no issue going directly to IVF. I really don't think they'd be that particular and you do have a problem attaining a successful pregnancy. I started on the plan in May and had my retrieval in June. I didn't have to undergo anything prior to the IVF.

[Anonymous]

Thanks for the answers! I had previously called Aetna directly, and they wouldn't answer questions without my actually being on the plan or without it being open season. But I will try calling MDIPA. Of course a lot might depend on who actually approves it.

[Anonymous]

OP, can you say what your "battery of tests" were? I have a similar situation to yours.

[Anonymous]

Can't remember all of them, but they include karyotype (the blood test to look at your chromosomes) for both spouses, ovarian reserve testing (blood test that tells us something about the number of eggs left in the ovaries), prolactin, blood sugar, androgens (male hormones like testosterone) and some other tests. The tests to look at the structure of the fallopian tube I believe was also done. All came back fine. I'm also 32, so age isn't a factor.

It's been really tough because the ultimate conclusion seems to be horrible luck, ie each egg just happened to have bad chromosomes. IVF can prevent this.