Kaiser Federal questions

[Anonymous]

Kaiser has been discussed in several other threads recently, but I have some additional questions:

1. What is the difference between Kaiser Standard/Basic vs High other than premium differences? Are there any differences as it relates to infertility coverage?

2. Does Kaiser cover ICSI if it is not needed for male factor reasons? What about assisted hatching? If not, what does SG charge for ICSI?

3. Does it cover FETs? I was on an Aetna plan this year through my husband that covered 3 IVF attempts, but FETs were not covered.

4. If you've already been going through infertility treatments and join Kaiser, how long does the process take to get referred to SG?

[Anonymous]

Anonymous wrote:Kaiser has been discussed in several other threads recently, but I have some additional questions:

1. What is the difference between Kaiser Standard/Basic vs High other than premium differences? Are there any differences as it relates to infertility coverage?

2. Does Kaiser cover ICSI if it is not needed for male factor reasons? What about assisted hatching? If not, what does SG charge for ICSI?

3. Does it cover FETs? I was on an Aetna plan this year through my husband that covered 3 IVF attempts, but FETs were not covered.

4. If you've already been going through infertility treatments and join Kaiser, how long does the process take to get referred to SG?

I can answer some of these -- on my first year with Kaiser fed, and I've done two SG retrievals. Everything has been GREAT with KP, and I highly recommend them. In terms of standard/basic, I think the only difference is that one of them has a lower OOP max, which you will quickly hit with IF services. You'll end up saving money in the long run because after you hit your max everything is free, even the stuff they cover at 50% (after you hit max, it is 100% covered).

ICSI is not covered for non-male factor reasons. Neither is PGS. To do PGS at SG, you must also do ICSI. So that is annoying to pay OOP but still better than paying for everything OOP!

It covers 3 IVF attempts. I forget if FET means fresh or frozen. I don't know what the deal is for fresh. Retrievals and frozen transfers both count as an attempt. So you could do one retrieval and two frozen transfers, or three retrievals, or two retrievals one frozen transfer.

I had already done IUI with SG, and so as soon as my plan was active I made an ob/gyn appt and laid out my case, and she put in a referral to SG. We had already been trying for three years and did three IUIs at that point. Basically, I think if it's obvious you are having difficulty, they're going to refer you. They probably go by that 6mo for AMA or 1 yr for younger guideline. It also probably depends on the doctor you see a bit -- maybe some are weird about it? But mine was totally on board and supportive. It was very easy.

[Anonymous]

OP with a couple of follow-ups. Thanks to PP for the helpful info, by the way.

1. It sounds like the referral from Kaiser to SG comes from OB and not from general doctor. Is that right? Another thread mentioned that the referral has to come from the GP but that doesn't make a lot of sense.

2. Does Kaiser federal have rules about how many embryos you can freeze and still get another cycle covered? For instance, Aetna has a rule that once you have two frozen embryos, they won't cover another fresh cycle. You have to use those embryos in an FET first.

My situation is that my current insurance is expiring this fall and I'm thinking of signing up for Kaiser federal only for the remainder of the year. I might want to get two fresh cycles in during that time and with EPP protocol, the process can take a while for a full cycle. I don't want to be stuck having to do an FET before I am able to do a second fresh cycle if there are two or more frozen embryos. In my case this is unlikely, as they usually don't make it to blast, but it's good to plan for a possible better outcome anyway!

3. From other threads, I've got the price of ICSI as $2000, biopsy (for PGS) at $1500, and PGS at $3000. Is that current? What about freezing and shipping?

[Anonymous]

The Kaiser OB refers you to Shady Grove. If you go to the Kensington center, I found Dr. Aretha Makia to be excellent for this. Everything was done super-quickly and I got the referral fast.
Shady Grove charged us $1800 to freeze embryos per cycle. The storage fee per batch per year is $530. So if you freeze embryos for two cycles on different dates and keep them longer than a year you will get two storage bills.
Shipping costs are included in the PGS fee.

[Anonymous]

Thanks for the info. I don't understand the $1800 vs $530. Are you saying that the freezing process and storage are separate? At my previous clinic it is one flat rate of $1000 for cryopreservation for one year per cycle, so I am a little confused here.

[Anonymous]

Anonymous wrote:Thanks for the info. I don't understand the $1800 vs $530. Are you saying that the freezing process and storage are separate? At my previous clinic it is one flat rate of $1000 for cryopreservation for one year per cycle, so I am a little confused here.

The $1800 will include the first year of storage.