Insurance IVF Coverage

[Anonymous]

I was looking into changing insurance plans in the event that we need to go the IVF route. I am a fed and it looks like United Health covers IVF up to 6 times in a lifetime with a $100,000 cap. The only issue is that you have to have been trying for 2 years. How do they count 2 years? The cover the injectibles too.

I got pregnant with a non-viable pregnancy in May 2008 and haven't been able to get pregnant since. The pregnancy ended in August of 2008. We had been trying for about 6 months before we had sucess. Does a non-viable pregnancy count as fertile? I'm just wondering how they count these things.

I will be 41 next month so time is of the essence. The coverage looks pretty good, so I would love to take advantage of it. They told me that the 2 years did not have to occur under their plan for documentation. The person I spoke to at United Health could not tell me how they counted the years. We meet all the other criteria.

Any insight or experience anyone has would be wonderful. TIA.

[Anonymous]

In my experience, they will look at this based upon the medical notes from your RE. If you tell your RE you've been trying for two years unsuccessfully to have a child, that should be what the RE will put in the notes.

We also have one of the United Health Care plans and I just checked my copy of our Plan (if you haven't, request a copy of your particular policy) and there is no definition of "infertility" in the definitions section. If your copy similarly lacks a definition, UHC should not be able to argue that infertility can only be defined narrowly to mean "inability to conceive" vs. the broader concept of "inability to achieve a live birth" within a two year period.

[Anonymous]

Thanks. That sounds more promising than I thought. I am currently with BC/BS and I've been seeing an RE since Feb 2009. The May 2008 pregnancy was the old fashioned way, with the help of acupuncture. I had my IUD removed in Dec of 2007, which I am certain I can get documented from my OB, if need be. I did one round of drugs with TI and it didn't work. I took a break and I'm now doing acupuncture again and I plan to do the drugs again starting with the next cycle. The plan requires trying an alternate/less invasive form before IVF. Check It also requires that we use my eggs and my husband's sperm. Check. I looked at the requirements and the only issue was the 2 year requirement.

I really think it would help me relax knowing that in January I could start IVF and have it paid for, at least partially, by insurance. It would be great if I could get pregnant on my own. I feel like I am getting in my own way. (another story) Knowing I have that alternative would be a great stress reliever.

The only downside is that I am so used to going to whatever specialist I want to see without going to a GP. Their maternity care looked pretty good too. I am assuming that once you are pregnant you can just go to your OB. We don't have any health issues that require ongoing care, so we could do it.

[Anonymous]

I didn't realize there were any local Fed plans that covered IVF fully -- I thought the most was 50%. Interesting.

I would verify about the 2 year thing. I know most of the plans count a miscarriage as a pregnancy and start the clock over (which sucks, in my opinion.)

[Anonymous]

I am a fed with the 50% coverage. I spent weeks research and looking into all the Fed plans that cover IVF (Aetna, United, MD IPA, Kaiser, etc). In the end I didn't choose United because they only let you transfer 2 eggs at a time. As someone over 40 I wanted to option to transfer as many as my ER recommended and not be tied to the number chosen by United. I ended up going with Aetna and only have to verify the two years of trying in an over the phone interview (before I ever saw an RE) when I enrolled in the infertility part. I liked them except for the medication aspect. They really charge a lot (double in some cases) for their meds so your 50% copay ends up being full price. After talking to others it looks like MD IPA offers the exact same coverage but also covers meds a lot better (20.00 co pay in some instances) so I am going with them for baby #2. FYI - I didn't pick Kaiser because I had already had some testing done and was told I would have to redo everything in house with them.

[Anonymous]

Also, I forgot to add to previous post that Aetna is on open access HMO so I could go straight to my RE and never had to go to anyone else or get any approvals or referrals to seem them.

[Anonymous]

Does the federal employee United plan cover IVF fully (100%)?


17:12 poster---we just did IVF with MDIPA (they've now paid for all three of our kids to be conceived via. IVF). In this last cycle, I paid a total of $225 for just over $9K (yes, $9K of medication. I need the highest doses of menopur and gonal f that are given to IVF patients. So yes, the MDIPA pharmacy benefit can't be beat!

[Anonymous]

Is MDIPA only for MD state employees? Does anyone have a link for the plan description, I couldn't find it at the opm website. thanks!

[Anonymous]

sorry, found it - I didn't realize it's an HMO!

[Anonymous]

I'm a fed too, I thought IVF coverage for these plans are only in MD? Virginia doesn't have the same laws or coverage that is mandated.

[Anonymous]

Fed trumps state law. If you are fed it does not matter what state you live in. This is common sense 101.

[Anonymous]

To the 17:12 poster, can you tell me what kinds of questions they asked you to verify that you've been trying for 2 years? Did they ask you if you've been pregnant, regardless of whether it resulted in a live birth? I don't want to deal with an accusation of insurance fraud. I would really love to be able to start IVF, if need be in January, rather than in August, when I will be 42.

[Anonymous]

I understand that fed trumps state law, but that doesn't mean that the same plan is open to someone living in VA vs someone living in MD. MDIPA is not offered to FEDS who live in VA.

[Anonymous]

OP, have you tried talking to your RE's office about this (if you have an RE)? I was thinking of going to work for the fed gov't and my RE's finance people could give me lots of info on the different insurance plans since they deal with them all the time. You might not get all your questions answered, but it might help... Good luck!!! And to PP 08:56, there is very little that is simple or "common sense" about insurance!!!

[Anonymous]

OP here. I haven't talked to my RE office yet because I am on a break from doing the injectables with TI. I am planning to go back on the drugs next cycle and I was planning to ask them about the options then. I just wanted to get some insight from those who may have the experience. I'm also planning to talk to the insurance people during open season. I am just trying to make plans and be prepared.

Like I said, if I feel like I have IVF in reserve with some insurance coverage, even 50%, I'll be able to relax a bit. Maybe I'll be able to relax enough so that I won't need IVF.

Like I said above, my issue is with the interpretation of 2 years. I'm sure I'm not the first patient with this issue. I guess the worst case scenario would be that I have to wait until August of 2010. I have good FSH, LH and estrodiol numbers and I'm doing acupuncture (which I think helps with hormone numbers and egg quality) and plan to continue doing it so it won't be the end of the world, but I would prefer to start sooner rather than later.