Federal Plans and IUI

[Anonymous]

I tried to find a thread on this but it was over a year old, so TIA for any help. I'm 36 and conceived DD (now 7 months) on my third IUI after a year and a half of trying. I was temping/charting and all of our numbers look great so it was diagnosed as unexplained. I am not a fed and IUIs are no longer covered by any of my insurance options. DH is a fed and open season is coming. I would like another child and even though DH says we are one and done, I would like to have options in case he changes his mind. I know it's not always the case but I assume I would need intervention again. I know none of the plans cover IVF anymore but any info on IUIs? I vaguely remember reading about BCBS covering them. Any information? Thanks!

[Anonymous]

No, none cover IUI.

[Anonymous]

The federal CareFirst BlueChoice covers IUIs and drugs used with IUIs.

[Anonymous]

Anonymous wrote:No, none cover IUI.

This is correct.

[Anonymous]

You would have to check this year's plans, but last year CareFirst and Kaiser both still covered IUI.

[Anonymous]

Anonymous wrote:You would have to check this year's plans, but last year CareFirst and Kaiser both still covered IUI.

That is not correct. I had an IUI last year (July 2016), with federal CareFirst. The nonfederal plans covered IUI, but the federal did not. However, it did cover the medications leading up to the IUI. My out of pocket costs were low -- $500 for the IUI and $100 for the trigger shot. Insurance covered all monitoring plus letrozole and prometrium.

My understanding was IVF wasn't covered either, but I didn't get that far.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You would have to check this year's plans, but last year CareFirst and Kaiser both still covered IUI.

That is not correct. I had an IUI last year (July 2016), with federal CareFirst. The nonfederal plans covered IUI, but the federal did not. However, it did cover the medications leading up to the IUI. My out of pocket costs were low -- $500 for the IUI and $100 for the trigger shot. Insurance covered all monitoring plus letrozole and prometrium.

My understanding was IVF wasn't covered either, but I didn't get that far.

I was on the CareFirst BlueChoice plan for 2017 and it covered up to 6 IUIs. I had to pay $80 out of pocket for each procedure and $100 for the ovidrel trigger. Clomid and letrozole were free as were the progesterone suppositories. My monitoring visits were a copay of $40 since it was a specialist. Not sure why people are saying this plan didn’t cover IUI, it most certainly did. I did 3 of them this year on this plan so I’m speaking from experience. I’m not sure if this will be changing for 2018 but I would start there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You would have to check this year's plans, but last year CareFirst and Kaiser both still covered IUI.

That is not correct. I had an IUI last year (July 2016), with federal CareFirst. The nonfederal plans covered IUI, but the federal did not. However, it did cover the medications leading up to the IUI. My out of pocket costs were low -- $500 for the IUI and $100 for the trigger shot. Insurance covered all monitoring plus letrozole and prometrium.

My understanding was IVF wasn't covered either, but I didn't get that far.

I was on the CareFirst BlueChoice plan for 2017 and it covered up to 6 IUIs. I had to pay $80 out of pocket for each procedure and $100 for the ovidrel trigger. Clomid and letrozole were free as were the progesterone suppositories. My monitoring visits were a copay of $40 since it was a specialist. Not sure why people are saying this plan didn’t cover IUI, it most certainly did. I did 3 of them this year on this plan so I’m speaking from experience. I’m not sure if this will be changing for 2018 but I would start there.

FEP? I just had two IUIs under FEP Carefirst and they covered nothing beyond the initial diagnostics. Each IUI was $1800 out of pocket, not counting meds, which were completely out of pocket as well (several hundred more each time).

[Anonymous]

I had an IUI with FEB BCBS and it was NOT covered... but here's a tip: If you go to GW, they can charge insurance as a hospital rather than a fertility clinic, so your monitoring and meds *are* covered. I paid $400 OOP at GW versus the $2500 I would have paid at SGF.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You would have to check this year's plans, but last year CareFirst and Kaiser both still covered IUI.

That is not correct. I had an IUI last year (July 2016), with federal CareFirst. The nonfederal plans covered IUI, but the federal did not. However, it did cover the medications leading up to the IUI. My out of pocket costs were low -- $500 for the IUI and $100 for the trigger shot. Insurance covered all monitoring plus letrozole and prometrium.

My understanding was IVF wasn't covered either, but I didn't get that far.

I was on the CareFirst BlueChoice plan for 2017 and it covered up to 6 IUIs. I had to pay $80 out of pocket for each procedure and $100 for the ovidrel trigger. Clomid and letrozole were free as were the progesterone suppositories. My monitoring visits were a copay of $40 since it was a specialist. Not sure why people are saying this plan didn’t cover IUI, it most certainly did. I did 3 of them this year on this plan so I’m speaking from experience. I’m not sure if this will be changing for 2018 but I would start there.

FEP? I just had two IUIs under FEP Carefirst and they covered nothing beyond the initial diagnostics. Each IUI was $1800 out of pocket, not counting meds, which were completely out of pocket as well (several hundred more each time).

Yes, FEP, CareFirst BlueChoice, HealthyBlue. If it helps, my card says it’s the BCBS 080/580 plan. I had two IUIs at CFA and one at Shady Grove. They used two different codes because I paid $80 out of pocket at CFA and a little less (I think it was $76) at SG. When I was switching to SG I called BCBS to make sure my 6 IUI authorization was still valid for the year since I was changing clinics. It was, even with the different code that SG had uses. Not sure what clinics those with this coverage are using, but if you’ve been paying out of pocket I would check with how your IUI is being coded.

[Anonymous]

I'm on FEP BC/BS Basic and I was told by the billing specialist at GW about a month ago that IUIs weren't covered and would run me around $1400. She recommended I get a Maryland exchange plan in addition to my federal coverage, she said they would cover up to 6 IUIs. I clearly have some calls to make - maybe I just need to upgrade from basic to standard? Or switch to SG? I love having all my doctors in one place but I don't love it $1400/month worth!

[Anonymous]

To clarify, under the Federal Plans there is the BlueCross BlueShield national plan and the CareFirst BlueChoice local plan. The national plan does not cover IUIs but the local plan does. So, if you are on BCBS Basic or Standard, IUIs are not covered; however, under CareFirst BlueChoice, up to 6 IUIs are covered.

[Anonymous]

not a fed but I had very different experience with IUI at SGF and Columbia fertility. Specifically CFA charged monitoring appointments to insurance differently so I only paid copay for these while SGF charged around $400 for each monitoring appointment. On the other hands IUI itself was much cheaper at SGF than CFA.

[Anonymous]

As of this year, the regional CareFirst BlueChoice plan covers up to 6 IUIs. Page 37 of https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2017/brochures/73-718.pdf

[Anonymous]

Regional Carefirst BlueChoice (regional HMO) covers 6 IUIs. You can also get IUIs at 50% of their cost through Kaiser.