Empire Blue Cross Blue Shield infertility coverage

[Anonymous]

Has anyone had Empire BC/BS insurance during fertility treatments? We have the option to go with this plan through my husband's work, and the little information we can find so far indicates that they cover treatments 100% (!) minus co-pays, with 3 IVF attempts and a $25,000 lifetime benefit. We are waiting to get more information through my husband's HR department (I have lots of questions re: coverage of IUI, any waiting periods, etc.), but was curious if anyone had real life experiencing dealing with them.

[Anonymous]

Hmmmm... We are with Empire BC/BS (Federal) and they cover only a small portion of the initial workup - and as far as I understood they do not cover ANY of the actual procedures. The 3 IVF attempts are complete news to me? Which BC/BS do you have (or want to get?)?

[Anonymous]

I did. The coverage really depends on which options your company buys from Empire Blue. It it is best to work with your HR department and/or call Empire Blue and get a run down of which infertility options your company has contracted from them.

I had Empire Blue through my company and they offered very little infertility coverage, and no IVF costs. Then we switched to my husband's health plan, who also offered Empire Blue, but they covered 3 IVF attempts. It was hard getting a cost estimate at first because parts of the process were technically out of network (like the anesthesiologist), but most of the IVF procedures were in-network. In all, I think we spent around $3,000 for our one IVF attempt, which was successful. This pretty much exhausted our out of pocket expenses for the year, so we'll have very few expenses for the actual birth. Didn't plan it this way, but if you can get your IVF done in the first three months of the year, you could save some money on the birth costs.

Empire Blue's customer service was really helpful and I would recommend them. My OB's office kept making a silly clerical error on billing and Empire Blue actually called the doctor's office and straightened everything out for me.

[Anonymous]

PP here. Also, I had no waiting periods. Empire Blue allowed the doctors to make most of timing decisions. I didn't have to try IUI first, but I had four failed IUIs previous to switching to Empire.

[Anonymous]

That's great to hear about Blue Cross/Blue Shield, but would anyone tell me what their plan is called? It is NOT the federal plan I presume? Not the PPO? How can there be so many different ones? In the same area?

[Anonymous]

OP here. No, this is definitely NOT the federal Carefirst BC/BS plan (which I have currently and provides absolutely no ART coverage, which is why we're exploring our options). My husband's company is incorporated in NY state, and they offer Empire BC/BS to all their employees. Thanks to the poster who responded about your experience with them. It's so frustrating to try and figure out insurance - my husband and his HR colleague called Empire today and the Empire rep couldn't answer basic questions regarding what they covered. Argh. I guess we keep digging.

[Anonymous]

Policies are different by employerors. You can not compare insurance plans. What Blue Cross provides one company will be different from another. If you want to understand your plan and benefits ask to receive a copy of the Summary Plan Description (SPD). Your health plan administrator/company is required to provide a copy. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits.

It's amazing how many people don't realize that it is your employor who determines what is in and out of the plan. They choose the plan and how what they are willing to offer/pay. If you want something covered in a plan you need to get your employer to support it and get it include in your plan.