Insurance coverage question

[Anonymous]

Well, its open season and everyone is talking about changing insurance, so I thought I would ask a question too.

I work for the federal government and was researching health insurance coverage for infertility treatments. I noticed that Aetna, Kaiser, and MD-IPA/United Health Care all offer some sort of coverage. But I also noticed that all three said they will not cover IVF unless a couple has been infertile for at least 2 years, the infertility is based on specific reasons (outlined in their benefits book), and less costly measures have been tried and have failed.

My husband and I just had our first appointment with a specialist. He recommended considering changing insurance. We also discussed moving more quickly from IUI to IVF - possibly only doing a cycle or two of IUI before moving on.

My question is, for those of you who have coverage for IVF, how does this coverage work? We've been trying for one year and have unexplained infertility. If I switch insurance now, will it cover IVF or will I have to wait at least another year?

I'm confused by all this stuff!

[Anonymous]

I have Aetna PPO and it offers really good benefits coverage for IVF. Something like 90% of everything is paid for for IVF egg retreival and transfer. Drugs were minimum $7 co-pays and all my office visit and blood draw and sonograms were $20 co pays.

My employer offers this great coverage b/c they are in the state of Maryland which has mandatory infertility coverage--meaning employers over 50 people have to have some type of infertility coverage. You should check the state information on www.resolve.org. I beleive the only state that covers is Maryland though in this area. Not VA and DC.

I was diagnosed with irregular periods and no other factors. I don't remember waiting 2 years, but I do remember restrictions like you have to be transferring your eggs, your husband has to fertilize, etc. They would not cover donor on either side.

[Anonymous]

I have the federal Aetna plan and used it for two IVF cycles. Overall I had a positive experience with Aetna--they did pay the 50%. You can be trying for UNDER two years IF you have certain diagnosed issues. The main thing is that you have to have the treatment preauthorized and your dr's office will do that for you. The trick is that you don't know whether they'll preauthorize. Their guidelines are pretty vague and you don't know until you do it. Having said that, they definitely could have found room to jerk me around (by requiring me to try IUI or something before IVF) but they did not--they approved and paid for the IVF. Saved us big time $$!!

[Anonymous]

I would ask the RE office's financial office what they think about your specific situation. They are so used to working with all of the insurance companies that they could probably tell you what each one will and will not pre-authorize for your specific diagnoses and time ttc.

I have MD IPA and they paid for 50% of both treatment and diagnosis and covered my meds for IVF at the same co-pays as other prescriptions. We had no problem getting immediate IVF pre-authorization, but we have severe male factor IF (so one of the listed conditions.)

As an aside, as you may know, the Maryland IF insurance mandate does not apply if you are a Fed gov't employee

[Anonymous]

Be careful about relying on your RE's insurance people. We had a horrible experience with ours---who told us that our insurer required us to try 6 IUIs before we could proceed to IVF. I was extremely upset at this and called the insurance company, only to learn that the majority of what the RE's insurance coordinator had been telling us was false. I blew a gasket with the RE's office and insisted that that particular coordinator be removed from handling my file.

The bottom line is that you are your own best advocate with respect to insurance policies. Request a copy of the actual policy and any endorsements so you know exactly what the language of your policy says. Appeal any denials of coverage---it is surprising how successful you can be. Try to find someone at the insurance company whom you can contact with questions.

One of the PPs was correct---you can be treated under 2 years if certain criteria are met---that's why you need to look closely at your policy to see what those criteria are.

[Anonymous]

We used Kaiser and then MD IPA through the federal gov't. With Kaiser, we had been trying for two years including Clomid (no IUI) and surgery for endometriosis. After we failed to get pregnant following the surgery (using a trigger shot and TI), our RE recommended that we go straight to IVF. Kaiser agreed. We got pregnant and then switched to MD IPA for various reasons.

When DB was one year old, we consulted with our RE and decided to do another IVF. MD IPA accepted our diagnosis and we started to cycle a month later.

[Anonymous]

Would not use Aetna Federal because the cost of meds is so high (but otherwise had no problem with them). I am using MD IPA this time...

Aetna was easy to move to IVF. We did one cycle of IUI and then they approved the IVF. I only had to answer a few questions over the phone including how long we had been trying.