Federal BCBS - Meds

[Anonymous]

Sorry - another med question. Does anyone know if the Federal BCBS Standard plan pay for any injectible fertility drugs. So far, I am thinking they don't, but I just wanted to see if anyone else had a different experience.

[Anonymous]

I'm on federal BCBS and I think they may cover meds. Here is what the benefits catalog says, although it says nothing med specific...

Infertility services
Diagnosis and treatment of infertility, except as shown in NOT COVERED

STANDARD:
Preferred: 15% of the Plan allowance
Participating: 35% of the Plan allowance
Non-participating: 35% of the Plan allowance, plus any difference between our allowance and the billed amount

BASIC:
Preferred primary care provider or other health care professional: $25 copayment per visit
Preferred specialist: $35 copayment per visit
Note: You pay 30% of the Plan allowance for drugs and supplies administered or obtained in connection with your care.

Participating/Non-participating: You pay all charges (except as noted below)
Note: For services billed by Participating and Non-participating laboratories or radiologists, you pay any difference between our allowance and the billed amount.
deductible)” when the Standard Option deductible does not apply.


NOT COVERED:
• Assisted reproductive technology (ART) procedures,
such as:
? artificial insemination (AI)
? in vitro fertilization (IVF)
? embryo transfer and Gamete Intrafallopian
Transfer (GIFT)
? intravaginal insemination (IVI)
? intracervical insemination (ICI)
? intrauterine insemination (IUI)
• Services and supplies related to ART procedures,
such as sperm banking

[Anonymous]

I have BCBS- they cover the meds (with a co-pay) and monitoring, but do not cover IUI or IVF procedures themselves.

[Anonymous]

Anonymous wrote:I have BCBS- they cover the meds (with a co-pay) and monitoring, but do not cover IUI or IVF procedures themselves.

Agreed -I used injectibles for IUI and IVF in 2008...while the procedures were not covered, the meds certainly were. I think you may need to do mail order, though.

[Anonymous]

I'm in the middle of an IVF cycle now. If you go through the mail order pharmacy you will pay only copays for the meds. I have Bravelle, Lupron, progesterone in oil (after the IVF) and the trigger meds. (not ovidrel) I paid 130 for all of those drugs for one cycle.

I have BCBS federal. I've paid 8600 for the rest of the cycle. If I end up with embryos to freeze, it will end up being another 3000.

[Anonymous]

Open season is coming up. Can you switch? MDIPA (which our agency offers) seems to have the best coverage for the actual procedures. you can search them on this forum for more.

[Anonymous]

OP Here - Currently we have Fed BCBS. We are switching to Aetna for the fertility coverage, but I have heard their drug coverage is not very good. We can not switch to MDIPA because a few of our important doctors do not participate and we don't won't to lose them. I was thinking I could order my meds through BCBS in December, for my cycle in January.

[Anonymous]

Speaking of Open Season, I noticed that for 2010 BCBS Carefirst (the HMO option) is covering IUI and the meds. However, the PPO only covers the meds.

[Anonymous]

bcbs federal pays for all the doctor visits, bloodwork to monitor the ivf cycle?

[Anonymous]

BCBS Federal PPO covers the bloodwork, ultrasounds and mail order meds during an IUI or IVF cycle (with copays).

[Anonymous]

Anonymous wrote:BCBS Federal PPO covers the bloodwork, ultrasounds and mail order meds during an IUI or IVF cycle (with copays).

As someone who is just starting the research and needing to make a decision to switch or not switch soon, can anyone give a rough estimate of this breakdown in actual dollars. Obviously, each RE practice has different charges, but is anyone willing to share a rough estimate of covered (meds, etc) vs. non-covered (actual procedure for IUI and IVF)?

TIA!

[Anonymous]

I've done a lot of cycles, so I'll estimate costs.

$65 for each fertility med, but that covers 3 cycles (or possibly a bit more). Most cycles, I used about 5 different meds. If you're doing IVF, there might be a couple more.

Each ultrasound and bloodwork appointment was about $40-50 in copays. If it was just bloodwork, it was less than $10. There were usually 3-4 us appts and 2 bw appt.

For most of my cycles, where we did timed intercourse, my meds and my appointments totalled less than $300. IUI was not covered, so that was an additional $500 at my RE.

[Anonymous]

Anonymous wrote:BCBS Federal PPO covers the bloodwork, ultrasounds and mail order meds during an IUI or IVF cycle (with copays).

AHHH! Thank you for posting this, I've been trying to find out. The copays are often $100 though, right?

Thank you!!!