Federal BCBS v. Federal MD-IPA

[Anonymous]

So of all the federal plans, BCBS and MD-IPA are the only ones that cover all the docs I see. We are now starting with Columbia Fertility and I'm trying to figure out which plan offers better coverage for infertility treatments.

It looks like federal BCBS will cover the drugs but not IUI or IVF. MD-IPA, as I read it, covers IUI, but not the drugs or IVF.

Am I reading those right? It seems like people on this board are getting better coverage than that, but I can't tell if it is a difference between federal and non-federal plans or if I just am not reading this stuff correctly.

Anyone?

P.S. My husband is going to call Columbia Fertility, but I thought I would ask here too.

[Anonymous]

I am with you trying to decide if we should switch from Fed BC/BS to MDIPA or Aetna. None of my doctors are on MDIPA except the RE.
I am looking for anyone on Aetna to comment as well.

Thanks.

[Anonymous]

we have federal MDIPA and have had it for 8 years during which I did 3 IVF cycles which resulted in 2 pregnancies (and 3 kids).
Federal MDIPA pays 50% of anything infertilty related. They pay 50% of any diagnostic testing ordered by your RE. I circumvented this by having my PCP order my cycle day 3 diagnostic bloodwork and hsg and so they were paid in full (all tests ordered by the PCP are paid for in full). I went to an outside radiology place for the hsg and not to the RE's practice.

With regards to treatment, MDIPA pays for of up to 6 cycles of IUI (lifetime) and 50% of up to 3 IVF cycles per live birth with a maximum benefit of $100,000 (which you wouldn't touch unless you did all three IVF cycles for 4 or more kids). Meds are covered completely aside from copays. During my last IVF cycle I used approx. 8K of stims (I'm a REALLY crappy responder) and MDIPA paid for it all minus about $150 in copays.
They are by far the best federal plan if you anticipate actually needing to use IUI and/or IVF.

[Anonymous]

whoops,
previous poster here----
MDIPA pays for 50% of up to 6 cycles of IUI (lifetime).

The general rule of thumb is that they pay for 50% of anything an infertility doctor does. Also, they have contrated rates with SG and I imagine with other DC area practices so 50% is NOT 50% of the self-pay rate but 50% of some lower negotiated rate (for instance, 50% of the total IVF cost at SG under MDIPA is just under $4K).

I'm not sure if Columbia takes MDIPA. I know Dominion doesn't. Shady Grove does.

[Anonymous]

There has been a lot written on this. Look at past posts. BCBS will only cover meds for IVF and both MDIPA and Atena cover 50% of IVF. The difference between the two is that MDIPA only has a co-pay for meds (a few hundred dollars) vs Aetna which covers 50% but can be as high as 3k or 4k for IVF depending on your protocol. Both has Shady Grove at a provider.

[Anonymous]

I just switched today from BC/BS to MD IPA. I chased down the answers to a lot of questions. BC/BS covers all the diagnostic testing, monitoring and drugs with co-pay. They even cover monitoring with an IVF cycle even if you are paying out of pocket for the IVF.

I found out though, that if you have diagnostic testing done under old insurance plan within the last year or so MD IPA will accept your diagnosis so that you can start IUI or IVF. You have to have been trying for 2 years, though. You also have to be married and using your own eggs and your husband's sperm. Not a big hurdle for most married couples, but for some it might be.

CFA is also on the MD IPA HMO. I checked before I switched.