MD Carefirst HMO questions

[Anonymous]

I'm looking at switching to insurance through the MD exchange to get coverage for IUI and potentially IVF. The HMO would be $300/month less than the PPO, but I'm nervous about HMOs possibly not giving us access to the doctors we want. If you've had the HMO, do you know which of the local fertility clinics accept it? Are there particular pharmacies you have to use for your fertility meds? (I'll also call our clinic to get their perspective, but I can imagine us having to change clinics at some points.)

[Anonymous]

I had the HMO plan. I was able to search from the Carefirst website which doctors were in network. I used Shady Grove and I didn't need a referral. I've seen 2 OBs since I was pregnant and all of them took Carefirst. I haven't had anyone say they were out of network with my plan yet. As for pharmacies, I was under the impression that I had to go through CVS specialty, although the prescription coordinator at SGF went through Ambulatory Pharmacy for my drugs. Overall, I haven't had any complains with my plan. The only time I've had anything out of network was the company that did the blood test when they did nuchal fold testing at 18 weeks. I think I paid $240 so pretty much one months saving of choosing HMO over PPO.

[Anonymous]

What about genetic companies for PGS/PGD testing? Are those considered in-network for an HMO since presumably they're located in other parts of the country?

[Anonymous]

I had the PPO plan and I don’t believe PGS testing is covered unless there are certain circumstances

[Anonymous]

Right, I fit into that "special circumstance" category due to being a genetic disease carrier. Trying to figure out if I have to get the more expensive PPO to get the genetic lab covered.

[Anonymous]

Anonymous wrote:Right, I fit into that "special circumstance" category due to being a genetic disease carrier. Trying to figure out if I have to get the more expensive PPO to get the genetic lab covered.

If you know what clinic you're going to, I'd ask what lab they send to and then find out if they're in-network. I'm not sure it won't be an easy task trying to find the right person to talk to at the testing company to tell you what's in network or not. Then again, when I got my nuchal fold testing done at an imaging center, they knew right away that the bloodwork lab was out of network. So maybe Carefirst is a large enough company that your clinic will know right away if you'll in network or not.

[Anonymous]

OP here -- thank you! Great to hear that you've had nearly everything in network!