Federal Health Plans & IVF coverage
![[Post New]](/jforum/templates/default/images/icon_minipost_new.gif){kind=icon}
Anonymous
| In reference to the above question. My authorization was for IVF and yes it was effective January 13th. I know your pain. That's why I said speak to Caitlin, she really is on top of her game. I wouldn't talk to anyone else. When I said I called so many times with MDIPA.....they knew me by name. |
jindc
Member Offline
Member Offline
|
With MD IPA, they are not covering my Lupron (I am a lupron trigger because my RE worries about OHSS...MFI case). They will not cover Lupron for a trigger and Freedom said that since the start of the year, they have had a lot of issues with coverage for Lupron (which was $199, FYI).
While it's great to have some coverage, I think there are intentionally so many hoops to go through that they hope you just give up and pay OOP for most things. At a certain point, what's the point of covering IVF if you aren't going to do it right? And by right I mean realizing the different and time sensitive nature of the process. |
Anonymous
|
I believe SG-K St have two finance people; I didn't deal much with the man (can't recall his name), except for during my very first appointment there. Once I got close to starting my IVF protocol, Anita (I believe that's her name), was fantastic. I had an issue with Kaiser re-referring me back to SG after a laparoscopy; after that stressful fiasco, I became really nervous about securing my final authorization from Kaiser for the remainder of my IVF treatment at Shady Grove.
Not only did Anita explain how getting the final authorization worked, she encouraged me to call her back if I had any questions. Once things got going, and I scheduled my mock transfer, I called her; She checked on the status of my Kaiser authorization (which SG's finance department works directly with Kaiser's referral department...something along those lines). Apparently they hadn't received the final authorization. Anita had SG's central finance department follow up with Kaiser, and within 2 hours I got my authorization for the 3 IVF cycles. I got an email from SG detailing all the relevant information, and Anita called me back to let me know. With so much to worry about with IVF, I really valued l Anita's quick & informative responses, and would recommend anyone at SG-K St (who has insurance authorization questions) to try to chat with her! |
Anonymous
| I just got the IVF pre-authorization with MDIPA through Shady Grove in Rockville. However, Shady Grove said that for the meds, the endometrium inserts were denied by MDIPA. Does anyone else have this issue with MDIPA? |
Anonymous
| No - I just got my meds delievered and I'm on MDIPA. My co-pay was $270 for all meds including endometrin. What pharmacy did you use? I went through Freedom Fertility as that is what MDIPA said I had to use. Shady Grove had nothing to do with processing my meds other than submitting the prescription which they sent to Grubbs and then Grubbs forwarded it on to Freedom once they were told by MDIPA that they couldn't process it. |
Anonymous
| Thank you for the reply. I am also going through Freedom. However, all these meds need pre-auth. Somehow, the endometrin did not get authorized. I have no idea why. I am trying to work with MDIPA and they said Shady Grove needs to fill out another pre-auth form for endometrin. So I don't know why the original pre-auth form filled out did not get approved for this particular med and everything else is. |
Anonymous
| PP here. It turned out that MDIPA messed up in putting the authorization in. They had approved all meds, but did so in the same approval as the procedure. Thus, when the authorization dept sent the approval to medco, they forgot to note that the medication approval is on the same list as the procedure approval and therefore medco did not know that the meds were approved. They ended up denying all meds until I got I a three way call with Medco and MDIPA. Everything is fixed now. |
Anonymous
| How does one go about getting meds from the MDIPA pharmacies? Are they mailed to the patient? Or can I get it from an on-site pharmacy at SG or a CVS? Please advise. |
Anonymous
| Freedom fertility overnights the meds to you. You can have them hold it at the FedEx facility nearest you so you don't have to worry about being home or scheduling a hold or redelivery. |
Anonymous
|
Does anyone know what the costs of these might come out to for one cycle?
Follistim Menopur Ganirelix Lupron trigger HCG trigger |
Anonymous
| Do you have insurance (what kind) or self pay? Freedom Fertility will tell you over the phone for self pay. Depends on your dosage (high or low stimulator). |
jindc
Member Offline
Member Offline
|
I was quoted $900 per vial of Follistim because I was having issues with MD IPA approval (but they ended up covering everything). Lupron was $300 (I did Lupron trigger). Freedom does have a list online of what meds cost. However, Follistim comes in different doses per pen.
http://prices.freedomfertility.com/ It might be worth calling Grubbs, too, to compare. You sound like you are on the same exact protocol I was on, 17:07. Good luck! |
Anonymous
|
jindc...how was your experience? its my first time doing this whole thing. my injections class is in May and I'd be starting the meds in June.
also, what's Grubbs? is it covered by MDIPA? |
jindc
Member Offline
Member Offline
|
Grubbs is a pharmacy in DC - and no, MD IPA will only cover through their pharmacy. If you're looking for prices WITH MD IPA coverage, I can tell you that with the same protocol (though, I'm not sure of your dosage...I was on a very low dose of everything, 175IU of Follistim, 75IU menopur, etc)....everything together was under $350 with MD IPA. I did have to pay for Lupron trigger out of pocket but they paid me back after the appeals process. The Follistim was $100 a pen. So it would depend on your dose of each medicine, but that was my experience and OOP cost.
This protocol seems to be common with younger women/male factor cases to avoid overstimulation. I cycled in January with GW (1st cycle, too). I'm 14 weeks pregnant today. Hopefully everything is still good. |
Anonymous
So happy for you jindc  thank you for sharing, and good luck with your pregnancy!
|