Federal Health Plans & IVF coverage
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Anonymous
I'm sorry. Take some time for you to process, but I truly hope your story and journey doesn't end with heartache. Hopefully, with enough pushback insurance will pick it back up (or for the first time at all) in 2018. |
Anonymous
| Is RESOLVE aware of these Fed changes and will they help campaign against this? |
Anonymous
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To anonymous @ 11/15/16 @ 19:04
Have you considered donor egg or donor sperm so you can do IVF without genetic testing? (Sympathies to your plight. This change sucks) |
Anonymous
I'm a long time reader and first time poster. 
I'm at SGF and considering moving to Aetna as my 2017 plan. Since, other posters say SGF will honor previously negotiated Aetna rates for IVF, which would save my husband and I a few thousand on a cycle. Two questions for you guys, any feedback is appreciated. Will SGF honor Aetna pricing if you didn't have the plan before? In my case, I currently have Kaiser and have been using that coverage at SGF. I'm a little worried they won't give me the same billing rate as patients that came to the practice as Aetna. Which of the Aetna plans are you guys considering? My husband and I are healthy and have no kids (hence the IVF) So, I was considering the Aetna Open Access (Basic) plan. But, the overall satisfaction with the plan is one of the lowest and rated as "fair". Some additional googling uncovered lots of people saying they routinely have their claims denied and it's a long process to "prove" that your medication or procedure is needed with any of the plans. And this isn't just for infertility services. But for everything. Sorry for the long post but does anyone have experience with any of the Aetna plans or a story to tell of someone they know with an Aetna plan? I'm considering: Aetna Direct (CDHP) rated "Good", $121.52 biweekly premium Aetna HealthFund CDHP and Value Plan (CDHP) rated "Good", $271.25 biweekly premium Aetna HealthFund CDHP and Value Plan (Value) rated "Good", $144.89 biweekly premium Aetna Open Access (Basic) rated "Fair", $158.54 biweekly premium |
Anonymous
no advice on Aetna, but if you are already doing IVF with Kaiser then you have been diagnosed with infertility and have proof of it. So probably Aetna will consider it a pre-existing condition, not something you have to prove from a scratch. |
Anonymous
| I have the Federal Employee Aetna open access plan and used it to cover ivf in June (it worked!). I've been really happy with the plan and coverage and I plan to keep it next year, even though I don't need fertility treatment anymore. All of my doctors accepted it, I haven't had trouble with billing for any type of treatment (fertility or otherwise), and the rates are low. I recommend it. |
Anonymous
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We've had Aetna open access for several years. Apart from the dropping IVF thing, I have no complaints. Good network. Claims paid quickly and correctly, and they stepped in and handled all those "your hospital is in network but the random doctor isn't" situations quickly. Has a decent preventive dental benefit (I found it best to call and select the PPO). For 2017 they are covering 3 days inpatient for childbirth (more for c section) w no copay - good news for the pp who got pregnant in june.
Biggest complaint is that there is no out of network reimbursement benefit at all (except for dental). So if you see someone not in their plan, they won't pay anything. For those considering choosing Aetna for the SG discount, it is not a bad choice. |
Anonymous
Just to add re the other options, Aetna Direct is designed for people who have Medicare. The Value plan isn't bad but maybe not the best option if you are planning on having a year with high medical expenses (I'd say the same about the HSA plan). CDHP is a good plan, but they really raised the price this year and I can't see justifying paying so much more than Open Access - save that money for IVF. |
Khugs23
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| I currently live in NY and have been waiting to change my insurance this open season to federal GHI - they cover 3 rounds of IVF plus meds. I just found out I'm transferring to VA for work and there are ZERO insurance plans with IVF coverage....GHI is not available in VA. It's unbelievable. One round we can swing, but if that doesn't work - and the next doesn't? My friend just spent 25K on IVF, which didn't take and she had no eggs left to freeze! Luckily she lives in NY and is switching to GHI! I have no luck! This is devastating! |
Anonymous
Where in VA will you work? You might consider living in MD and buying an individual plan on the MD exchange. |
Anonymous
| I can't! Work is putting us up in housing in Herndon for 18 months. |
Anonymous
I've had Aetna Open Access with mixed success. They are very strict about in-network services. I tried an appeal process and was denied and another time they kept coming back for more info so I gave up. Many providers accept it here so it isn't too hard to get coverage for very basic stuff, but anything special or expensive and you're out of luck. So it's a gamble - if you're paying OOP for IVF at SG it could save you $5k - so even if you needed uncovered services and had to pay those OOP you might still come out ahead. Also, it shouldn't matter if you were a patient at SG before or had Aetna - the contract rate exists or it doesn't, as I understand it. |
Anonymous
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In case anyone is curious, here's some other reasons why the health plans dropped IVF coverage:
- The reason that Kaiser, MDIPA, and Aetna offered IVF benefits is that they are HMOs located in Maryland. Up until 2 years ago, OPM required HMOs to offer any benefits mandated by their home states. Maryland has a state mandate requiring coverage for IVF. - The ACA has something called the "Cadillac" tax that in 2020 (it was supposed to be 2018) will impose a tax on any health plans with premiums over a certain threshold. - Because of the ACA's Cadillac tax, OPM decided to give the HMOs some flexibility and relax its requirement for HMOs to offer benefits mandated by their home state, particularly if those benefits are not deemed "essential" by ACA. - As such, Kaiser, MDIPA, and Aetna were able to drop their IVF benefits. |
Anonymous
Yes. We are actually having a planning call tonight to see how best to move forward. |
Anonymous
Thanks! I only saw two days in patient delivery covered on the website though! |