Feds - benefits open season! Infertility coverage advice...
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Anonymous
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Hello!
After 3 cancelled IVF cycles and 1 BFN, 2 different REs with Aetna and all its problems, maybe it's time to change. I read thru both Aetna and MDIPA benefits brochures and fertility coverages. After paying almost 5k just in meds each cycle and dealing with Atna Specialty Rx. I think MDIPA looks better. But I just wanted to know from fellow IVFers your experiences in changing insurance between cycles... Also I understand that with MDIPA I would have to have a Primary Care Phys. to make all referrals including to the fertility clinic that I am already a patient with Aetna. Is this correct? How much of a pain is this? I would like also to know if after changing to MDIPA because or fertility coverage you felt that it was better than Aetna in terms of overall coverage, doctors, reimbursements etc... Thank you so much! |
Anonymous
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You do need a PCP, but it's really not that troublesome (and frankly, you probably should have a PCP anyway -- when we're in fertility treatment world, we tend to neglect taking care of the rest of our bodies).
I did what you did - I was being treated at a clinic with insurance that didn't cover IVF, I switched to MDIPA and between making appointments, IVF authorization paperwork, etc., I was able to start a cycle when my period started at the end of January. The key is: (1) find a PCP NOW, (2) make an appointment with the PCP for the first week of January, (3) get the authorization (takes a few days). After that, your fertility clinic will take care of getting all the other authorizations for your cycles. |
Anonymous
| I've read up on this, and think going with MDIPA makes a lot of sense. I like the pp's advice on logistics. |
jindc
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Hi there:
I'm an Aetna customer and am leaving them for MD IPA so we can start our first cycle, hopefully in January (with everyone else!) My recommendation would be to find a doc ASAP. The first PCP appointment I could get was January 14th. Since I'm doing IVF with GW, I figured I'd go to a GW doc since they all take the same insurances. The internal medicine department only takes new people at the G Street location or where ever it is. So even before you have the insurance, make the appointment. |
Anonymous
| I highly recommend MDIPA. I found a PCP at General internal Medicine Group in Ballston, which is set up to deal with referrals and HMOs. I'm sure there are other similar shops. I'm really surprised to say this, but I didn't even mind being on an HMO, and the fertility coverage was great. |
Anonymous
| My DH is the federal employee but I have fully-paid family insurance through my employer. Is it possible for DH to put me on a federal plan only (but then keep him on mine)? |
Anonymous
| PP: No. Federal insurance plans are either Self (i.e., the federal employee) or Self+family. If you have secondary insurance (i.e., the insurance through your work), the federal insurance company will need to know that and may possibly require you to exhaust your benefits first. Not sure, but with the forms, they do always ask if you or any family member has another insurance plan. |
Anonymous
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You don't need to wait until January to get an appointment with a PCP that takes MDIPA. I switched last year, and I scheduled an appointment with my PCP in December. I got my referral forms at that time. We had everything in place and were able to get insurance processed for an IUI the first week of January.
BTW, GW Medical Faculty Associates takes MDIPA and they can usually take new patients. One advantage is that for referrals etc you are relying on the entire GWDocs system, so things get processed quickly. The downside is you usually see a resident (not your actual PCP). |
jindc
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I currently have Aetna, switching to md ipa and GW takes both do I tried to get an appointment with a PCP for December to start a cycle ASAP in January and the first appointment I could get with anyone at GW was January 14, hence the recommendation to call as soon as you know your plans. I'm sure other docs can see you sooner if you don't care where you go, but for me, GW is easy because of the docs system and it's a few stops away from work.
One question for veterans: if I want to change OBs (again, going to GW because it's convenient), should I do that sooner too? I am a patient at Foxhall but it was a major schlep and if (when?!) I get pregnant, it would be a huge time waster driving there. I've never had an OB in DC (my PCP did all that) so I don't know the waits for new patients. |
Anonymous
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OP here. Thankful for the input .
I forgot to ask if infertility is gonna be considered a pre existing condition? Can they deny infertility coverage? |
Anonymous
If you are talking about an employer-sponsored group health plan, and you didn't have a long break in prior coverage with no creditable coverage, then no. (This is a long way of saying, no if you are moving from a group plan to a group plan. No such thing as preexisting conditions by law if that is the case). |
Anonymous
| There has been extensive discussion on this - do a search. MD IPA is the best plan as it covers meds and Aetna doesn't. This saved me over 6k per cycle. I've had both and MDIPA is much better. |
Anonymous
| OP: There is no such thing as a preexisting condition in any federal health insurance program. |
Anonymous
| Does anyone know exactly how much the out-of-pocket expenses are for meds under MDIPA. I'm on a high dosage of meds and am wondering how much to allocate for my FSAFEDS. Also, how much is the out-of-pocket for the IVF procedure under MDIPA? Thank you! |
Anonymous
Are you planning to freeze leftover embryos if you have any? If so, that alone is $2-$3K ($2400 at CFA). I was on a relatively low dose, and my meds with MDIPA were ~$200. The remaining procedures (prior to my maxing out my oop after which monitoring etc is no copay) were about $1500 oop. Since the limit on FSAFEDS is now $2500 instead of $5000, I would max it out. Keep in mind that if your first cycle is successful, you can use your FSAFEDS for things like a breast pump. |