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Infertility Support and Discussion
Reply to "DC Government insurance coverage options for IVF"
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[quote=Anonymous][quote=Anonymous]OP, did you ever hear back from Aetna? If so, are HMO benefits for infertility different than PPO? For UHC, based on your write-up, does it mean you have to first shell out $3500 OOP before they will begin to cover 50% of covered services? And if you do not get prior authorization they say they will only cover 50% of services but they already do that so how is this a penalty? Maybe I missed something. Thanks![/quote] No, it means the opposite. You pay 50% until you've paid $3,500, then you don't pay anymore. So if a procedure is $1,000, you pay $500 7 times until it reaches $3,500, then you don't have to pay anything for the 8th time. The preauthorization thing means they'll deny coverage for anything that requires preauthorization. Since infertility treatment (versus diagnosis) requires preauthorization, anything coded as infertility will be denied.[/quote]
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