Reply to Poll: Federal Kaiser or Aetna for IVF

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[quote=Anonymous]With all the changes to the federal coverage for IVF (MDIPA dropping it and new language for Aetna), I wanted to take a poll of which insurance ppl are leaning towards.

There are pluses and minuses for both.  For example, none of my current MDIPA doctors are in the Kaiser network.  I would have to give them up and they are a great team (from my PCP, OB/GYN, eye dr, etc.).  On the other hand it seems like Kaiser has a $2500 OOP max which is very attractive (and will probably increase next year:)).  Also, I'm a patient at SG and had my son through IVF with them so I'm happy that SG is covered.  I was 35 then and I'm 39 now so it may be a different ball game.  Plus we would save $200 per month in premiums compared to MD IPA (which ended up very expensive over the last few years).  Also, Kaiser added covering ISCI and PGD this year which is a good to have if needed.

Speaking of a different ballgame.  The unknown scares me for Kaiser but even moreso with Aetna.  Aetna has new language that suggests that undx fertility and DOR may not be covered.  I know for a fact that I was coded with DOR even though I have PCOS.  I even asked SG about it when I peaked on my computer during monitoring and they game me a lame excuse that they needed to put in some type of diagnosis.  I figured that they just wanted the numbers to look good for statistics since PCOS usually responds well to IVF (and mine did).  Another thing is that early last year (2014) I had my FSH measured and it was 9.9 mIU/ml on day 3.  I don't know what it is now but Aetna has a cut off of 19 mIU/ml on day 3.  I don't want to have a random (or even not random) surge on a test blow my IVF coverage.

There is also an upside to Aetna for some.  It appears that they will cover donor eggs and sperm although not the charge of the actual sperm egg or sperm themselves.  Also, as I read it again, it doesn't even mention needing to be married (which I am).  It just states "partner" or "couple" in the language.  Perhaps, single folks will now be covered without the requirement of the wives' egg and husband's sperm.  For sure, same sex couples are covered (and the couples may not have to be married).  Kaiser covers all married couples (opposite and same sex) with the operative word being married.

With all this taken into consideration, Kaiser appears to be the least "risky" of the two in terms of coverage for my situation.   I'm pretty sure that I will just bite the bullet and go with Kaiser.  What about you and why? Weigh-in.[/quote]

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