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[quote=Anonymous][quote=Anonymous][quote=Anonymous]For those that are on MDIPA, how do you feel about the non-fertility coverage? I'm tempted to switch because the fertility benefits are better, but I want to consider the full range of our health needs.[/quote]

I have had MDIPA for almost 10 years.  They were much easier to deal with before they were bought/taken over by United Healthcare.

They are very prickly about referrals and pre-auths.  And, no, it isn't just getting a referral from the PCP.  For some procedures, you need a referral AND a pre-auth.  They aren't exactly timely with the pre-auths.  I had a situation where my doctor submitted all of the paperwork for an outpatient procedure a month in advance of the procedure, and one day before it was scheduled to take place, they still had not authorized it, saying they needed more information.  I spent a day on the phone -- lots of phone calls.  I finally got a manager to rush through a pre-auth and I went ahead with the procedure the next day.  Well, they still denied coverage, and it took 2 months back and forth with the doctor to finally get them to cover it.

More recently (like 2 weeks ago), I had another outpatient procedure.  The doctor's office got a preauthorization.  But even though they will pay the claim for the doctor and facility, they are denying the anesthesiologist and giving "no precert" as the reason.  Well, I would assume if a procedure is pre-authorized, then that means the entire procedure.  I have an inquiry in with them.

Their game is to make the entire pre-auth process complicated and not at all transparent.  That is how they deny things, and you have to keep at it to get them to cover it.

[b]I'll bold this because it is important:  Just because you get a procedure pre-authorized with MDIPA doesn't mean they're going to cover it.[/b]

And I am very good at getting referrals from my PCP.

The other thing another PP mentioned is that LOCATION matters with radiology.  It isn't enough to use a facility they are contracted with; you have to use a facility in the same county as your PCP.  But this isn't spelled out in the documentation.  There's just this "RAD: [County]" on your card that you are supposed to understand means you have to stay in that county.  So that means it isn't enough to call the radiology place and ask if they are in network for MDIPA.

And their premiums have gone up significantly for next year.

I'm seriously considering making a switch.  [/quote]

22:20 here. Ugh, that sounds horrible! We're definitely switching back to BCBS. Will also save us almost $300/month. I will say, we have not had too much trouble getting pre-authorizations (for ultrasounds at RE, and labwork at specialty lab) with MDIPA. Everything worked smoothly for us these two years. But they are just expensive, and the referral requirement and radiology restrictions really bother me.[/quote]

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