I know this thread is pretty old but I still came across it so someone else might as well. I am dealing with Shady grove for IVF. I have carefirst HMO in MD (being in MD makes a differwnce due to the mandate) Anyways, as far as getting specifics from your insurance company... call Shady Grove, even if you are not dealing with Shady Grove and ask them to email or fax you a copy of the insurance questionnaire. SO HELPFUL!! Has specific codes on it for procedures and drugs. That way your insurance company can look for the exact thing youre seeking answers to.

Anonymous wrote:I had a similar situation with CareFirst via DC HealthLink when I made a ton of phone calls trying to figure out the specifics of coverage / exclusions beyond what they put in their marketing materials. I finally reached out to DC Health Link directly and asked them to require that their approved provider, CareFirst, give me the information before I made a purchase. I did get it but it's ridiculous that people who want to be pro-active, informed consumers have to jump through sooo many hoops.

PP, can you share the information you received? Any specifics about the coverage are appreciated.

I had a similar situation with CareFirst via DC HealthLink when I made a ton of phone calls trying to figure out the specifics of coverage / exclusions beyond what they put in their marketing materials. I finally reached out to DC Health Link directly and asked them to require that their approved provider, CareFirst, give me the information before I made a purchase. I did get it but it's ridiculous that people who want to be pro-active, informed consumers have to jump through sooo many hoops.

I need to know that do care first blue choice , Inc cover the IVF expenditure? I am married and the sperm donor will be my husband and of course eggs will be taken from me.

I'm in a semi-similar situation. I want to cancel my BCBS FEP coverage and enroll in a Carefirst MD plan. My boyfriend is covered under one and I was reading his benefits package and it said IUI and IVF are covered completely. His is not through a MD company and neither would mine be so I think it sounds pretty good.

I have Care First from MD, and its pretty simple. By Md law if your coverage is through a company based in Md, they have to provide coverage. They cover 6 IUI's per live birth. They cover 3 IFV's per live birth. They cover the meds for the IUI, and some for the IVF. The problem, is the staff at Cash First is dumber than a box of rocks and you will never get good customer service. I had 2 IVF cycles but Cash First rejected my third saying I had 3. It took them over a month to learn how to count to 3, and me waiting and calling every few days to see if they figured it out. It also amazes me how many doctors offices do not know what is covered and not covered patient by provider, you would think the money source would be memorized and they would know, but nope, even the doctor's offices don't have a clue. Good luck, and be patient, both the doctors and the insurance company will make this the hardest thing you ever did, as if its not hard enough already.

I'm the PP with Carefirst Bluechoice. I just checked and it's actually HMO Open Access. I wouldn't bother calling them, they will tell you it's not covered. In fact, when the financial people people at Shady Grove gave me the summary of my plans infertility benefits, IUI's were not covered (though I think testing and the HSG were). Just have Shady Grove submit the request and keep your fingers crossed. I've had 6 iui's covered and all testing. My doctor did make a note in my file that I had a boyfriend but still wanted to pursue motherhood (not sure if that helped). My nurse said that she has seen a few of her patients have iui's covered and that insurance agencies are becoming a bit more open minded.

here, not hear. sorry.

Anonymous wrote:Original poster here. Thank you all for your replies. I have tried calling Carefirst and it has been very difficult getting detailed information about their infertility coverage. They are only providing me with the information listed in their "summary of benefits" which simply states that infertility treatment is covered ... no details about what is covered and what is excluded. One of the customer service reps told me that I would need to apply for the plan in order to receive the policy details regarding coverage. I will try calling Carefirst again today, and hopefully have better luck.

To the individual who has the Carefirst PPO, by any chance do you know if your PPO is Blue Choice or Blue Preferred?

Thanks again!

I'm not that person, but Blue Choice or Blue Preferred ONLY applies to the network, not to what services are covered. Your plan might still be very different because what is provided in the plan varies from employer to employer, even if the same network applies.

I don't see how legally they can make you apply for the plan before sending the booklet, if you request it. Are you in Maryland? Contact the insurance commissioner. If you request the plan details, they should disclose them, even if that means they send you a link to a PDF of the book and not the book itself. But in no way should you actually have to purchase the plan before being able to look at the detailed book of plan coverage. That's ridiculous.

I have found BC/BS to be kind of sneaky when it comes to the details of coverage. I considered switching to them this year, but at the health fair, they were the ONLY plan/company that didn't have copies of their coverage book. EVERY other plan had a book that you could take to look through before signing up.

If you push the issue, especially if you call the insurance commissioner, they might agree to send you a book. But I wouldn't count on anything people tell you hear about their coverage until you see that book. Because all of the plans vary.

Original poster here. Thank you all for your replies. I have tried calling Carefirst and it has been very difficult getting detailed information about their infertility coverage. They are only providing me with the information listed in their "summary of benefits" which simply states that infertility treatment is covered ... no details about what is covered and what is excluded. One of the customer service reps told me that I would need to apply for the plan in order to receive the policy details regarding coverage. I will try calling Carefirst again today, and hopefully have better luck.

To the individual who has the Carefirst PPO, by any chance do you know if your PPO is Blue Choice or Blue Preferred?

Thanks again!

I'm in your situation. Single with donor sperm. I have Carefirst Blue Cross PPO and have all tests, bloodwork covered. Shady Grove submitted requests for iui's and they have been accepted! Haven't tried meds, monitoring or ivf yet so I don't know if that would be covered.

I don't know about those particular insurance plans, but I am also single and having IVF with donor sperm. It seems like almost all insurance plans cover the diagnostic tests/ ultrasounds leading up to IVF, even if you're single. I have had at least half a dozen ultrasounds, Day 3 bloodwork twice, HSG, and a mock embryo transfer, and my insurance (United Healthcare) covered it all. I think I would not be covered for IUI, though (but that wasn't an option with my diagnosis). Good luck!

I would call them. The same insurance company will offer different plans depending on the employer. You should verify what will be applicable to you.

You should call, because I thought that most insurance plans that cover infertility cover require that you be married.

I also think a lot of people who respond on here might be talking about the Federal Carefirst plan, which might not have the same coverage as the Carefirst plan you are looking at.

Is there a phone number you can call and request the detailed plan booklet? That should spell out the infertility coverage.

Is anyone familiar with Carefirst Blue Choice or Carefirst Blue Preferred infertility coverage in Maryland? I'm considering enrollment in one of these plans. I am single and will be using a known donor for insemination. I know I will not qualify for IVF coverage, because Maryland law states that IVF coverage is only allowed if the patient's eggs are fertilized by her husband's sperm.

Does anyone know if I would still qualify for infertility coverage for blood tests and ultrasounds leading up to IVF? Is IUI covered? Any information would be greatly appreciated!