You need to call them and fight this, its definitely 25k annually for FEP BCBS. Something is wrong. They rejected me but then it got pushed through. They are still year one doing this.

It's a 25k yearly max, not lifetime

I realize I'm reactivating a VERY old thread here, but I was hoping for some advice on this topic.

My initial fertility treatments were partially covered by our insurance through my husband's employer in 2022 and 2023. It started as Empire BCBS and switched to Anthem BCBS - unfortunately it didn't reset in that switch, but I was ok because I did three retrievals and the policy covered up to three retrievals.

Then earlier this year we switched to the Federal BCBS (FEP Blue) plan, which was structured as a $25,000 lifetime max. I was under the impression that it reset because he switched employers and the policies were completely different. I did my fourth and final retrieval earlier this year, and just found out from the clinic that my retrieval costs were denied by insurance because I had met my $25,000 max which surprised me because I have only been on the plan for several months. So it appears that what I already did through my husband's previous employer did not reset when he switched to a government job.

Does anyone have experience with this type of situation? All of the threads I've read talk about things resetting when you switch employers, but does not apply if both employers are pulling from the same network? In my mind Anthem BCBS and FEP Blue were different, but maybe not?

Anonymous wrote:Sort of side topic here -- if you are a fed living in DC are there any plans that pay for IVF? I have BCBS Basic and it only covers diagnostics. Thanks!!

Federal MD IPA and Aetna cover 3 cycles of IVF per live birth. The drug copays are significantly lower with MD IPA. Kaiser also offers some coverage. MD IPA only covers diagnostics at 50%, so finish those while you are still under BCBS.

Anonymous wrote:Sort of side topic here -- if you are a fed living in DC are there any plans that pay for IVF? I have BCBS Basic and it only covers diagnostics. Thanks!!

I'm the pp with the United Healthcare primary and secondary. My secondary is the federal MDIPA plan and we live in DC. It's an HMO and requires in-network treatment and referrals, but it covers 50% and includes medication.

Side topic person--Move to MD and get insurance from the state exchange. MD is a fertility rights state so you get really good coverage--like 3 tries (IUIs/IVFs/FETs) and then 3 tries more post live birth. It might be more. That said, there is not total equity: if you are a lesbian or gay couple, they won't provide coverage, which sucks.

Sort of side topic here -- if you are a fed living in DC are there any plans that pay for IVF? I have BCBS Basic and it only covers diagnostics. Thanks!!

Some insurances measure coverage maximums as lifetime maximums, meaning if insurance had a limit, they would count tries with previous insurance. But there have been some changes on this in the law driven by the Affordable Care Act restrictions on coverage limits. I'm not certain how this has all shaken out in every state. So I think the answer is perhaps and depends.

When I asked shady grove they said it depended on whether or not the insurance copies talk to each other - they don't always - but there are no guarantees

Yes in my case, MDIPA to Aetna. I called before switching, though, to confirm. I doubt things have changed (this was between 2012 and 2013), but no harm in asking.

I have both primary and secondary coverage (both United Healthcare, but different plans under my and my husbands employers) for this purpose. My primary is close to the limit and I confirmed with United Healthcare that notwithstanding the limits on my primary, I can then use my secondary coverage, no problem.

I have seen this question on this forum before--you might want to google/search for it. From my memory, no, if you exhaust with one company the next company will not provide coverage since you have already used the services at another company. We actually asked a finance person at SG this same question and they wouldn't answer the question. Just to be safe, I would call the the company you are considering switching to and ask.

Yes, if for example you are switching from Aetna to MD IPA.

I would assume the answer is yes. My employer switched insurance companies this year and my infertility benefits and coverage re-Started. As long as it's a totally different insurance company and not just different plan I think it would be the same for you.

If an employer (i.e. fed gov't) has more than one plan that covers infertility can you switch plans after exhausting the benefits of one and get coverage again?