Trouble TTC

Does anyone have Cigna Open Access Plus?

My husband called our insurance today to try to find out what they cover for IF and he came away confused. It sounded like they have a cap of $10k but he wasn't sure if that was total or just for IVF. If any of you have this type of insurance and happen to know more about IF coverage, would you mind posting or sending me a PM?

We'll call the insurance company again later in the week but now I'm anxious that our coverage isn't quite as good as I thought.


BabyFruit Ticker
Baby Birthday Ticker Ticker

Re: Does anyone have Cigna Open Access Plus?

  • It's up to each employer to decide what amount of IF coverage is involved in the plan, even if the plan is technically the same name.  We have Cigna OAP also, but ours does not cover any IF treatments at all, only diagnosis/testing.  You should look at the Summary Plan Description from your employer, it will describe the benefits (it's often available on the company's benefits website, if you have one of those -- if not, you may have to request a copy from the HR department). 

    Always missing my Mommy (1954-2010) and Daddy (1943-2012)
    TTC since 2009 ; BFP 9/13/10 = MC 10/21/10
    DX = DOR/POA (AMH=1.1; AFC=4-5)
    Surprise BFP 8/31/11 while waiting to cycle for IVF
    Welcomed our little miracle 5/7/12
    Baby Birthday Ticker Ticker

  • Thanks ELF! That's really helpful. I had no idea that each employer decided how much IF treatment to cover. I'll ask him to request a copy of that summary plan from HR.

    BabyFruit Ticker
    Baby Birthday Ticker Ticker
  • image ELF4321:
    It's up to each employer to decide what amount of IF coverage is involved in the plan, even if the plan is technically the same name.  We have Cigna OAP also, but ours does not cover any IF treatments at all, only diagnosis/testing.  You should look at the Summary Plan Description from your employer, it will describe the benefits (it's often available on the company's benefits website, if you have one of those -- if not, you may have to request a copy from the HR department). 

    This. Mine opted to not cover IF. It sucked.

    TTC since April'09/ 3 failed rounds of Clomid/ Surprise Natural BFP- 9/22/11/ DX. Dec '09 w/ Inappropriate LH Secretion Syndrom/PCO/ Anov 28 months Lilypie First Birthday tickers
  • My Cigna is OAP too... and it looks like HSGs are covered, and only SOME fertility meds.  Like it doesn't cover clomid.  (Some people use Femara instead of clomid and it DOES cover that though)  (Of course this is my plan).  I think FET and Retrievals are covered, but it doesn't show me the rates for those online with my doc... (I'll look and see if it can find some samples with other docs though) Does not look like the cover IVF or IUIs though...
  • I have Cigna OPA as well and IVF is covered with no cap or limits however, injectable meds are not covered at all. Anything I get at the regular pharmacy is covered, IUI's are covered etc. My DH's company has a really really good plan
    Me (35) & DH (36)
    Married 5/2011; TTC since 2/2012
    DH: Everything perfect  Me: DOR, Endo

    2 rounds of 50mg Clomid - BFN followed by a CP
    2/2014 - Round 1 IUI (clomid, Gonal-f, trigger) - BFN
    March 2014 IVF #1 225 Menopur and 225 Gonal-F, cetrotide
    3/31 ER - 6R, 6M, 6F no frosties  Transferred an 8 cell and 9 cell on 4/2 - C/P

    image image
  • jencity9jencity9
    1000 Comments 500 Love Its Name Dropper First Answer
    member
    I dorm have that insurance but mine has a "lifetime max" and does cover treatments after the deductible up to that max BUT medications are not covered which is often one of the major costs. I'm assuming that's what your cap is but you'd have to figure out still what exactly goes toward that max.

    Me: 32  DH: 33  Married: March 2004

    July 2006: started TTC
    2008: HSG (normal), couple rounds of clomid through gyno
    2008 - 2010: dragging my feet out of fear and procrastination
    October 2010: first consultation with RE, dx PCOS and fibroids (DH slightly low count/motility)
    Oct. 2010 - Dec. 2012:  In DENIAL! avoided the issue because I was scared of surgery
    January 2013: returned to RE, fibroids grew significantly
    February 2013: second HSG, fibroids pushed on tubes which blocked them somewhat
    March 2013: MRI to determine what type of surgery may be necessary

    July 29, 2013: fibroids (5) removed via robotic laparascopy
    August 2013 - Nov 2013 : benched due to recent surgery

    IUI #1, Dec. 24, 2013, BFN 
    IUI #2, Jan. 25, 2014, BFN
    IUI #3, Feb. 25, 2014  BFN
    IUI #4 canceled due to lack of response to letrozole
    IUI #4.1 April 28, 2014, BFN

    May 16, 2014: wtf consult, start prepping for IVF in June and add injects for one last IUI in the meantime
    IUI #5 started letrozole and bravelle but canceled after HSG led to new diagnosis

    May 21, 2014: third HSG, tubes blocked, hydrosalpinx??
    June 11, 2014: consult, approved to move on to IVF because the hydro is not completely blocked therefore allowing fluid to move through rather than backwards

    Current:  PUPO (IVF #1)...  beta is 8/23
    Most of June: attended IVF seminar and did about 3 1/2 weeks of BCP
    7/7: start lupron
    7/16: e2 = 252, continue lupron
    7/24: e2 = 56.7 (told to start follistim 150 iu in 2 days, continue lupron)
    7/29: e2 = 232
    7/31: e2 = 879, follicles above 10 mm: 4 on right and 9 on left, about 20 smaller ones
    8/2: e2 = 2065, 24 follicles over 10 mm: (11 on one ovary, 13 on the other)
    8/3: no details about e2 or follies, but trigger tonight at 10!
    8/4: pre-op with b/w to confirm hcg trigger
    8/5: egg retrieval, 22 retrieved, 20 mature
    8/6: day 1 fert report: 8 fertilized (half IVF, half ICSI)
    8/8: 3 day transfer of 2 embies, a grade 2, 8 cell and a grade 3, 10 cell

    PAIF/SAIF/All Welcome!

    image
  • @jencity9 check on that lifetime max. It was one of the items that was abolished with the ACA.
    Me (35) & DH (36)
    Married 5/2011; TTC since 2/2012
    DH: Everything perfect  Me: DOR, Endo

    2 rounds of 50mg Clomid - BFN followed by a CP
    2/2014 - Round 1 IUI (clomid, Gonal-f, trigger) - BFN
    March 2014 IVF #1 225 Menopur and 225 Gonal-F, cetrotide
    3/31 ER - 6R, 6M, 6F no frosties  Transferred an 8 cell and 9 cell on 4/2 - C/P

    image image
  • jencity9jencity9
    1000 Comments 500 Love Its Name Dropper First Answer
    member
    @sportschick33 oh wow I didn't realize that! Is that for anything in general or regarding IF? Now I'm really curious... But I'm pretty sure I've spoken to them this calendar year and confirmed that.

    Me: 32  DH: 33  Married: March 2004

    July 2006: started TTC
    2008: HSG (normal), couple rounds of clomid through gyno
    2008 - 2010: dragging my feet out of fear and procrastination
    October 2010: first consultation with RE, dx PCOS and fibroids (DH slightly low count/motility)
    Oct. 2010 - Dec. 2012:  In DENIAL! avoided the issue because I was scared of surgery
    January 2013: returned to RE, fibroids grew significantly
    February 2013: second HSG, fibroids pushed on tubes which blocked them somewhat
    March 2013: MRI to determine what type of surgery may be necessary

    July 29, 2013: fibroids (5) removed via robotic laparascopy
    August 2013 - Nov 2013 : benched due to recent surgery

    IUI #1, Dec. 24, 2013, BFN 
    IUI #2, Jan. 25, 2014, BFN
    IUI #3, Feb. 25, 2014  BFN
    IUI #4 canceled due to lack of response to letrozole
    IUI #4.1 April 28, 2014, BFN

    May 16, 2014: wtf consult, start prepping for IVF in June and add injects for one last IUI in the meantime
    IUI #5 started letrozole and bravelle but canceled after HSG led to new diagnosis

    May 21, 2014: third HSG, tubes blocked, hydrosalpinx??
    June 11, 2014: consult, approved to move on to IVF because the hydro is not completely blocked therefore allowing fluid to move through rather than backwards

    Current:  PUPO (IVF #1)...  beta is 8/23
    Most of June: attended IVF seminar and did about 3 1/2 weeks of BCP
    7/7: start lupron
    7/16: e2 = 252, continue lupron
    7/24: e2 = 56.7 (told to start follistim 150 iu in 2 days, continue lupron)
    7/29: e2 = 232
    7/31: e2 = 879, follicles above 10 mm: 4 on right and 9 on left, about 20 smaller ones
    8/2: e2 = 2065, 24 follicles over 10 mm: (11 on one ovary, 13 on the other)
    8/3: no details about e2 or follies, but trigger tonight at 10!
    8/4: pre-op with b/w to confirm hcg trigger
    8/5: egg retrieval, 22 retrieved, 20 mature
    8/6: day 1 fert report: 8 fertilized (half IVF, half ICSI)
    8/8: 3 day transfer of 2 embies, a grade 2, 8 cell and a grade 3, 10 cell

    PAIF/SAIF/All Welcome!

    image
  • SportsChick33SportsChick33
    Fifth Anniversary 250 Love Its 100 Comments Name Dropper
    member
    edited March 6
    In general. I think they can limit the number of procedures but insurance itself can't have a lifetime max

    Check this out

    Me (35) & DH (36)
    Married 5/2011; TTC since 2/2012
    DH: Everything perfect  Me: DOR, Endo

    2 rounds of 50mg Clomid - BFN followed by a CP
    2/2014 - Round 1 IUI (clomid, Gonal-f, trigger) - BFN
    March 2014 IVF #1 225 Menopur and 225 Gonal-F, cetrotide
    3/31 ER - 6R, 6M, 6F no frosties  Transferred an 8 cell and 9 cell on 4/2 - C/P

    image image
  • Lillovebug79Lillovebug79
    250 Love Its 500 Comments Name Dropper First Answer
    member
    edited March 6
    Mine has a lifetime max of $12,000. It also has a max of coving 50% of 6 IUIs with ovulation induction. However my prescription insurance is different and it only covers 30% of injectable drugs and they have to be filled through their specialty pharmacy (Caremark). Each plan is so different. When I called, I ended up more confused. I agree with PP sit down with your plan summary, review it, make a list of questions, then call.

    Edited to include: my lifetime max is for infertility. They are allowed to limit and give lifetime maxes on those types of things. I guess it's lucky that my prescription plan is different because it also has a lifetime max of $10,000 but that's just for infertility drugs and when it only covers 30%, it would take a while for me to max it out.



    ********Siggy/Ticker Warning***********



    Me (35) no known issues DH (37) MFI. TTC 21 months (24 cycles)
    Dx MFI with low to normal count, low motility, morphology 3%
    HSG normal, ultrasound and labs on me all normal. 

    1 cycle of Clomid 50mg and TI, unmonitored by OBGYN= BFN
    1 cycle of Clomid 50mg and IUI, unmonitored by OBGYN= BFN
    Started seeing an RE!!
    2 more cycles of clomid 50mg (great response), with IUI and Pregnyl trigger (4.8-8 mil good ones after wash) = all BFN
    1 cycle of clomid 50mg (3-7) followed by Follistim 75iu (7-11) + IUI = BFN
    December 2013 DH saw urologist and is taking Anastrozole, CoQ10, and L-Carnitine
    IUI #5 natural cycle (needed a med break) = BFN
    IUI #6 Follistim 75iu (CD3-10) + Pregnyl (CD11) + IUI (final count after wash 300K) = BFN
    IUI #7 Follistim 75iu (CD3-9) + Pregnyl (CD11) + IUI on 2/20 (post wash count 12.5 million)= BFN
    IUI cancelled (DH OOT) Clomid 50mg (CD3-7) 1 follicle +(not well timed) TI = BFN
    IUI #8 and last one!! Clomid 100mg (CD3-7) +OPK before US + IUI 4/17 (post wash 8.5 mil)= BFN

    Pre-IVF testing complete! SHG great and measurements taken! Labs for infectious diseases completed, FSH (5.4), TSH (1.6), Prolactin (11), AMH (2.6), Estradiol (40).

    Started BCP 5/29 and Lupron 6/11 prep for IVF #1! Started follistim 225u/day on 6/28. Monitoring on 7/2 >15 follicles measuring 11-14, E2 758. Monitoring on 7/5 all ready to go!! Great follicle sizes and lining is at 9. Tigger 7/5, ER 7/7 16R 9M 3F. Stimmed too fast in just 7 days. 7/10 3dt of 2 8-cell grade 2 & 4. 7/14 P4 >60.
    Holy crap BFP!!!
    Beta #1 (14dpo) 7/21 112 Beta #2 (16dpo) 7/23 286 a Beta #3 (18dpo) 7/25 761 Beta #4 (21dpo) 2631!!! Hold on tight little embies!!
      First Ultrasound 8/7- 1 perfect little bean with a beating heart 117bpm!! EDD 3/30.


    PAIF/SAIF/All Welcome!

    image




    Pregnancy Ticker}
Sign In or Register to comment.
Choose Another Board
Search Boards