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.

DX with PCOS 5/2005
Thyroid Cancer 7/10
TTC since 9/10
3 Rounds Clomid: No Response
4th Round of IUI (Letrozole + GonalF + Ovidrel): BFP!!!
Me: 33 DH: 34
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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.
    DX with PCOS 5/2005
    Thyroid Cancer 7/10
    TTC since 9/10
    3 Rounds Clomid: No Response
    4th Round of IUI (Letrozole + GonalF + Ovidrel): BFP!!!
    Me: 33 DH: 34
    Image and video hosting by TinyPic image BabyFruit 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
    250 Love Its 500 Comments 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: 31  DH: 32  Married: March 2004

    July 2006: started TTC
    2008: HSG normal, clomid through gyno
    October 2009: saw RE, dx PCOS and fibroids (DH slightly low count/motility)
    Oct. 2009 - Dec. 2012:  In DENIAL! avoided the issue, NTNP
    January-July 2013: returned to RE, fibroids grew significantly, another hsg (fibroids blocked tubes this time), MRI
    July 29, 2013: fibroids (5) removed via robotic laparascopy
    August 2013 - Nov 2013 : benched due to recent surgery

    IUI #1, Dec. 24, 2013, BFN  (cd6 follie 12 mm, pregnyl cd10, iui cd12, progesterone)
    IUI #2, Jan. 25, 2014, BFN (Letrazole cd4-8, cd10 3 follies- 14, 15, 16 mm, pregnyl trigger cd14, ruptured follicle 3dpo worst pain ever!! but supposedly all 3 follies/eggs are still good, progesterone
    IUI #3, Feb. 25, 2014  BFN  (Letrozole cd3-7, cd11 3 follies: 17.9, 14.1, 12.2, trigger cd13, iui cd15)

    Current Status: IUI #4 canceled due to no response for a while and then ovulation unexpectedly... in 2WW for possible TI.

    PAIF/SAIF/All Welcome!
  • @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
    250 Love Its 500 Comments 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: 31  DH: 32  Married: March 2004

    July 2006: started TTC
    2008: HSG normal, clomid through gyno
    October 2009: saw RE, dx PCOS and fibroids (DH slightly low count/motility)
    Oct. 2009 - Dec. 2012:  In DENIAL! avoided the issue, NTNP
    January-July 2013: returned to RE, fibroids grew significantly, another hsg (fibroids blocked tubes this time), MRI
    July 29, 2013: fibroids (5) removed via robotic laparascopy
    August 2013 - Nov 2013 : benched due to recent surgery

    IUI #1, Dec. 24, 2013, BFN  (cd6 follie 12 mm, pregnyl cd10, iui cd12, progesterone)
    IUI #2, Jan. 25, 2014, BFN (Letrazole cd4-8, cd10 3 follies- 14, 15, 16 mm, pregnyl trigger cd14, ruptured follicle 3dpo worst pain ever!! but supposedly all 3 follies/eggs are still good, progesterone
    IUI #3, Feb. 25, 2014  BFN  (Letrozole cd3-7, cd11 3 follies: 17.9, 14.1, 12.2, trigger cd13, iui cd15)

    Current Status: IUI #4 canceled due to no response for a while and then ovulation unexpectedly... in 2WW for possible TI.

    PAIF/SAIF/All Welcome!
  • SportsChick33SportsChick33
    Fifth Anniversary 100 Comments 100 Love Its 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
    100 Comments 100 Love Its 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.
    Me (34) no known issues DH (37) MFI. TTC 17 months (20 cycles)
    Dx MFI with low to normal count, low motility, low morphology
    HSG normal, ultrasound and labs on me all normal.
    4 months of clomid 50mg, 3 with IUI and Pregnyl (4.8-8 mil good ones after wash) = all BFN
    1 month of clomid 50mg (3-7) followed by Follistim 75iu (7-11) + IUI = BFN
    DH saw urologist and is taking meds to help but they take at least 3 months to work
    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)= ???


    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). Ready to get started!

    PAIF/SAIF/All Welcome!
  • calindicalindi
    250 Answers 500 Love Its 1000 Comments Third Anniversary
    member
    In general. I think they can limit the number of procedures but insurance itself can't have a lifetime max

    Check this out

    It can still have a lifetime maximum for infertility, I'm pretty sure.  They just can't put a cap on the insurance itself, meaning a severely sick patient won't simply have their policy lapse because they became too expensive.

    Since infertility is unlikely to kill any of us (no matter how it feels sometimes), it's not viewed quite the same way.

    Also, this post was SEVERELY necromanced... however, I like seeing super old posts sometimes and evidence that most people do eventually get pregnant :-)
    image
    imageimageimage
    National Infertility Awareness Week is April 20-26th
    Fighting a struggle that 1 in 10 couples face while trying to conceive

    Me: 28      DH:  31
    Off birth control March 2012 - Actively trying since Sept 2012
    DX: Unexplained Infertility

    History:
    Cycle # 1-17: The Old Fashioned Way = BFNs
    Cycle # 18: IUI #1, Natural Cycle (Ovulated 1/30) = BFN
    Cycle # 19: TI, Femara/Follistim (33.3iu), Ovidrel, Prometrium (Ovulated 2/25) = BFN
    Cycle # 20: IUI #2, Femara/Follistim (50iu), Ovidrel, Prometrium (Ovulated 3/24) = BFN (c/p)

    Current Cycle:
    Cycle # 21: IUI #3, Follistim (75iu), Ovidrel, Prometrium
    CD 1 (4/8) - 5 days of Follistim, then back for monitoring 4/15

    Next Step:
    Break until Fall 2014, then (if necessary) IVF with CNY
    Phone consult scheduled for 5/14

    My Blog

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