Anyone from NJ on the board who has Horizon Blue Cross Blue Shield (HSA HMO access in particular)? DH's company is changing insurance to Horizon and we're trying to figure out what fertility coverage they have. It says on the "benefit highlights" that they require pre-approval for infertility coverage, but will cover 100% after deductible and copay. BUT, "Certain fertility services are excluded," and nowhere in the document does it list what these certain excluded services are (and apparently there isn't a plan book). Gah! I am so confused.
Just thought I might ask to see if anyone was familiar with how Horizon in NJ operates (while I wait for DH to find out more). I know I'm in a mandated state, but neither my or DH's company has 50 or more employees, so I'm not sure we qualify.
TIA!
Re: NJ folks: fertility coverage with Horizon BC/BS?
I'm not sure about the last line because my co. is over 50. We have bc/bs and are covered 100% for 3 retrievals and as many FET as needed.
Check it out because they are all different. good luck..I agree very confusing.
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
TTC #1 since 4/10, Dx: MFI IVF planned for April/May
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
Thanks, kinsalebride. DH's plan is, I believe, only a quasi-HMO, in that referrals aren't necessary. I'd love to get the PPO version but it would be double the cost of the other plan. Maybe if things get tougher for us then we'll bump it up next year (I know it would be heaps cheaper to pay for more insurance than to pay OOP for fertility treatments if we end up needing them). Just having a devil of a time getting straight answers out of anyone so far (part of this due, I'm sure, because I'm back-seat-driving this investigation -- though even DH is getting frustrated with the lack of answers now).
I think we're probably going to switch me to his plan anyway since it's better than mine, fertility coverage notwithstanding. But I kinda want to know what I'm getting into first, know what I mean?
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
I have Horizon BC/BS HMO and love it. I do need referrals, but I only had to make one phone call to my primary care physician for the referral to the specialist and they took care of the rest. I do not have any copays for office visits (this is KEY because there are sooooo many visits) and my meds copay is $20. IUIs, ultrasounds, bloodwork etc is all covererd 100%. There is a lifetime maximum of 3 ER's but IVFs are covered 100%. There is no maximum $$ amount and no deductible.
Check into the specific coverage they are offering. Horizon has a few different plans. We chose this one because we knew we were having fertility treatments and this was the most comprehensive. (my employer has over 50 employees)
Hope this helps- good luck!
&& ~ that's awesome that you have so much coverage with the Horizon HMO. I hope ours is as good (still waiting to get contact info for the rep - ugh this is a slow process)! It's so hard to know what to do when you don't quite know what you're up against. My DH (king of spreadsheets) started listing out the employees at his job last night and came up with at least 50, so maybe we'll be in luck there.
Hopefully we won't need the coverage, but I'll feel a little more at ease knowing the option is there. OOP isn't going to be an option for us (unless we win the lottery or something).
Thanks to everyone for your thoughts!
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
:sigh:
Finally got our answer. The plan at DH's company is for small businesses, so neither the HMO nor the PPO has fertility coverage. They'll cover diagnostic testing, but that's it.
BUT, further investigation into my own plan (also a small group plan) shows that I do have coverage for artificial insemination (IUI and ICI), including meds (and diagnostic testing).
So, I'm not going to switch... whew, 'cos I almost did!
photo by Scott Metzger
kikijbird ~ Erica (aka Kiki) & Paul ~ 24 April 2010
The JBirds Bio ~ Updated 03.02.10 - Invites!
My Ovulation Chart
Me: 41 DH: 46. We are TTC our 1st, started July '11,
3 cycles clomid with Ob,
1 cycle Tamoxifen with Ob,
Diagnosed PCOS 11/5/12
clomid, trigger & timed bd 12/12 BFN
1st clomid IUI 1/4/13 BFN.
2nd clomid IUI 2/13 cancelled didn't respond to clomid.
3/15/13 scheduled laparoscopy & on bcp.
May 10 IUI from injectibles - BFN
May 22 done with interventions it will either happen or it won't.
February 2014 No longer actively trying, but not preventing.
SURPISE BFP 4/2/2015!!!!!!!!!!
Miscarriage 4/23/15