Insurance question

carrieandr

I emailed an insurance agent about possibly changing my plan and I asked about RE's and fertility testing and procedures.  He said, "I will tell you upfront that there is no insurance company that will cover the infertility treatments.  Seeing a specialist yes and testing to see if there is a problem yes but as far as the actual treatments go the answer is unfortunately no."

--Is it true that no insurance company will help with infertility treatments?  I'm not sure I'll need them yet, but I wanted to get the best coverage, just in case.

happyktmom

You can purchase a rider to cover infertility treatments and testing if you can get in touch with your hr person. You may or may not be able to control that. If it a plan through the exchange, it won't work. Good luck!

BernieRae

Been wondering about this too after hearing people on here talk about being covered. I just learned that some states have laws that require infertility treatments to be covered by insurance plans. Unfortunately I don't live in one of those states. I plan to contact my state legislators. Won't help me right now (or ever) but change has to start somewhere.
Found the info here https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx

jilligan14

I'm self-employed so have a plan through the marketplace (exchange) and we spent DAYS researching which plan to get (H spent many hours on the phone with Blue Cross, the marketplace, the fertility clinic, etc It seems like everyone keeps saying, "Call this other person" so it takes a LONG time to get real answers but we got there in the end). There are a few Blue Cross plans that cover infertility testing and basic treatments. The plan I have now has covered ALL of my testing (tons of blood work, ultrasounds, etc.) and I only pay $30 copay for consultation visits with my RE. I also have a max of 3 lifetime treatments, which can include IUI but not IVF (I haven't used any of these yet). I think with those treatments I pay 20% after my deductible (which is $1,000). The medicine was all covered too and my Ovidrel shot only cost me $30 (it's full price is like $140). The only issue is that my current plan is no longer going to be offered in 2016 so we are currently in the process of researching once again (ugh). The plan I was on was a bit pricey but I was able to get a subsidy for it since we don't make that much. I guess it depends on how much you make and what kind of subsidy you are eligible for. Once I settle on a plan, I can send you details if you're interested. Don't be discouraged - there are plans out there, you just have to search for them.

carrieandr

I'm self-employed, so no HR dept.  If different states have different rules, that explains why I thought I had heard other people say things were partially covered.  My insurance is going up $160/mo. after just going up $75/mo. last year.  I'm thinking of switching to HMO, but I need to find out the consequences of that first.  Ugh...insurance.

Piperella

I'm in Virginia for what it's worth and I work for a school system that has Anthem Healthkeepers.  Here's how mine works:

Fertility Meds: Highest Co-Pay, but covered

Fertility Meds + IUI: Will pay for IUI, not Meds

IVF: Absolutely nothing covered

They do this to say they have some sort of infertility coverage, but it allows them to stay far away from covering IVF.  Check about the cash price of IUIs.. because even a 20% copay for 1000 is expensive... my all cash price for an IUI was broken down to be about $200 for the SA/collection and then $250ish for the IUI itself.. It was right around $500 when all was said and done (I did Clomid though with my IUI). We were ready to pay that but ended up paying much less as ended up being covered by insurance as we paid OOP for the Clomid. Cash prices are much different than Insurance pricing.  There are some websites that give the codes for each of the procedures or medications.. you can call an insurance company to see if it is covered.  It's a lot of work, but I thought nothing was covered with mine, but have lucked out with some of the pricing for IUI.

DH has a silver plan through ObamaCare Exchange thing, and it actually paid for much of the SA too, even though we didn't think it'd be covered.  Sometimes there can be good surprises out there.

carrieandr

I currently have a platinum plan with obamacare. I got it because I was planning to get pregnant. Now that the monthly payments are going up to $657.48, I need to figure out which adds up better -- high ins, low costs, or low ins, high costs. It's all so confusing!

jilligan14

@CarrieandRoy - are you eligible for a subsidy through the obamacare or do you have to pay the full premium? I found that the Gold plans seem to have a lot of good coverage and are more affordable than the Platinum plans. I'm looking at the Blue Value Gold 1000, which covers basic fertility stuff and seems affordable for having a baby.

carrieandr

I have to pay full price.  I think I better look up the plans and see the details.  The insurance guy told me to call him, but I should probably check it all out first.

Sporty1216

Our plan does not cover infertility, but we are on a high deductible plan, which has some nice advantages in our experience. our monthly premiums are super low (like $200), but our family deductible is $4k. Max out of pocket is $6k and we can put up to $6750 in our HSA account. The balance rolls over each year, so if we end up having some out-of-pocket expenses for IUIs or something, there's a bit of a reserve there. It's not ideal, in that it doesn't cover infertility if we need to go that route, but I do like the fact that our monthly costs are low and we can put money away in the HSA pre-tax. Anyway. Just one more thing to throw in the mix!

Jenniferk08

I'm on Aetna and ours covers I believe up to $10k for treatments or it might be Ivf. I forget the exact.
I would call around and ask. Doesn't hurt.

emsmama15

I'm not in a state that mandates infertility coverage, but I've had plans through both HealthPartners and Blue Cross that covered up to 6 IUIs per pregnancy.  They also cover injectable meds (my IVF meds are costing me $260 because of all things the progesterone supplement my doc wants me to take isn't covered).  Injectables can be a HUGE expense if you get to that point.  And like @Piperella mentioned, sometimes they'll cover meds, but if they're related to IVF, they won't.  It's such bullish*t, honestly.  I pay a lot for my insurance (less starting in January since my hubby got a job with Blue Cross) to get the coverage I do have.  

carrieandr

That's weird, @emsmama15. It was Blue Cross that I was talking to. I don't know if IUI's would help me, though, since my problem is MC's.

agriffin92013

Think it depends on the state because I have Blue cross in GA and they only cover the diagnostics part of infertility no treatment of any kind

emsmama15

Yeah, I'm sure it depends on the state and on the plan.  Ugh.  I hate insurance for the most part, though I'm super happy with Health Partners right now since I just picked up all my IVF meds and didn't have to sign over my first born to pay for them!!