IVF what does your insurance count as an " attempt"

Ash_SE

I know all insurances are different. However what does yours count as an attempt ? I.e. My limits are 3 attempts per live birth for IVF coverage. 

Tryimg to to get a feel for responses. 

Mine:

I've tried to get an answer from Carefirst  BCBS of Maryland but no luck. If I do ER, biopsy, freeze, PGS and then do a FET with any normals is that 1 attempt or will the insurance count that as 2 attempts? I know FETs are counted as attempts but what of a stim and ER with no transfer. Or what if I get OHSS ( high risk) and I loose the option for Fresh transfer anyway? Thanks so much! This board is a great place for knowledge.

radmom27

I have Tufts healthcare which does cover infertility treatment.  Each insurance company varies a little in what they cover as a cycle.  I would get a copy of your policy and read the fine print.  

I had a fresh IVF "cycle" this past year where I prematurely ovulated and did not have a retrieval.  Although there was no retrieval or transfer (which is where the real costs are in IVF treatment), this cycle was counted as one of my allotted cycles.  I know that when I have a frozen transfer, it counts as one of my cycles I'm allowed per year but is not counted in my lifetime max.  If I get OHSS and cannot complete a fresh transfer, then the frozen transfer will count as a different and separate cycle.  

I've found Tufts to be a bit more slimy than BCBS ( I had them for a short time and liked BCBS much better).  Insurance companies in general, are pretty slippery, slimy organizations and will do everything and anything to cover as little as possible. I would call someone at your insurance company (mine has a dedicated infertility hotline) to make sure to know EXACTLY what they cover and what counts as what.  And after you know, do everything in your power to maximize the coverage you do have.  This may mean lower levels of stims to avoid OHSS...things like that.  

hibiscus118

Hi, I also have CFBC of MD with the 3 "attempts" so it sounds like we have the same or very similar.   

I think what you you are describing is 2 attempts.  I had:
1 fresh cycle with ICSI, no PGS and froze embryos not used. 1 attempt
1 FET with assisted hatching. 1 attempt

I don't think insurance would combine then because of the time lapse between.  Also, I had to pay OOP for freezing.  I was also under the impression that if I had to cancel my fresh cycle because of OHSS it would be counted as 1 attempt. 

ETA: the rest of my post that disappeared! 

rainbowwishes5

Wow that's so specific. 3 attempts per live birth. Not even sure what they mean??? 
AFM- my insurance specifically covers 4 ERs and I am averaging 1 FET per 1 ER and that's all so I have an effective 4 IVF lifetime cap. already halfway thru my max!

Ash_SE

hibiscus118 said:

Hi, I also have CFBC of MD with the 3 "attempts" so it sounds like we have the same or very similar.   

I think what you you are describing is 2 attempts.  I had:
1 fresh cycle with ICSI, no PGS and froze embryos not used. 1 attempt
1 FET with assisted hatching. 1 attempt

I don't think insurance would combine then because of the time lapse between.  Also, I had to pay OOP for freezing.  I was also under the impression that if I had to cancel my fresh cycle because of OHSS it would be counted as 1 attempt. 

ETA: the rest of my post that disappeared! 

Thanks for the info. This makes me nervous. Another local board said they told her a FET after an ER with no other transfer counted as 1 attempt. If you did a 2nd FET with leftover embryos from first ER that was a second attempt.

If you did a freeze all , have some and don't do FET but try to go right into another stim ER then the first counts as an attempt even no transfer. It keeps people from banking and getting stims without transfer. 

I think yours is similar. You did a fresh transfer the first time right? 

The only thing that seems weird is that if you have to freeze to OHSS ( to cut down on even more medical issues ) they would count that as 2. That I'm going to call about. Hopefully I get a good answer

artemis618

My employer insurance has a lifetime max on egg retrievals - I get two on the condition that I complete a transfer within 90 days of the second.  I unfortunately got no blasts from the first one, so I'm not sure what happens if I don't get anything to transfer this time.  I'm not exactly sure to which codes the lifetime max applies (I'm guessing the ones that require prior authorization), all other infertility services (and meds!) are covered at the same rate as other medical expenses (after deductible, 90% in network or 70% out of network), so I would hope at least office monitoring visits and ultrasounds (and meds) would be covered at the standard rate if we opt for more cycles OOP, but I haven't inquired for sure (and mean to after this ER).

FuzzyDust

Wow, covering attempts is kinds unclear, as it can mean almost anything.
I have Premera Blue Cross, and my plan covers $15K lifetime limit for reproductive treatment, which I pretty much used by 1 cancelled IUI and 1 IVF cycle. Still waiting for my IVF bills to roll out to see if I went over yet.