Insurance Question: CT State Mandate?

Junebug66

Hi Ladies,

   Just wondering if anyone knows about the Connecticut State Mandate?  My RE said our best chance would be through IVF with ICSI due to MFI.  However,  according to the mandate, we have to do a third IUI before we can move forward with IVF, even though our chances of an IUI conception are very slim.  I'm wondering if there is any way we can skip another IUI and move onto IVF and remain covered? 

   Also, does anyone know if the CT Mandate covers ICSI?  I know we can get coverage for two IVF cycles, but I can't find any information on ICSI coverage.

   Thanks!

krissyh21

You should call your individual heath care plan and ask them specific questions. I am in MA and they have very strict guidelines about what needs to be done before moving on with IVF, I also know when I was looking into buying my policy (I self insure) that each company had their own set of rules and regulations even though IVF is mandated.

As for ICSI, my insrance company does not cover it for me because of know issues with sperm. If I had issues with fertilization after my first IVF, then I could prove I needed it. 

epphd

I don't know whether they cover ICSI, but it might be something you could pay for out of pocket for a relatively small fee ($500 or so, I would guess).

One thing to note: a mandate is in NO WAY a guarantee of coverage.  If the company providing the insurance is "self funded" or "self insured" (same thing) they do not have to follow the mandate. This basically means that the company pays each insurance claim rather than regular premiums for each employee - for large companies it is almost always cheaper to self fund. You don't have to ask the employer if they cover IF, but you can ask if they self fund - this will tell you whether to ask more detailed questions.

Here is a website that has some info on this issue: https://www.fertilityauthority.com/articles/insurance-coverage

GL!

Junebug66

Thanks for the info!

Our old plan was self funded, and we were not covered.  In January, DH's company switched to an HMO which is held to the state mandate.

Shan&Kev7707

I don't think you need to do an IUI before IVF in order to be covered.  There is NO WAY that I would get pregnant with an IUI and IVF w/ICSI is our only option.  I am in CT as well, but we are still trying to figure out what my insurance covers.  The least of my coverage would be mandated coverage and UConn has said nothing about doing an IUI first.  If your Dr. recommended IVF, you should be able to move forward with that procedure.