What Kind Of IF Coverage Do You Have?

patchen30

If you are lucky enough to have IF insurance coverage, what exactly does it entail?  I'm just wondering what is standard. 

I am lucky to have coverage, but it is limited so I don't want to waste any coverage doing something that might not be that effective (although how do we ever know what's going to be effective, such a guessing game)...

Dr.Loretta

There is no standard. Most insurance companies have some form of IF coverage, but it's up to the individual company plans to decide what they're going to carry.

I'm on DH's insurance, which covers all diagnostic like any other health issue (95%). We have a $15K combined lifetime coverage for treatment, from fertility meds to IVF and beyond.

kimarino13

I have 100% coverage for all diagnostics, and I have up to 4 lifetime IVF or IUI cycles that are covered between 90% (up to my OOP max) and 100%. ?Donor egg/sperm and genetic testing costs are also covered. ?FETs are covered as well, and do not count against my 4 lifetime IVF cycles.

I am so, so grateful.?

ETA: ?My company is headquartered in MA, so that is why I have such great coverage.?

EastCoastGirl*

I don't know if there is such a thing a standard, except in states where coverage is mandated. I live in a state without a mandate, and I have a dollar amount limit on my own plan, and another similar limit through my husband, which is my secondary insurance.  I also have a small amount of coverage for IF medications, and those charges don't count towards my two limits. 

Even with the two plans together the amount I have isn't a lot in the overall scheme of things, especially as our clinic's charges seem so much higher than what's usual (for example, our SA cost $400; someone here did a poll last week and I think the norm was like $150); but I'll take what I can get.

XXXXX222

We are super lucky. ?After a $300 deductible, procedures (IVF and IUI) are covered 90%. ?We have a lifetime limit of $10,000. ?We've done three Clomid cycles (one with TI, two with IUI), and decided that it would be smartest to move onto IVF, before any more of that $10,000 is used up.

I've called the medical insurance and our prescription plan companies a few times and have always gotten very different, very vague answers about drug coverage. ?Most of the time, they concluded that IVF drugs were not covered at all. ?Finally, I begged the financial coordinator at our RE to call and ask to have this in writing, and they confirmed that drugs *are* covered. ?I guess you never know until you call and argue and ask for specifics in writing.

ashely929

in the State of MA Insurance has to cover IF related costs.  I haven't had to pay more than a co-pay for anything related to my IF.

MrsWood1228

we are covered at 100% - less $20 specialist co-pays for every single visit... even those 10 min. monitoring u/s visits.

we do have a $15,000 lifetime max on IVF... and i don't think they cover the whole donor egg process and it's many facets. fortunately, my eggs are good - i'm just struggling to get them mature-size and out of the ovary!  *lol*

GL to you.

eileenm21

I am in NY and I have covereage for IF - anything related to it - diagnostic to IVF - at 90% in net work, 70% out of network up to a $25M lifeltime max

sweenbean

We are very lucky to live in MA, where our IVF is paid for. With prior authorization, IVF,FET,DE, and meds are paid for. We don't need prior authorization for IUI, unless there are meds involved or donor sperm

floridakat

We're only covered for diagnostics, not for medications or treatments. And at that, we have a $4200 annual deductible to cover before the diagnostics are paid at 100%.

I'm just hoping my upcoming lap/hysteroscopy is covered. I know it's not diagnostic, but wouldn't consider it a treatment, either.

seniah_05

I live in IL.  My ins covers most everything except copays for meds and doctor's visits (literally see the doctor - does not incl monitoring appts where its a nurse or a tech) and it does not cover PGD or Cryo.  I can't remember the IUI limits off the top of my head but for IVF I start with 4 lifetime ERs (FETs do not count towards that number).  If one results in a birth I get an additional 2. 

I my insurance (even if dealing with the pharmacy hoops is the most utterly ridiculous and annoying process in the history of the free world).

ladychicago

i work for a large employer, but they are affiliated with a Catholic order...    so the good news is that I have all testing, drugs, and monitoring covered at 80%.    but the bad news is that I only get 3 lifetime IUIs and no IVF coverage.  

but i still feel VERY lucky to have what i have.

Gummybear

I have a lifetime limit of $30,000 for ART. This includes diagnostis and treatment, including IVF. What is not covered is the embryo biopsy (PCR) and PGD testing, since it is considered "research" protocol (approx. $6,000 oop per cycle). Cryo is also not covered (approx. $1,000 per forzen/stored batch). Up until this year everything else was covered 100% plus copays of $40 per visit. This year, it is covered 90%, so our oop have gone up a bit. Drugs are not included in the $30,000 and I have a $21 co pay for each Rx. No lifetime limit on drugs.

My company is based out of NJ so coveregae is mandated. Also, I work for a pharmaceutical company and the industry standard is to provide ART coverage. Most companies have ART covereage in some shape or form, though I believe my compnay has some of the best.

caden

They cover diagnostics, IF drugs and 1 IUI. Nothing else.

lovemymonkey

like PPers already mentioned, it depends on the type of coverage your employer purchases.

My primary insurance covers 3 IVF attempts per birth up to $100K lifetime. My secondary insurance (through DH) has a $45K lifetime cap.

chosner82

Before my husband switched jobs, we had 50% coverage on anything billed as infertility excluding IVF and anything else other than IUI. This included medications. Since he's switched jobs, they only cover diagnostics - no treatments. It really sucks!

Kelli&Jed

After reading all these posts it looks like MA would be a good place to move to for IF baby making   I am wondering if there is a list somewhere telling all the states that require IF coverage?  Hmmm, google here I come.

Mainer-in-Texas

I have coverage for diagnostics, but not treatment. It means we are paying $600 OOP for each IUI + clomid. Injectibles would be more because the drugs are expensive and not covered.

MH's insurance covers up to 6 IUIs and $10K towards IVF. If we aren't PG by December, I am going on his insurance next year so we can have coverage for injectibles and/or IVF.  (I would go on it now if I could, but I can't until open enrollement).

wiscgirl95

Diagnostics only on my coverage, DH insurance covers diagnostics then $2000 cap on fertility treatment.  I'll switch to DH's plan just to get that $2k.  After that, we're moving to MD, or MA, or NY.  Just kidding, we'll get a 2nd mortgage.  Grrrr. No mandates in WI!

But, like PP's said, you have to read your policy very carefully and then call to confirm.  Yes, some states mandate IF coverage, however that may only apply to employers of a certain size, etc.  So check your policy carefully.  I hope you have good coverage!

Kelli&Jed

Here's what I found if anyone is interested in moving

Since the 1980s, 14 states, Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia, have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Twelve states have laws that require insurance companies to cover infertility treatment. Two states, California and Texas, have laws that require insurance companies to offer coverage for infertility treatment. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California and New York have laws that specifically exclude coverage for the procedure.

Gummybear

Kelli&Jed:

After reading all these posts it looks like MA would be a good place to move to for IF baby making   I am wondering if there is a list somewhere telling all the states that require IF coverage?  Hmmm, google here I come.

Hope this helps!!

https://www.resolve.org/site/PageServer?pagename=lrn_ic_stintro

https://www.inciid.org/article.php?cat=insurance101&id=243#w

Two*True

kimarino13:

I have 100% coverage for all diagnostics, and I have up to 4 lifetime IVF or IUI cycles that are covered between 90% (up to my OOP max) and 100%.  Donor egg/sperm and genetic testing costs are also covered.  FETs are covered as well, and do not count against my 4 lifetime IVF cycles.

I am so, so grateful. 

ETA:  My company is headquartered in MA, so that is why I have such great coverage. 

I'm jealous that donor sperm is covered under your plan!  We have awesome insurance that covers everything up to $50K lifetime.  If sperm was covered too I'd only pay $20 in copays for ovidrel and clomid and I'd be oh so happy.

smcswain

I have United Healthcare. It's a ChoicePlus plan. I think that coverage depends more on the company you work for than the actual insurance company. With my past two employers I also had United Healthcare, but neither included IF coverage.

My insurance now includes 3 IVFs and 3 IUIs and the following, all @ 100% (after copay):

Covered Health Services for infertility services and associated expenses including:

?  Diagnosis and treatment of an underlying medical condition that causes infertility when provided by or under the direction of a Physician;

?  Drug Therapy,

?  In vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) procedures, and zygote intrafallopian transfer (ZIFT) procedures;

?  Embryo transport;

?  Artificial insemination.

?  Donor ovum and semen and related costs including collection, preparation and storage of.

 

The following services are not covered:

?  Donor Compensation

---

tapgirl

My insurance covers up to $15K lifetime for infertility treatments.  We have used most of that at this point.  For this upcoming IVF cycle, we'll have enough insurance to cover most of the meds, but will be paying OOP for the procedures. 

JackieMac824

I have Keystone Health Plan East - it covers IUI's and oral fertility medication but it does not cover any injectable medication or IVF or any procedures such as ultrasound and blood work for IVF.  We are basically totally OOP for IVF.

epphd

Old job: worked at Yale; they have a self funded program with the Yale Fertility that covered 4 IVFs lifetime for employees.  80% coverage if you went someplace else.  It was incredibly generous.

New job: work at a research center in the northwest.  No coverage AT ALL for diagnostics, treatment, or meds.  Our donor egg costs were completely out of pocket.

*jenjen*

My insurance covers nothing  

fallbride110406

We have co-pays for meds (new this year, just in time for us thankfully) and my office codes my ultrasounds as GYN, so they cover those.  Otherwise, OOP.

miamicubajam

My insurance covers up to 3 cycles per lifetime of IVF or IUI's 100%. Includes Diagnosis, ART and ICSI.

mrs.oz

I live in Hawaii which is a mandate state.  I have a division on BCBS which is called HMSA in Hawaii. 

It's funny because the HMO plan covers everything including injects, IUI, and ONE LIFETIME IVF.  But the PPO plan only covers one lifetime IVF (w/meds).  I don't like having an HMO but I do it to get my IUI covered.  I've only had this insurance for the last month since I got a new job but I'm about to get my 2nd IUI with this insuance. 

My co-pays are $15.  The billing person at my RE's office says they cover IVF 100% but my handbook says they cover 80%.  I guess I'll find out what the deal is in a few months if we need IVF>

Quizzle

One thing to keep in mind: Texas' 'mandate' is utterly useless. They require the insurance company to offer it to the employers, but the employers don't have to purchase it. We're on DH's insurance, he's a teacher, and we have absolutely no IF coverage at all. Not even diagnostics.

 

My last job covered diagnostics and 6 IUIs. No drugs or IVF.