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Highmark PPO and infertility

ginogomermisserginogomermisser member
in Infertility
Does anyone have Highmark of PA(Blue Cross/Blue Shield) PPO??? Im a little confused about what they pay after all IF testing. Do they pay for any ultrasounds from IUI or the Clomid? Wondering if anyone knows of any tricks of the trade??? Thanks Alot!!!! 
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Re: Highmark PPO and infertility

  • Genie0120Genie0120

    It depends on who your employer group is that holds the insurance.  If its an ASO employer group (meaning the employer group takes the risks and pays all claims costs) they typically have their own inclusions and exclusions and the benefits are just administered via Highmark.  ASO groups are more likely to carry the infertility rider than any other group.    If your employer group is just a standard plan that follows one of the Highmark standard PPO plan offerings, also known as a fully insured groupv (meaning Highmark takes the risk)  infertility is rarely covered,  nothing after the diagnosis is paid for. Some plans dont even pay the testing for infertility.  Your best option is to call and ask Highmark, or check your schedule of benefits/SPD that is provided by Highmark or your employer group.

     I work for a ASO employer group and we dont have the infertility rider - most pass because of the cost.  Its been an expensive road being out of pocket.  There are only a few handfuls of employers that actually cover it around here such as Univ of Pittsburgh, Eaton, etc.  It would be nice if we were a mandated state where infertility has to be covered, it sucks that we arent!   I hope you have some infertility benefits, that would be great!  Best of luck to you!

    Mrs. Georgean 5.13.06 Holy 2nd Surprise BFP - Expecting our 2nd little one on Feb 9th 2013 After 3 years of unexplained infertilty, trying, hoping, and lots of peeing on myself.....Clomid Ovidrel IUI on 7/27/09 Best RE ever = BFP on 8/11/09 9/23 Missed m/c at 10.5 weeks. Very thankful for the time we had together. One lonely follie Clomid Ovidrel jacked up IUI on 12/31/09 (thanks to the nurse who wrote down the wrong protocol ) = 1/14/10 BFN - go figure. 150mg Clomid Ovidrel IUI on 2/12 - beta 2/26 = BFN Again..... Last IUI before a nice break...Cmon Luck of the Irish! Trigger 3/15, IUI 3/17... BFN and taking a little break before Follistim
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  • Genie0120Genie0120

    Sorry about that,,,I thought I was on my local Pittsburgh board when I saw your post, not realizing I was on the infertility board and responded assuming you are local.  Sorry!

    Mrs. Georgean 5.13.06 Holy 2nd Surprise BFP - Expecting our 2nd little one on Feb 9th 2013 After 3 years of unexplained infertilty, trying, hoping, and lots of peeing on myself.....Clomid Ovidrel IUI on 7/27/09 Best RE ever = BFP on 8/11/09 9/23 Missed m/c at 10.5 weeks. Very thankful for the time we had together. One lonely follie Clomid Ovidrel jacked up IUI on 12/31/09 (thanks to the nurse who wrote down the wrong protocol ) = 1/14/10 BFN - go figure. 150mg Clomid Ovidrel IUI on 2/12 - beta 2/26 = BFN Again..... Last IUI before a nice break...Cmon Luck of the Irish! Trigger 3/15, IUI 3/17... BFN and taking a little break before Follistim
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  • ginogomermisserginogomermisser member

    Hahahaha...I work for the state(PA) so I guess its safe to say that we dont have any riders attached to our plan. I called them prior to testing and they covered all testing but stated that Assisted I is not covered. I just read a brochure that stated egg induction/stimulation is covered and gave to medical code and terminology for doctors to use. Im guessing that they mean Clomid for egg stimulation. I will call them again and ask the doctor what the medical codes are for everything included in IUI. I just wanted to get a ballpark figure for IUI with clomid and start to save for the second cycle. Thanks so much for your help :) Merry Christmas   

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  • suni785suni785

    I have Highmark PPO as well...They covered the basic bloodtests and consultations w/ copay but that was it..they told me they dont cover any assisted technology..oh and they did partly cover clomid which i only ended up paying 10 bucks for...so that was good but no IUI or ivf or ultrasounds..I actually just got a huge bill for my ultrasound at umpc 570 bucks! so be careful of that....I learned my lesson the hard way...

    Im about to do an IUI w/ clomid cycle which doctor in pittsburgh do you go to assuming you are seeing an RE? I am having trouble deciding b/w Dr. Wakim at Magee and Dr. Erb at Rhs....I just want everything to go right w/ this IUI! 

    Hope that info helps! 

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