Any NYC ladies out there? Question about coverage

dhreczuck

I have a consult with my RE today to discuss injectables and of course $$$ is the first thing on my mind.

NY State has mandated infertility coverage up to age 44, but my plan only covers the basics to comply with that law, meaning blood work, ultrasounds, I believe iui, ect. but anything relating to IVF, they do not cover.

I'm wondering then if they'll cover the drug costs associated with IUI since they cover the actual procedure. I could just call and ask my insurer, but I'm paranoid that if my RE somehow codes meds to get coverage that I'll tip off my insurance company. Anyone is NY had experience with med coverage? I have United Healthcare.

Country Girl in the City

I am not in NYC but I do have United Healthcare.  My coverage changed at the beginning of the year.  Meds that were covered in 2011 are no longer covered.

You should be able to go to the website on the back of your card and look up your coverage.  That way you don't have to talk to anyone.  You can even put hypothetical scenarios to find out how much it will cost if you have a c-section and things like that.

Good luck!

mtlaurel

Not in NY and not with United Healthcare, but I wouldn't be too paranoid about calling and asking your insurance. I call my insurance co. a whole lot and the person on the other end never seems aware of the fact that I've used up my IVF coverage. I really don't think they try to put 2 and 2 together between your questions and your claims. Good luck.

Catch23

(siggy)

Lurking and butting in....

My friend's husband works for the state of NY and gets a $50K infertility benefit as part of the state's insurance plan.  When they struggled to get PG, he actually started applying for state jobs (he's a computer programmer) just to get the $50K infertility benefit.  I know that was not your initial question, but I thought i'd throw it out there if changing jobs for you and DH is at all an option.

Good luck.

dhreczuck

Well, I just spoke to my RE and they gave me a list of questions worded exactly as they should be asked to find out about coverage. They are very organized! Last time I called United about my trigger shot it literally took me a 1/2 hour on the phone to find out if it was even covered.

My RE told me United typically covers the meds, and the IUI is definately covered but I'm going to call anyway and get the official answer!

chicagobride_07

Definitely call- I live in a state where infertility coverage is mandated (in fact, my DH actually works for one of the largest employers in the state) and we have very limited infertility coverage and no coverage for IVF and/or infertility meds.  DH's employer is self insured (alot of companies are) which means that they do not need to adhere to the mandate.  Neither plan covers injectibles. 

I've learned with insurance that you can't just generalize "United Healthcare or BC/BS typically covers this"- because there are a million different plans and the level of coverage is really employer specific.  A girlfriend of mine has BC/BS of Illinois with full infertility coverage; mine is very limited.  Same insurance company.

Good luck!

dhreczuck

Thanks! I actually work in HR, so I was keeping an eye on which insurance plan we stuck with (ultimately the decision is always financial)   this year since all my dr.s are UHC, and that's who we're going with and my plan is staying the same so for at least for another year I'm good! We are not self insured thank goodness, then the focus is always on cutting benefits because the company holds the most liability. 

BBN2012

Please make sure that United is not only your insurer, but also your pharmacy. I have Aetna insurance but CVS caremark is my pharm. After months of thinking I couldn't get injectibles covered because that's what Aetna told me, it turned out it wasn't their decision because they don't provide my meds plan. $2000 of Gonal F + HcG was $60 after many phone calls. GL!

dhreczuck

Oh Lord, this is ridiculous, so far spent 2 hours trying to find out if they'll cover the meds and so far noone can answer this question for me. As a policy member shouldn't this information be easily available! GRRRRR.. getting ready to throw phone across room.

 

They told me Medco is my pharmacy plan and that the actual pharmacy I have to order from is Freedom Pharmacy.. but still no answers.. (the women at freedom was actually very nice and said worst case, they can call for me and say they have a prescription pending to get the cost)

lsgabriel

I am in NYC.  And I also have UHC w/ExpressScripts. The NYS Fertility Demonstration program is an option depending on your practice. NYS coverage mandates diagnostics, not treatment. Good luck!