Insurance query — The Bump
LGBT Parenting

Insurance query

Hi everyone,

New member here. Love this board! I was hoping I could ask the veterans a question.

We are looking to TTC this coming year. We obviously want to make sure we have the best insurance choice before we begin. I have a short period of time for open enrollment to change my provider if needed.

I am hoping you all could lend some advice as to what you think are the most pertinent questions I should ask regarding coverage?

Thanks for any help!

Re: Insurance query

  • I'm not sure if you're familiar with all the terms, so ask if you're not sure. 

    Most often coverage is under the "infertility" benefit.  It can be a little tricky to get information on.  Often your employer is the one who determines what that coverage looks like.  At my employer the infertility coverage is the same in all our health plan choices.  At my wife's employer, the PPO has more generous coverage than the HMO.

    Questions to ask:

    1. What is required to begin using your infertility benefit?  Some plans require 12 months of unprotected hetero sex (that won't work) or even 12 IUIs before they will begin to pay.

    2. What is covered?  Diagnostic workups?  IUI?  IVF?  

    3. Are meds covered under the medical benefit or under pharmacy benefits or a speciality pharmacy program?  This can make a big difference for copays/deductibles.

    4. What are the copays and deductibles?  We had to accept higher cost-sharing in exchange for more generous fertility benefits, which was good to know ahead of time.

    5. Are there any limits on coverage - either annual or lifetime? 

    To get all this information I spoke with two different insurance companies and my wife's employer.  It was a pain, but it's very reassuring to know we have some coverage. 

    Same sex couple TTC with donor sperm.  I am 35 and carrying.  Endometriosis and DOR.
    AMH 0.5, AFC 5-8, FSH 7ish

    IVF #1 - antagonist.  Empty follicle syndrome.  1 retrieved, 0 fertilized.
    IVF #2 - antagonist.  Ovulated early.  3 retrieved, 2 fertilized, 0 blasts
  • Thanks so much for the response! That is super helpful.

    Off I go to call the insurance co's.

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