Questions for those who have IVF Coverage.

Lauren79

I am looking into adding IVF onto my husbands company policy.  While I am off this week I am going to make some phone calls.  I am willing to do a few more months of injectibles but my RE says I have a better chance with IVF. 

When I was in the office last week I found out that they can test the eggs genetically first before putting them in.  This part wouldn't be covered by insurance.  This would help me out greatly since  I keep having m/c's.   They will also put one back in a no charge if the first one doesn't take.   

Anyways, DH offers BCBS to his employees and I have BCBS through my job.  I have heard some of you say you have 4 transfers covered.  Is that right?  With what insurance company?  How much is covered?  Any OOP costs?  I asked my husbands agent about adding coverage to the policy and he seemed like he wasn't sure what I was talking about.  I have 5k coverage but that's it.  He seems to think that is the only coverage BCBS will offer.  I think he is incorrect.

Any ideas or advice is greatly appreciated.

Thanks. 

egsquared

Both my employer and DH's employer offer a PPO through BCBS of Illinois.  My employer does not include IF coverage (only testing) and DH's employer DOES include IF coverage.  So, it's possible for one insurance company (in our case, BCBS) to offer different plans.  We were on my insurance last year, but switched to DH's this year to do IVF.

Under our plan, I have a $500 individual deductible and then a $1,000 out of pocket max.  Everything is covered at 80% if you use an in-network provider.  They do cover 4 egg retrievals, but there is a stipulation that if we would give birth to a live baby after this (our first) egg retrieval, then we would only have 2 more retrievals covered. 

As far as the testing you're talking about, I think you mean the PGD (or PGS) testing.  This is a biopsy of the embryo (not the egg) for a bunch of chromosomal abnormalities; it will also tell you the sex of the embryo.  This is typically not covered under insurance, but under our plan, if you provide a letter from the dr. about why it is medically neccesary, then it is covered.  I've had multiple miscarriages too, so if we had a lot of embryos from this IVF, we were going to have the testing done.  Unfortunately, we only had 2 good embryos, so we just transferred them back and are hoping for the best, and if we get a BFP we're just praying to not have a m/c. 

There are definitely pros and cons to having th biopsies done, so I would research it a lot first.  It seemed very black and white to us at first - of course we want this done!  But even now, we weren't 100% feeling great about it.  Maybe a good thing the decision was taken out of our hands? 

I'd definitely call BCBS back and get some more information.  I would think there's a way for you to get coverage.  GL!

jeannaqueena

Hey, I would call Megan in the financial office or go in and talk to her.  When I spoke to our BCBS agent she said we had 5k, but when talking to Megan at CC she explained that the 5k had certain stipulations.  For instance, it was only good for monitoring and bloodwork, no medication, and could only be applied for TI cycles, not IUI or IVF.  Plus we had to meet our deductible first.  Well, by the time we did that we knew that IUI and TI weren't going to work for us. Yup, the insurance company knows how to protect themselves. 

All this to say each plan is sooooo different.  Megan can pull up your current plan and give you your exact number on the spot.  As for your DHs plan I would see if you can get her to look it up too!  I hope y'all have better coverage than we did, which was 100% OOP.....vomit.  But if it works it will be worth it!!!! 

You might want to see how long the waiting period is if you switch plans too and if you can even be added now.  Most policies have a renewal / change period.  

 GL! 

KristyLynn26

We also have BCBS through my husbands employer. We have an IVF lifetime max of 4 fresh cycles also but this covers pretty much everything included with the IVF cycle (even ICSI, assisted hatching or genetic testing with a doctors note if its shown necessary) and does not include FETs (if we were ever blessed to have any frosties). We have a $45 copay for all visits/procedures and either a $35 or $45 copay (depending of the medicine) for all drugs as long as they are ordered through their preferred mail order pharmacy (Prime Therapeutics aka Triessent Specialty Pharmacy). Drugs do have a $7500 yearly cap at which point we would have to pay OOP (but so far that has not been an issue). 

GL and if you have any other questions feel free to PM me. Our RE actually gave us a list of questions to ask our insurance company when I called them and I found it really helpful. It might help you in making sure you have the proper coverage. I can try to find it and send it to you if you'd like. Just let me know. Best of luck Lauren! 

nawlinsgrl

I have Cigna, but it is a specialized plan through my state university, so it might differ by state/plan if just regular Cigna.  I have $25K lifetime coverage (covers the costs they negotiate, not OOP prices) for IF medical treatment, and $10K for the meds.

After two IVF cycles, I still have $16K left, but burned through all my medication money, and was out of pocket a couple thousand.  For the medical part, I still pay my usual medical copay/deductible, which varies throughout the year (I start off with $2000 HRA that covers all insurance expenses, then pay the next $1000 of insurance expenses, then 10% of insurance expenses until I hit a total of $2000 paid, and then it's all covered at 100%). 

I estimate I only paid around $3500 total for both cycles, counting meds.  Had I needed to keep going, I'd be totally OOP for meds, so those costs would start to rise significantly, but I estimate I could do at least 3 more IVF cycles before I'd start having to pay OOP medical expenses.