Insurance or OOP?

nicolecoy · February 2013

I have great blue cross insurance but it covers nothing to help you get pregnant which sucks but never really mattered until now that we are going to the specialist. We had to pay OOP which wasn't to bad, our first appointment was 575.00 which covered my first u/s, mine and dhs blood work and a sonohysterogram. Our insurance covered covered alot of meds but our clomid was a little more. So we had our first IUI and it was only 400.00 which was the IUI, u/s and sperm wash which as I have read online not so bad. Now then Im wondering if an IUI doesn't work and we get IVF its nearly 9600 which again I read online isn't way to much but it is for me to just come up with right now. So I was just curious does your insurance cover it, are there special loans for it or whats the deal? I really worry about the costs and its pretty scary.

vegasbound0606 · February 2013

I'm OOP. They run a few things thru BCBS for me just to see if they'll pay and sometimes they do. This was a huge source of stress for me!

jschwind22 · February 2013

We were extremely fortunate enough to have insurance coverage until 1/1 and this covered our first IVF. Now we are completely OOP and paying for a FET. My RE has a finance person who goes through all the costs. They have packages that make things a little more affordable rather than paying for each thing separately (ultrasound, blood draw, etc.). I met with her today and she gave several suggestions for financing options. There are loans out there that can pay your RE directly, or she mentioned a special medical credit card that their office accepts. If your RE has a finance person (which they should), I would start there. Like you said, the prices you mentioned seem pretty reasonable. Hopefully your IUI's work and you won't have to worry about it. Good luck!

Julie21613 · February 2013

Luckily our health insurance covers up to 6 IVF's. Only co-pay we have is for our meds. Which ran about $180. So, i'm not complaining. Although... I'm on my 5th IVF as we speak.....

Roeni · February 2013

My insurance covered everything but the meds. I went to an RE out of network so it was covered 60% instead if 80%. My meds were not covered at all and we spent about $5k on those.

ball.and.chain · February 2013

I also have BCBS, but my plan covers everything.

JewelsW1980 · February 2013

My insurance covers NOTHING. We saved for a long time and took a personal loan through the Na vy Fed eral Cre dit Uni on for the rest. Warning thoughpaying on our lost pregnancy every month BLOWS!

We received donated meds from my SIL so we didn't have that cost. My IVF with ICSI cost 12,500 without meds.

dede0726 · February 2013

We are completely OOP. Thankfully because of everything I had to go through last year I met my OOP max for the year so I got my meds all filled before the end of the year and a lot of them were covered. We are in a shared risk program and took out a loan for 2/3 of it and a loan from my in-laws for the other 1/3.

NYCGal276 · February 2013

I'm OOP. Fortunately the costs have been manageable, but I know my clinic boasts having payment plans. If your clinic doesn't, you may want to look into a 0APR credit card and make your own payment plan. GOOD LUCK! :-)

starspangledgirl1 · February 2013

Im from Mass which is a mandated state, I paid $180 for all my drugs this cycle and the ins co paid everything else. I get 6 IVF attempts. I so admire the couples who pay OOP and all the sacrifices you all make to conquer IF. Its inspiring. GL to everyone!

RosyGlow · February 2013

starspangledgirl1:
Im from Mass which is a mandated state, I paid 180 for all my drugs this cycle and the ins co paid everything else. I get 6 IVF attempts. I so admire the couples who pay OOP and all the sacrifices you all make to conquer IF. Its inspiring. GL to everyone!

I'm so interested in this! What's the copay for this? What's a mandated state? We are OOP right now but maybe will get insurance coverage coming up on March 1st once I am on hubby's plan Aetna. Anyone else have Aetna?

ball.and.chain · February 2013

RosyGlow:
starspangledgirl1:
Im from Mass which is a mandated state, I paid 180 for all my drugs this cycle and the ins co paid everything else. I get 6 IVF attempts. I so admire the couples who pay OOP and all the sacrifices you all make to conquer IF. Its inspiring. GL to everyone!

I'm so interested in this! What's the copay for this? What's a mandated state? We are OOP right now but maybe will get insurance coverage coming up on March 1st once I am on hubby's plan Aetna. Anyone else have Aetna?

Several states have passed laws mandating that insurance offer some kind of coverage for IF treatment.

https://www.ncsl.org/issues-research/health/insurance-coverage-for-infertility-laws.aspx

starspangledgirl1 · February 2013

ball.and.chain:
yes, exactly this.....a handful of states have to offer IF coverage. Mass is one of the best. I think I have a $20 copay every time i go in to the Dr. I used to have ins through a company based in CA, but I worked in Mass, and they only covered one IVF. Then my hubby got a job actually based in Mass and thats when we got the 6 IVFs covered, we just finished #1. Were very lucky. We had to wait 3 LONG years to get it though, as before there were always "loopholes" w/ other companies we worked for. In those 3 years I went from age 37 to 40, and now its gonna be harder to get preg. GL!!
https://www.ncsl.org/issues-research/health/insurance-coverage-for-infertility-laws.aspx
RosyGlow:
starspangledgirl1:
Im from Mass which is a mandated state, I paid 180 for all my drugs this cycle and the ins co paid everything else. I get 6 IVF attempts. I so admire the couples who pay OOP and all the sacrifices you all make to conquer IF. Its inspiring. GL to everyone!

I'm so interested in this! What's the copay for this? What's a mandated state? We are OOP right now but maybe will get insurance coverage coming up on March 1st once I am on hubby's plan Aetna. Anyone else have Aetna?
Several states have passed laws mandating that insurance offer some kind of coverage for IF treatment.

vpine · February 2013

There's grants you can apply for if needed, you can find them online. My clinic lists several on their website..

I have United insurance, it covered Ovidrel but not all of Bravelle injections. I paid $35 copay each ultrasound/bloodwork, had 4 of those total and then I triggered, I didn't have to pay for IUI, my insurance covered it. I saw statement and Dr charged them $525 for each IUI procedure (I had previously met my $500 deductible for, car accident medical bills a few months prior). Insurance covers $10K for IVF coverage if I get to that point.

I'm in TX, mandated state too.

Lacyj67 · February 2013

We are completely OOP. It sucks but thankfully my dad came through with a nice gift towards the amount and I did some meds on a new 18 month no interest Bank of America credit card. So far we are almost 20,000 deep but only owe about 4,000 on cards. For our next upcoming cycle in April I have been saving like crazy and have almost all of what we need.
It's stressful but you will learn to just let it be what it's gonna be. I have the type of personality that goes for it and makes things happen so its a lot of penny pinching but worth it if all this works in the end! Good luck!

RosyGlow · February 2013

Thanks, Ball.and.Chain and StarSpangled for explaining the mandated state situation to me. That's wonderful - I wonder if more states are working toward coverage for this? IF is such crap - and it's so unfair that people have to deal with the financial burden on top of every other terrible pain of IF to begin with. I hope that this becomes the norm someday.

jakraft837 · February 2013

I too have BCBS (of IL) ins.

$9600 is inexpensive for IVF, IMO. I got the breakdown for our current IVF cycle (basic) and it was just shy of $16,000. This did not include freezing or any other specialized embryo testing.

The one suggestion I would make is to call your ins about your scripts. My ins covered them, so i was just getting them thru walgreens. Paid $10 for Clomid, but $77 for HCG shot and $20 for progesterone suppliments (=$107/month). When i switched to Follistim for injectables cycle, my RN wanted me to get scripts thru pharmacy at hospital. Luckily, I called ins to ask them how much it was goign to cost me so i was prepared when i went to pick them up and they told me instead to get them direct thru "their" pharmacy, Triessant. The total cost for all three scripts was $40. I looked online and walgreens is a Triessant pharmacy, but it is still cheaper to get it directly thru them.

Triessant just got bought out and is now called Prime Theraputics.

Hope this helps!

Williamandshawnna · February 2013

RosyGlow:
starspangledgirl1:
Im from Mass which is a mandated state, I paid 180 for all my drugs this cycle and the ins co paid everything else. I get 6 IVF attempts. I so admire the couples who pay OOP and all the sacrifices you all make to conquer IF. Its inspiring. GL to everyone!
I'm so interested in this! What's the copay for this? What's a mandated state? We are OOP right now but maybe will get insurance coverage coming up on March 1st once I am on hubby's plan Aetna. Anyone else have Aetna?

We have Aetna, but through Bank of America, which has a great IVF plan, it's own IVF nurse staff etc. Not too sure about other Aetna plans.

Firefly062 · February 2013

- TICKER WARNING -

I'm in MA too and if your company is based somewhere else that doesn't require IF coverage OR if your company's is a self-funded policy, they don't have to cover it. My company is based elsewhere and self-funded so they didn't cover it.

Luckily, my husband's company has amazing insurance (Cigna) and is covering everything. We pay a small co-pay on visits and on medication but everything else is taken care of and it's unlimited lifetime IVF/IUIs. We've had no trouble at all with them and honestly we are so thankful every single day. I agree with the PP and admire everyone who has to do this OOP. It's really unfair that it's like this.

Enchanted616 · February 2013

We are 100% OOP. There are loan you can take out, many medical ones with great interest rates (CareCredit had 0% for the first year). We talked about taking out loans, but decided against it for our situation.

frenchy6 · February 2013

Wow didn't realize how many of us are paying OOP! I'm in NJ which is also a mandated state but I guess my employer found that loop hole! It won't be easy but we have money saved and in order to not wipe out our entire savings we chose to put half of the cost on Care Credit. Just praying this will be our first and ONLY try!

Good luck!!!

frenchy6 · February 2013

frenchy6:
Wow didn't realize how many of us are paying OOP! I'm in NJ which is also a mandated state but I guess my employer found that loop hole! It won't be easy but we have money saved and in order to not wipe out our entire savings we chose to put half of the cost on Care Credit. Just praying this will be our first and ONLY try!
Good luck!!!

Oh and here is a link to a financing company that is on my doctors website. https://www.arcfertility.com/refund-guarantee.html

not sure of the costs but you may want to look into it. I'm going to give them a call.

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