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Ladies w/ IF insurance coverage, ??'s(SAIFW)

LuckynTiggerLuckynTigger
in Infertility

Okay, my sis emailed me a copy of their medical coverage and here is what it says about IF coverage....I am trying to understand it.  Please Help

Infertility services. Services for the dianosis & treatment of infertility when provide by or under the direction of a Physician, which include artificial insemiantion and intrauterine procedures.

Limit: Network & Non-Network benefits combined are limited to $2,000 per person per calendar year.

Network benefits: You pay the deductible then the plan pays 85% of the scheduled fee.

Non-Netwark benefits: You pay the deductible then the plan pays 55% of NEE

image TTC with PCOS since Feb. 07. Currently on a break to save $$ for IUI. Searching for My Mini M&M
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Re: Ladies w/ IF insurance coverage, ??'s(SAIFW)

  • LuckynTiggerLuckynTigger

    I forgot to add.....Insurance starts the beginning of the month after you were employed.  Example: she started at the end of oct and insurance started nov 1

    image TTC with PCOS since Feb. 07. Currently on a break to save $$ for IUI. Searching for My Mini M&M
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  • oct11bride03oct11bride03

    It sounds like they cover diagnosis and IUI...the language is a little fuzzy to me about IVF, but since they don't mention fertilization or anything like that it doesn't sound like IVF is covered.

    It also sounds like you have a pretty low limit with $2k, although every bit helps. Looks like the $2k kicks in after the deductible and you are responsible for 15% of the cost of each procedure. The 85% the plan pays goes toward meeting that $2k.

    If your husband is covered under the plan you get $2k/pp, which is good.

    I'd find out the plan deductible. Also see if prescriptions are separate (they are at most places). That alone would eat up a lot of the $2k.

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  • EastCoastGirl*EastCoastGirl* member
    I would read this that the policy covers both diagnosis and treatment of infertility; you meet your deductible and then you pay 15% of the usual and customary amount (which is usually slightly different from the billed amount) and then your insurance will pick up the remaining 85%.  They will pay 85% on your claims after your deductible has been met until you reach your $2000 per year limit. 
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  • pinkcallalilypinkcallalily member

    I think insurance companies tend to be very unclear on their IF coverage.  I've found the best thing to do is to call the insurance company and ask them to explain it.  It sounds like it only covers $2000 per year, which would basically be one IUI cycle.  I'm not sure if it would also cover an additional $2000 for your husband or if it will only cover women (my old insurance was like this).

    It took 3 1/2 long years, but we finally got our little miracle!
    IVF #1 - BFP (6dt)
    Unassisted Pregnancy #2 - lost at 15w6d due to T21, severe heart defects, and fetal hydrops

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  • kimarino13kimarino13 member

    imageEastCoastGirl*:
    I would read this that the policy covers both diagnosis and treatment of infertility; you meet your deductible and then you pay 15% of the usual and customary amount (which is usually slightly different from the billed amount) and then your insurance will pick up the remaining 85%.  They will pay 85% on your claims after your deductible has been met until you reach your $2000 per year limit. 

    This.


    After 2 rounds of IVF & 2 rounds of FET, we were blessed with identical twin girls!
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  • MBandBudMBandBud member
    imagekimarino13:

    imageEastCoastGirl*:
    I would read this that the policy covers both diagnosis and treatment of infertility; you meet your deductible and then you pay 15% of the usual and customary amount (which is usually slightly different from the billed amount) and then your insurance will pick up the remaining 85%.  They will pay 85% on your claims after your deductible has been met until you reach your $2000 per year limit. 

    This.

    I agree, but really agree with the statement to call the insurance company.  Not sure how much info they will give you if you are not on the plan currently, but they may.  However, could SIL find out for you?  GL to you!!

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  • LuckynTiggerLuckynTigger
    It is only $2,000 per year.  Which of course is more than what I have now and the pay increase would of course help to pay for treatments.  I guess I am going to have a looooooong talk with DH tonight and Pro & Con it to death.
    image TTC with PCOS since Feb. 07. Currently on a break to save $$ for IUI. Searching for My Mini M&M
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  • Danielle and EircDanielle and Eirc

    You should talk to the insurance company. I had an issue with my insurance - I was told I was covered 90% for in network with a lifetime max and nothing about a limited number of u/s's however after being closely monitored a few cycles they stopped paying for all of the u/s and they told me I have a limited amount in a 60 day time frame. 

    I haven't run into any other limits but I am only doing Clomid and TI right now...so I will be checking before I move to anything else. The insurance company advised me to have my Dr. send over a form that lists out all the procedures that they offer to see what my coverage and limitations are.

     Good Luck!

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