If you have IVF and IUI coverage, please come in

KMLP · November 2010

My RE just called and explained my benefits to me. She said that through my insurance I have $20,000 lifetime IF benefits that covers diagnostics, IVF, and IUI. I'm going to call her back on my lunch and see if she can put this in terms that I can understand because I'm kind of slow when it comes to insurance talk. So, if you have these benefits, about how much did you pay OOP for your IUI or IVF? Diagnostics means that ultrasounds are covered, right?

DeputiesWife · November 2010

My insurance is a bit different but I do believe that means your BW and U/S are covered.

JKGymnast · November 2010

I do have IF insurance benefits but everything is covered in full. The only costs to me are the $20 co-pays at my IUI appointments (not u/s or b/w appts), and the meds through Village Pharmacy (which cost about $45 total, each cycle - includes Gonal F and trigger.)

That reminds me - I have a TON of extra Gonal-F that I need to donate to you girls w/o coverage... Just waiting to see if this cycle worked or not (poas tomorrow!)

Mrs. Mo · November 2010

Yes, diagnostics = bloodwork & ultrasounds. You may also want to find out if they cover each item 100% or if you are responsible for a certain % of charges.

Example: My insurance covers $25K lifetime max BUT each visit/item they only cover 80%, so, only 80% goes towards that lifetime max & I pay OOP the remaining 20%. Also, this is all after the $400 deductible I have each year.

You also may want to find out if your meds. will go towards that amount or if those are seperate.

KMLP · November 2010

Mrs. Mo:
Yes, diagnostics = bloodwork & ultrasounds. You may also want to find out if they cover each item 100% or if you are responsible for a certain % of charges.
Example: My insurance covers $25K lifetime max BUT each visit/item they only cover 80%, so, only 80% goes towards that lifetime max & I pay OOP the remaining 20%. Also, this is all after the $400 deductible I have each year.
You also may want to find out if your meds. will go towards that amount or if those are seperate.

I will ask about the % I will owe. I'm pretty sure that's how my insurance works.

rebelina1 · November 2010

My insurance is very similar to yours. I just have to pay my $25 specialist copay for any ultrasounds and treatments (IUI, IVF). Bloodwork does not require the copay. I have great insurance but the u/s copays did start adding up when I was doing IVF. I think I went in for 10 days straight for an u/s so that added up to $250. I'm not complaining since that is just a drop in the bucket compared to what other ladies pay but it was something I never really thought about.

For a typical IUI cycle I have one monitoring appt ($25) and then IUI ($25). so, the cycle ends ups costing $50 for treatment. My meds are separate and I have crappy med insurance so all meds are OOP.

September2007 · November 2010

We have the same coverage (or will through December). The $20k is for anything that is coded as IF-related. So, if we use my treatments as a basis -- we had all the testing done (HSG, Hysteroscopy, b/w, and u/s, etc.), and we had 2 unmedicated IUIs. Total: $541.00

For my one IVF round, so far (not including b/w, u/s, ER, and ET), we've spent $4600 on just the medications. After we get through the entire round, the insurance company said it would be around $9k-$10k, just for the basis. Since they did ICSI for our cycle, I'm guessing it will be higher.

It's interesting, because for an OOP IVF cycle it is around $10k-$12k, but for insurance purposes, they only calculate what they actually paid out to the doctors, not that actual billed amount. In-network doctors have lower rates.

In all reality, IUIs are much cheaper $500 - $1200, but IVFS are much higher. From what I've been told, the $20k limit was to allow for someone to do 2 IVF treatments.

OOP: we pay all copays and 10% coinsurance. (On average $10 - $240) Hope this helps!!

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If you have IVF and IUI coverage, please come in

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