Question about IVF coverage limits

desabean · June 2011

Background: I did 4 IUI's covered by my insurance through work (care first) My first 2 IVFs (for Garrison) were in 2008 under my insurance through DH's work (Blue Cross of Illinois). DH switched jobs while I was doing my 2nd IVF and got Aetna which has 3 "lifetime" IVFs covered.

I used one in October 2010 and one in February 2011. I started a cycle in March/April that got cancelled the day after I started my stims because supposedly Aetna wouldn't approve it since I hadn't had unmedicated bloodwork in a year and their policy was 35+ needed it every 6 months.....I was furious but got the call yesterday (after my day 3 unmedicated bloodwork this weekend) that Aetna had approved me and we were good to go-- yay!

Well, today Aetna calls me and says " you had 4 IUIs so you are entitled to 2 more but you've had 3 IVF's so you are not eligible for anymore". I freaked. I asked her if she meant I couldn't do this cycle after I had been approved just yesterday. She clarified by saying "no, the mistake was ours to approve you for your 4th IVF so we need to honor that but after this one you are oop". I was relieved but told her that, by the way, I only had 2 IVFs though Aetna so this was not my 4th IVF through them. It doesn't really matter because they are going to pay for it and I know I only get 3 but after I hung up I started worrying if there is anyway they could be counting the IVF's that I did through other insurance companies? If they are counting all of my IVFs, this is actually my 5th. (OR....do they think that the cycle that got cancelled actually went through and they are counting that as #3???)

When they say it's a lifetime limit, I assumed (and honestly think I asked a year ago and was confirmed) they meant the limit had to do with for the particular insurance company, am I wrong???

MonkeysGirl05 · June 2011

I'm pretty sure you are right. Different plans, different coverages.

charmcitygirl · June 2011

I think you're correct that they should only count the IVFs that are with them, under Aetna. I think that they're counting the canceled IVF as an IVF attempt. But you might be able to ask them about the dates of the approvals and get a sense of what IVFs they're talking about. Did you do any FETs in the time you've been with Aetna? They might count that as an IVF too.

Our coverage is a monetary limit. We have $12,000 lifetime max. And we've already plowed through half of it for Jacob. Ugh!

pamela-matt · June 2011

I was always told if you start meds then it counts. So not fair but i guess insurance is in charge. In MA, it is 5 ivf cycles and if you have a live birth the count starts over. I did have to do unmedicated b/w every year bit i am sure each insurance makes their iwn rules. I am not sure why your doc did not know that. Their office should have caught that. I think that even though we had two different insurances, each ivf was counted in the total. Good luck getting things figured out.

LuckySunshineBaby · June 2011

We have Aetna with a, QPOS policy. I was told we had to make it to ER for a cycle to count. My ER for the cycle prior to this pregnancy was canceled the night before trigger to avoid using one of my insurance tries.

browneyedgrl4282 · June 2011

I was told for IVF cycle to count it had to make it ER but I am in NJ so the mandate might be different!

naflmj · June 2011

This is slightly different but we have 6 w/BCBS MA. I used one at my previous employer and now am on a totally different plan BCBS New England (though through MA) and policy and I have 5 left on my new plan even though I technically haven't used one. I'm glad they made the mistake and approved it for you!

naflmj · June 2011

pamela-matt:
I was always told if you start meds then it counts. So not fair but i guess insurance is in charge. In MA, it is 5 ivf cycles and if you have a live birth the count starts over. I did have to do unmedicated b/w every year bit i am sure each insurance makes their iwn rules. I am not sure why your doc did not know that. Their office should have caught that. I think that even though we had two different insurances, each ivf was counted in the total. Good luck getting things figured out.

This excites me, I didn't know this! What insurance do you have?

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