NYS Insurance/IVF Q?

eponine7682 · November 2011

Good morning all. Hope your week is going better then mine. DH's back has started to really hurt him once again. While his doctor isn't going to do additional surgery, he will need to get shots tomorrow morning in his spine to relieve some pain. He, understandably, has been miserable. I have a minor anxiety disorder where I get chest pain and between DH, my awful job, and a death in the family it's been terrible lately. No wonder why AF was late!

However, I have some good news. I have been worrying about my insurance coverage for IVF. We had an opportunity to switch, if not we would have been 100% OOP, but I am so very thankful that even if my job sucks major *ss, it has excellent NYS insurance that covers a lot of IVF treatments. We would never be able to afford it otherwise, at least not for another 5-10 years.

I have been worrying though because in order for me to switch I need to wait for NYS to come out with the rates for next year. Usually it's out by now, but I am still waiting. They say even if it comes out later I will have insurance by my 1st pay period in January - which is 1/3/12, but I am doubtful. Anyone else trying to switch in NYS right now?

Also, my AF is scheduled to come between the 28th - 30th. I will have to start meds cd1, right? For those who are lucky enough to have coverage, have you ever started a cycle on one insurance that doesn't cover IVF, but covers monitering and meds but then ended on one that does cover it? I am wondering how that will work/if it will work. I was thinking of asking my RE to code it as IUI in the beginning because my current ins. covers monitering/meds for that but then we switch it to IVF when I get into my new one. Is that too shady? I probably sounds inpatient and should just be thankful that I can finally do IVF, but DH is job hunting down south and I am afriad we will need to move before I am able to get KU, and I just know we will never have better insurance then this. Any advice?

theworms · November 2011

if you switched during open enrollment you should have coverage with new insurance at start of new year.

i don't work for NYS but NYC and think it should be the same.

my only concern is with some insurances you need to get pre-approval for IVF and have certain tests done. i would talk to your clinic's insurance coordinator about your switch and what tests, b/w, etc you need to fulfill for new insurance. your RE can also ask your insurance to waive certain things if you have had them done.

for ex. my insurance required, cd3, infectious disease, HSG and 3 IUI's before covering IVF. it also required pre-approval for IVF and FET. before we moved onto DS, my RE appealed to insurance and i didn't get the HSG or do IUI's because we needed IVF based on DH's NOA d/x. instead i just did cd3 b/w, infectious disease b/w and SHG.

and i don't know what protocol you are doing but stims typically start on cd3 or day off your baseline appt.

GL cutie and I hope it all works out.

eponine7682 · November 2011

theworms:

if you switched during open enrollment you should have coverage with new insurance at start of new year.

i don't work for NYS but NYC and think it should be the same.

my only concern is with some insurances you need to get pre-approval for IVF and have certain tests done. i would talk to your clinic's insurance coordinator about your switch and what tests, b/w, etc you need to fulfill for new insurance. your RE can also ask your insurance to waive certain things if you have had them done.

for ex. my insurance required, cd3, infectious disease, HSG and 3 IUI's before covering IVF. it also required pre-approval for IVF and FET. before we moved onto DS, my RE appealed to insurance and i didn't get the HSG or do IUI's because we needed IVF based on DH's NOA d/x. instead i just did cd3 b/w, infectious disease b/w and SHG.

and i don't know what protocol you are doing but stims typically start on cd3 or day off your baseline appt.

GL cutie and I hope it all works out.

Thanks so much Worms! I will talk to the coordinator when I go in for my SHG in a few days. That is a really good point about the IUIs. We have only done two, but that is because our RE said he wouldn't do a 3rd with DH's count. I will have to see what the requirements are. Thanks again!

hootie123 · November 2011

I don't know specifics - but if you are getting the empire plan - I know girls at my clinic that have it. It is amazing coverage!!! I also don't think you could start on one plan and then just switch to another plan once you've already started (exception would be if you were just on bcps). I would imagine even with the empire plan - they would want pre-approval before paying for IVF.

eponine7682 · November 2011

hootie123:
I don't know specifics - but if you are getting the empire plan - I know girls at my clinic that have it. It is amazing coverage!!! I also don't think you could start on one plan and then just switch to another plan once you've already started (exception would be if you were just on bcps). I would imagine even with the empire plan - they would want pre-approval before paying for IVF.

That's what I am getting Hootie!! I am so thankful, but kicking myself for not knowing about it a year ago! I see what you mean with the timing. I will have to ask. Something tells me I may have to wait till February, which sucks. But if I just tell myself that and get used to the idea, it might save me stress in the long run. Thanks for the advice!

Edwina.McDunnough · November 2011

I had to switch mid cycle and if you have all your approvals etc. it's seamless.

eponine7682 · November 2011

Edwina.McDunnough:

I had to switch mid cycle and if you have all your approvals etc. it's seamless.

Thank you. This gives me some hope. I can't imagine waiting yet another month, but of course if it needs to be done, it needs to be done. Thanks!

NYS Insurance/IVF Q?

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