Insurance, Fresh vs. Frozen

chicagobride_07 · July 2014

We paid 100 percent OOP for our first DE cycle. My DH now has coverage with IVF benefits, including DE. This is under our state mandate. I've been told this is medical costs only, so if we did a fresh cycle, we'd still be responsible for the donor gift, agency fees, donor insurance, etc. This is around 9K, all else is covered, subject to our deductible which I have met. I've been told frozen cycles are cheaper. I started looking into this and am confused. I've been quoted 15-17k for a frozen cycle, they don't use insurance. So, it's actually cheaper under insurance to do a full fresh cycle? This doesn't make sense to me. I'll follow up further with my insurance but just wondering of anyone has been through this and can advise.

poohniki · July 2014

According to the state mandate, you have unlimited FETs as long as the ER was covered by insurance. This means that if you do a fresh retrieval with a donor, you have the best possibility for having future siblings because you are likely to have quite a few blasts. Of course cryopreservation is not covered.
I've studied the mandate for a few years. And I've worked with multiple clinics. If you have any questions , please pm me.

Mrs.McIrish · July 2014

A few things: my insurer still classifies frozen eggs as experimental and will not pay for them. ASRM doesn't deem it experimental anymore but it usually takes a while for insurers to catch up to "modern medicine". So, yes, it was cheaper for me to a fresh cycle than a frozen one when insurance was paying in 2012. We paid for RBA this year.

I hate to be a negative nelly but did you check on age requirements? Many insurers won't pay for DE above 40. They pay before that because the IF is not expected under 40--once you are over 40, they don't consider it IF--they consider it just natural aging. I know my current insurer would,cover DE up to 44 but only if you were DOR when you were under 40 or a poor responder thru IVF after 40 if you passed a clomid challenge. My prior insurer cut it at age 40.
FWIw, 9K sounds really low to me for agency fees/donor compensation etc. It would have been around $20K for me if I used insurance for DE. Like you, the medical part would have been covered but not the agency fees, domor comp, donor trave..

chicagobride_07 · July 2014

Thanks ladies. Poohniki, I was referring to obtaining eggs from a frozen egg bank (which has additional costs over and above an FET). I've done two FETs which were covered by insurance, but not successful unfortunately. Now we need to go back to either a new donor or a frozen egg bank. McIrish, very helpful response. I checked with insurance and there are no age restrictions unless I am under 18! Lol, who makes up these rules. The 9K is our cost assuming we choose a local donor with no travel costs. The donor gift is 5k and we are getting a break on the agency fees as a second time client. God bless them.

Mrs.McIrish · July 2014

Ok-- when you said donor gift, I thought you meant a token gift and had left out the actual compensation part!!! Awesome on the agency cutting fees. Nice to not have age restrictions!!!!

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