[K&I]

I am just trying to get insurance and finding out as more as I can. And I have a question: What do insurance companies usually call "infertility treatment" (what do they cover?) If in plan description just says "infertility treatment 80% . contact your provider for preauthorization to receive benefits" - what all this means? (I do not want to call and ask before enrollment). This is the only plan (of 4 offered by my company) that covers infertility. I'll get it anyway even if it covers just some of procedures. What your insurance plans cover (if they cover inf. treatments). Lets discuss it. I think that it would be helpful for many people. Thank all of you!

[J9yinyang]

My insurance (Cigna) covers all treatments up to: hormones, medications to help ovulate or mature follicles, IVF, IUI, or any implantation treatments.

Meaning, what they cover is all of the testing and doctors' appointments leading up to the implantation, and any surgery to correct anything actually found to be functioning incorrectly, but nothing else.

[K&I]

Thank you for reply! Is IVF inf. treatment? What is says in your plan description? Unfortunally i can't just call and ask before enrollment (there is reason).

[J9yinyang]

Actually, we were never given a book or anything. I had to call customer service and ask them what was covered.

Here's the link to the part of their website that tells what they cover:

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0089_coveragepositioncriteria_infertility_diagn ostic_and_treatment_services.pdf

It's 23 pages in PDF form, so I can't just copy parts of it and past them, but the top of page two tells what IS covered, both male and female, under MY plan. You could probably find something similar on the website for your insurance carrier. They have to be up front about their services.

[K&I]

Originally Posted by J9yinyang

Actually, we were never given a book or anything. I had to call customer service and ask them what was covered.

Here's the link to the part of their website that tells what they cover:

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0089_coveragepositioncriteria_infertility_diagn ostic_and_treatment_services.pdf

It's 23 pages in PDF form, so I can't just copy parts of it and past them, but the top of page two tells what IS covered, both male and female, under MY plan. You could probably find something similar on the website for your insurance carrier. They have to be up front about their services.

Yes, I see your plan description, Jenine, thank you, but I have no idea where to find out about my insurance carrier....we have been living in the USA for couple years and all medical exams and treatments (if needed) had back home during vacations, don't know much about insurance...it says PPO in-network or out-of-network, HMO health Providers....may be this will tell you something...

[J9yinyang]

Does it show the insurance carrier on your card? I should be in the upper left hand corner.

[K&I]

Originally Posted by J9yinyang

Does it show the insurance carrier on your card? I should be in the upper left hand corner.

UnitedHealthcare, Private Healthcare System (PHCS) preffered provider networks....probably this is my provider

[J9yinyang]

Well, apparently, without signing up, you can't find out a lot of information about their health plans. You can ask the company you work for to give you a provider information book. It should cover most of what you need. You can also call the insurance company's 800 number and speak to their customer service, and ask them what the coverage is, without having an account, I believe. But I would guess that it would cover all infertility treatments, including IVF if necessary. I found on another website that they increased their lifetime benefits limit from $25,000 in 2004 to $50,000 in 2005, so that would cover about 3 rounds of IVF.

Sorry I couldn't be more help.

[K&I]

Originally Posted by J9yinyang

Well, apparently, without signing up, you can't find out a lot of information about their health plans. You can ask the company you work for to give you a provider information book. It should cover most of what you need. You can also call the insurance company's 800 number and speak to their customer service, and ask them what the coverage is, without having an account, I believe. But I would guess that it would cover all infertility treatments, including IVF if necessary. I found on another website that they increased their lifetime benefits limit from $25,000 in 2004 to $50,000 in 2005, so that would cover about 3 rounds of IVF.

Sorry I couldn't be more help.

Hi, I would like to thank you for trying to help - it is so important - to know that somebody that you don't even know wlling to help. Thank you very very much! Every day I am reading this forum and crying - I feel so bad for all of us, I understand everything what others from this forum feel and say. And there is only HOPE that someday our dreams come true!

[K&I]

Allergy tests 100% after $20 PCP / $30 Specialist copay. Allergy treatment 100% for injections and serum. Alternative medicine Not covered. Ambulance charges 80%. Birth control pills Covered like any other prescription drug. CAT scans 80%. Chiropractors 100% after $30 copay (unlimited visits). Christian Science practitioners Not covered. Cosmetic surgery Not covered. Dental treatment 100% up to age 19. Durable medical equipment 80%. No maximum.

Contact your provider for preauthorization to receive benefits. Emergency care 100% after $75 copay for in-area hospital, 80% for out-of-area hospital ($2,500 maximum).

Covers emergency care for life-threatening injury or illness in a hospital emergency room regardless of whether you have approval from your primary care physician.

Covers treatment in an urgent care center at 100% after $30 copay. Gynecology visits 100% after $20 PCP / $30 Specialist copay

Gynecological visits for treatment of a medical condition are covered like any other doctor office visit. Hearing care 100% after $20 PCP / $30 Specialist copay. Home health care 100% after $30 copay.

Contact your provider for preauthorization of benefits. Hospice care 100% for continuous and part-time care. Respite covered at 80%, limited to five days per episode. 30 day maximum for continuous and respite care combined.

Hospice stays must be pre-authorized by your PCP or referring specialist (pre-certification required). Hospital stay 100% after $250 copay per admission.

All hospital stays must be approved by your PCP or referring specialist.

Covers the cost of a semiprivate room. Private rooms are covered up to the semiprivate room rate unless:

• A private room is medically necessary.
• A semiprivate room is not available.

Doctor visits during hospitalization are covered at 100%. Immunizations 100%. Infertility treatment 80%.

Contact your provider for preauthorization to receive benefits. Laboratory charges 100%. Magnetic resonance imaging - MRI 80%. Mammograms 100% after $30 copay.

A non-routine mammogram as a follow-up to a medical diagnosis is covered as an X-ray. Mental health Inpatient hospital:
Covers expenses for treatment of mental health conditions in a hospital or mental health facility at 100% after $250 copay per admission. Limit 365 days per period of confinement.

Outpatient treatment:
Covers outpatient visits for treatment of mental health conditions at 100% after $20 copay. Unlimited visits.

Contact your PCP or referring specialist for preauthorization to receive benefits. Occupational therapy 100% after $30 copay. Unlimited visits.
Office visits 100% after $20 PCP / $30 Specialist copay. Organ transplant 100% after $250 copay per admission.

Covers hospitalization and surgery. Does not cover travel expenses.

Contact your provider for preauthorization to receive benefits. Pap smears 100% after $20 PCP / $30 Specialist copay.

A non-routine Pap smear as a follow-up to a medical diagnosis is covered as a laboratory charge. Physical exams for adults 100% after $20 copay.

Covers routine adult physicals every year. Physical exams for children 100% after $20 copay.

Covers routine check-ups for your children every year. Physical therapy 100% after $30 copay. Unlimited visits. Pregnancy / Maternity

• Doctor delivery charges covered at 100% after $250 copay per admission. Does not require preapproval.
• Maternity stay covered at 100% after $250 copay per admission. Does not require preapproval.
• Prenatal visits covered at 100% after $20 PCP / $30 Specialist copay for initial visit only. Covered at 100% after initial visit.
• Doctor's charges for the baby's first examination in the hospital covered at 100% after $20 copay.
• Newborn nursery charges covered at 100% after $250 copay per admission.

A child is covered at birth as long as the baby meets the dependent child eligibility requirements and is added to the plan within 31 days of birth.

Midwife services are not covered. Pregnancy termination 100% after $20 PCP / $30 Specialist copay. Prescription drugs You must use a pharmacy in the HealthPartners network.

PHARMACY COVERAGE:

Generic:
Up to 30 day supply after $10 copay.
Brand-name:
Up to 30 day supply after $25 formulary / $40 non-formulary copay.

A formulary is a broad list of prescription drugs your HMO has chosen to cover a wide variety of needs. Usually, your PCP or specialist will need preauthorization from the HMO to prescribe drugs outside the formulary.

If you or your physician request a brand name drug when a generic is available, you pay the difference in cost in addition to the normal brand drug cost.

MAIL ORDER COVERAGE:

Up to 90 day supply after $20 copay for generic drugs and $50 formulary / $80 non-formulary copay for brand-name drugs. Prostate specific antigen test - PSA 100% after $20 copay. Speech therapy 100% after $30 copay. Unlimited visits. Substance abuse Inpatient hospital:
Covers expenses for substance abuse treatment in a hospital or mental health facility at 100% after $250 copay per admission. Limit 365 days per period of confinement.

Outpatient treatment:
Covers outpatient visits for substance abuse treatment at 100% after $30 copay. Unlimited visits.

Contact your provider for preauthorization to receive benefits. Surgery

• Covers surgery in a hospital at 100% after $250 copay per admission.
• Covers outpatient surgery at 100% after $100 copay.
• Covers anesthesiologist services at 100%.
• Covers assistant surgeon services at 100%.

A second surgical opinion is not required, but is covered and may help determine if surgery is necessary. Tubal ligation Covers tubal ligation at 100% after $20 PCP / $30 Specialist copay.

Contact your provider for preauthorization to receive benefits. Vasectomy Covers a vasectomy at 100% after $20 PCP / $30 Specialist copay.

Contact your provider for preauthorization to receive benefits. Vision care Covers eye exam at 100% after $20 PCP / $30 Specialist copay. Does not cover eye glasses or contact lenses. X-rays 100%.

[J9yinyang]

Well, they're very general on this description of what they cover, but that could be a good thing. Even with 80% coverage, it will get expensive, but not as bad as no coverage. As an example, most initial tests that the RE (reproductive endocrinologist) will do cost about $200 each. And that would be about $1000 - $2000 right off. Of which you'd have to pay $200 to $400. Most insurance would cover this. But if you go so far as IVF, your insurance would cover all but $2000 of a $10,000 procedure, where everyone else here who isn't covered at all would have to pay the whole $10,000. I think most of us would take your insurance over ours.

I'd say you have a pretty good deal there, if the information they gave you is accurate.

I hope that helps! Good luck!!

[K&I]

Thank you!!!

[J9yinyang]

You're welcome!

[wantsbabies]

Hi! I am new to the site and wanted to know does nayone know baout BCBS of IL or UHC? THey do cover IVF but say I need an anuthorization, can anyone explain what that is and what they are aksing for on that authorization? (Accenture is the company) Thanks

[babyneed]

Originally Posted by wantsbabies

Hi! I am new to the site and wanted to know does nayone know baout BCBS of IL or UHC? THey do cover IVF but say I need an anuthorization, can anyone explain what that is and what they are aksing for on that authorization? (Accenture is the company) Thanks

Wantsbabies,

BCBS has different types of insurance--what is your PPO or HMO? I don't know about UHC.
I am having HMO BCBS IL which covered 3 ivfs with medication. But HMO are also having different type so call their customer service and ask for their benefits.

You will also call HR of your company and ask them document which listed what coverage provided by different insurance.

For preapproval, there are different clauses for all but basically you ttc more than a year and most probably you need to do some tests which are mandatory for finding good cause of infertility. Your PCP dr or WHCP (gynec) doctor can write approval for you after doing basic testing.

Hoping it will be helpful.