Originally Posted By Cindy

Please help we are a couple who used IUI 2 years ago and got pregnant. We lost our beautiful baby boy to a heart condition 9 months later. We now are trying again and have been for 1 year of IUI, they informed us that since this approach has not worked it is time for InVitro...Does anyone know of a insurance that covers this? I know of the cost and we just don't have it...I read on this message board that somebody has insurance that covers this...I sure would like to know what insurance that is...Please if anyone could help we would be gratefull..htwl9@msn.com

yes I too would like to hear about this ins? Mine only covers meds,ultrasounds,and lab. However we need to use ICSI as well,but if the rest is covered that would help sooooo much! you can reach me at wendyhuffstutler@sbcglobal.net

Good Luck and thanks if i hear of anything will let know.

Most insurance companies do not cover this because of the costs. It could be this woman had the greatest health plan. Sorry it is just the reality. I wrote a paper on why birth control pills are not covered. I have a degree in Insurance and Financial services. Call your HR department and ask to see the master copy of your HMO or whatever it is you have. It will tell you if it is cover. Most places have a 1800 number to ask about coverage. As far if there is any sole insurance policy you can buy most likely not. The whole theory of insurance is to transfer the risk. You are paying someone to take the $ risk that you need IVF. So since you already know you wil need IVF there is not real $ gain for the insurance company to take on the risk. If by chance you find a policy be careful most likely it is a scam. I am sorry to have to tell you this but as some one who is adopting you have keep your eyes open because there is so many scams out there. I am sure you have seen a few your self.


I should tell you that we are adopting because it's in our hearts. We tried for 6 months. So I am not trying to hurt you feelings. So please to do not take personal what I have said. I wish you the best of luck and hope you get pg soon.

I have a PPO plan with CIGNA and they cover IVF for lifetime upto $25000.00.

WE HAVE A PPO WITH UNICARE AND THEY COVER THE COST OF INVITRO.

I had cigna insurance and they covered everything but then my job switched insurance carrriers.... just my luck...... but yea they cover up to $25,000.00 you may try them. good luck

i also went throught the ivf in NC with it failing. i have bcbs and i called myself to verify my benefits. they told me that they would cover the diagnosing and curing of (like there really is a cure) but i had a lifetime max of 5000. after the ivf failed, i contacted the dr and got a receipt that had the cpt codes and diagnoses. i sent the claim to the insurance company and they paid. however when i called the dr to get my refund his staff and he argued that i had no coverage. they then argued with the insurance who said they were requesting a refund.

i work with insurance all day and i am in the middle of appealing the dr and his description to the ivf. i agree and understand that the actual retreival and transfer is not covered, but as far as i am concerned all the times you have to go for ultrasounds and labs should be considered part of the diagnostic portion. the appeal is in the works and according to bcbs there is no precedent for their decision.

i also had the hospital file a claim to the insurance and they also got paid by the hospital. the big lesson learned from me was not to take the dr's word- now i am fighting to get reimbursed as he has gotten paid twice.

I had 3 ivf and 3 iui covered 100% ($50 copay) per lifetime thru united healthcare while working for citigroup I have heard this same plan is available thru discover card employees.
unfortunately, I quit before I realized how rare this was, I deeply regret not doing ivf when I had the coverage.

It depends on the state laws and your employer. In many states Companies who are self insured do not have to offer infertility coverage even though the insurance company is someone like BCBS. Here in IL if you are using an HMO then infertility coverage must be included. This was the case with my job, but they way they got around it this year is they switched over to a POS which operates like a HMO, but supposedly has more flexiblity. They were then able to get rid of the infertility coverage which then saves them money on claimes. Find out what the state laws are and that will give you some guidance.

Does anyone out here know the "global" code for billing for ivf. I am fighting the insurance company and the doctor's office. No one seems to know the answer and the only thing they can tell me is that they are not qualified to answer my questions. I already did an appeal and their reasoning makes no sense. they say that the services are not covered but in the next sentence they say some of the charges are. At this point the dr has gotten paid twice. Any suggestions?

Global, HCPS, or HCFA Billing Coding?

Please specify what you mean by Global Coding

Well I would love to be more specific but I keep getting different answers from everyone. Basically what happened was the dr stated he would charge me a global fee and provide me with the CPT and DX so that I could submit to my insurance to see if they would pay. Well they paid for the ultrasounds and estradiols and denied a few others as inclusive to the estradiols. When the ins paid the dr. I req a refund for what the insurance paid-I had no problem paying for the non0covered charges. Well long story short he and the insurance co BCBS of NC are saying this is global. When I asked if there was one particular CPT code for IVF- they could not answer my question. Bur they also said that he should not have broken the codes down..Now the dr. is telling me I am committing fraud to the insurance company.

I work in a dr. office, so I know how to look up the codes. I have already sent a letter to the department of insurance and the medical board regarding both the insurance and the dr. Especially the insurance since they paid the claim and are now trying to deny it but will not proide any answers as to how they came to their decision.

Jennifer

Some of the more progressive states (Massachusetts is one) have "mandated" that insurance companies doing business in their state cover infertility treatment including the more expensive treatments such IVF, GIFT, ZIFT, ICSI and donor egg.

Check with your state's insurance department.

One exception - Large employers that are self insured fall under federal law called ERISA. They are exempt from any state mandates pertaining to health insurance. However, that does not mean your employer may not cover it voluntarily so check with your HR dept. if your employer is self insured.

I know you wrote this a long time ago, but thought I would let you know that you may want to check your state laws. I was searching online a few nights ago and found that texas law requires insurance companies that offer maternity to also cover infertility costs. It does not require them to offer maternity, but if they do, they must legally assist with cost of infertility treatment including invitro. My problem is getting insurance with maternity. Anyway, if you hear of any other ideas, please let me know. Thanks

Here is a state by state listing of mandated IF coverage


inciid.org ...... resolve.org both sites have tons of information about costs,procedures and what is / is not covered by insurance.

HTH.......and good luck