[amyccb]

So I just got new insurance and really did not think they would cover any infertility treatment but I was reading the explanation of benefits and it says this in one part under covered medical treatments,
Artificial Insemination including sperm washing, hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy, sono-hysterogram (hysterosonography), post coital tests, testis biopsy, semen analysis, blood tests, and ultrasound.
but under exclusions it says this
Infertility treatment other than artificial insemination services specifically mentioned in the Covered Medical Expenses section.

So my question is ivf artificial insemination or does that just mean something like iui???

[Aimers1]

Artificial insemination is usually IUI...it doesn't sound like IVF is covered

[gingerj]

Who is your insurance through?? Mine covered everything, including IVF, except for sperm analysis. My insurance covered 90% of all of it.

[Mom2MandyandTristan]

From working at a Fertility Clinic and dealing with Insurance (Plus HR) your coverage does NOT cover IVF but would IUI (AI) and most testing needed to dx IF. It even covers SA which is rare (at least the ins coverage I've seen).

[amyccb]

It is BCBS of Western New York, I am suprised that they cover even IUI, and it totally does not make since to me that they would cover that without IVF cause if we had to try that more than once don't u think it would just be more cost effective for them to do IVF. I don't know but maybe we will utilize this even though IuI didn't work for us, but we never tried it with the injectables because if it didn't work that would be less money we had left towards IVF.

[gingerj]

Originally Posted by amyccb

It is BCBS of Western New York, I am suprised that they cover even IUI, and it totally does not make since to me that they would cover that without IVF cause if we had to try that more than once don't u think it would just be more cost effective for them to do IVF. I don't know but maybe we will utilize this even though IuI didn't work for us, but we never tried it with the injectables because if it didn't work that would be less money we had left towards IVF.

I would call & clarify what it covers, I had to. My insurance is BCBS of Ky.

[Aimers1]

What is covered is determined by the state that you live in (in some states coverage is mandated to different extents), the company that is providing the insurance and the amount of coverage that you have. For example, I live in Illinois which is a mandated state. My BCBS HMO covers everything up to four egg retrievals and IVF. As for your coverage including IUI, the IUI and meds can be as low as $400 - $600 per cycle depending on the drugs that you take. IVF is at the cheapest (that I've seen someone mention) $4000 up to $16000 per cycle, again depending on the emds and your situation. So, for the cost of one low end IVF, you could do 10 low end IUI's! You should call and get a clear answer, because everyone's insurance coverage will be different. I am happy for you that you do have some coverage!

[momtocats4now]

From what I've been told, it not only depends on what state you live in, but what state your insurance is based out of.

For example, if you live in a mandated state (MA, IL, etc) and your insurance is in a mandated state, you are likely to get some sort of coverage. If you live in a mandated state and your insurance is based out of a non-mandated state, they are NOT required to cover anything. If you live in a non-mandated state and your insurance is held in a mandated state, they will probably cover something, but I assume that they may try to wiggle out of paying if they can.

Also, HMO's and PPO's (at least in MA) differ in what they consider "mandated". BCBS HMO of MA covers just about everything, there is no limit or monetary cap (of course, this depends on your plan, our plan covers everything but the copay) BUT the PPO has a monetary cap and whatever goes over, the patient is responsible for. So, while the state requires some form of infertility coverage, it's up to the insurance company to work within those laws.

[Tia1971]

hi Momtocats4now, I was wondering what plan you had w/ BCBS. I'm looking for the best plan out there. We live in MA but my company is self ins and only pays 10K lifetime. That's been eaten up so I'm looking to purchase an individual plan. My problem is that the sales reps won't provide specifics re: Infertility. I've called several companies and I'm told that after I've joined, they will work directly w/ my RE on coverage. (worried that might be too late!). I'm new here - any advice at all would be great!

[momtocats4now]

Sorry! I've been focusing on homework and have neglected the forums I have the Blue Cross Blue Shield HMO and it's freakin' amazing. I LOVE this insurance. We pay a $20 copay, no deductable, no cap, nothing. EVERYTHING was covered. All I had to do was get my PCP to call in a referral. One phone call for me, my doctor's office is on the ball with these things. I honestly can't tell you what we pay in terms of how much vs how much my husband's company pays since it's automatically deducted, but I think it's worth it. I mentioned on another thread to ask not what the insurance company will PAY for, but to ask what plan they recommend for someone dealing with infertility...You should be able to review what your plan coverage is prior to applying for coverage. If they're not willing to let you see that, I wouldn't go with them. Try visiting the website TITLE PAGE and see if the general plan information lists infertility. I got my information from the billing lady at Boston IVF in Waltham (I'm so sorry, I can't remember her name, but we went through everything at our initial visit) about the differences in MA PPO and HMO plans.

**OOOOH SOMETHING I DIDN'T THINK TO MENTION: An idea would be to call up your RE office and ask THEM who the best company to work with is. They'll have had pleanty of experience with dealing with the insurance companies!!

Originally Posted by Tia1971

hi Momtocats4now, I was wondering what plan you had w/ BCBS. I'm looking for the best plan out there. We live in MA but my company is self ins and only pays 10K lifetime. That's been eaten up so I'm looking to purchase an individual plan. My problem is that the sales reps won't provide specifics re: Infertility. I've called several companies and I'm told that after I've joined, they will work directly w/ my RE on coverage. (worried that might be too late!). I'm new here - any advice at all would be great!