[mmikowski]

my dh wears a size 13....

anyway Jen, we had to pay a 700.00 admin fee for our IVF which we were told comes off the bill and was not billable to insurance. We tried to check with the insurance but they said if the procedure had not been done yet than they would not pay. As it turns out it comes off the total bill but only because it was added to the bill. Then when DH talked to the billing lady she said oh well that is a fee we charge because a lot of people do not have insurance but it is only a one time fee if you do IVF again you will not have to pay it again. Well guess what the 700.00 is a fee for each time you do IVF. I am wonder what they did extra for me that they did not do for my IUIs because I paid for all the ultrasounds/bw/doctor visits each time and all they had to do was send the bill to insurance. Boy was DH fuming.

[hopeful2bmom]

Jen- First of all you should not have to pay for the IVF consult! Second- Are you sure you don't have 80% on IVF? 'Cause that sounds like the same amount as my 20% co-insurance. What I had to do was call my insurance company myself and have them fax me all of my coverage info. I did not trust the office people to do it and then leave me stuck with a $20,000 bill!
I had to pay on baseline u/s day for my ivf cycle. $2000.


Shawna- I may be up for a chat later

[ara79]

we had to pay $300 for our consultation for ivf. and we have to pay EVERYTHING (the total $14,000, including meds) all on the day of my baseline u/s...which is on the 18th. that is so much money, it gets overwhelming to me.

i'm feeling kind of blah today...

[jencat215]

My insurance covers it all, except copays:, as long as it is in network, which this place is:


Benefit: Infertility Services In-NetworkOut-of-NetworkBenefit LimitMember CostBenefit LimitMember CostInfertility Services Inpatient services None $250 copayment per admission Not covered; member pays all charges Outpatient lab tests and x-rays None No cost Not covered; member pays all charges Outpatient medical care services and office or health center surgery None $15 copayment per admission Not covered; member pays all charges Outpatient day surgical facility services None $150 copayment per admission Not covered; member pays all charges Service ProviderIn-NetworkOut-of-NetworkPPO provider networkNot covered
This health plan covers services to diagnose and treat infertility for a healthy member who is unable to conceive or produce conception during a period of one year. These covered services include:

• Artificial insemination.
• Sperm, egg and/or inseminated egg procurement and processing.
• Banking of sperm or inseminated eggs (provided these charges are not covered by the donor's health plan).
• Infertility technologies (such as in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, natural oocyte retrieval intravaginal fertilization and intracytoplasmic sperm injection).

All services must be furnished in accordance with Blue Cross Blue Shield medical policy and medical technology assessment guidelines. And they must be medically necessary and furnished by an infertility provider approved by Blue Cross Blue Shield.

Service Limitations and Exclusions
No benefits are provided for:

• Long term sperm or egg preservation or long term cryopreservation not associated with active infertility treatment.
• Costs that are associated with achieving pregnancy through surrogacy (gestational carrier).
• Infertility services that are needed as a result of a prior sterilization or unsuccessful sterilization reversal procedure. (However, benefits are provided for medically necessary infertility treatment that is needed after a sterilization reversal procedure that is successful as determined by appropriate diagnostic tests.)
• Services that are furnished to all patients due to a facility's routine admission requirements.
• Any charges for a private room that are more than the semiprivate room rate.
• Services or supplies furnished before the member's effective date. This means that if the member is already an inpatient in a facility on the effective date, inpatient benefits are provided starting on the member's effective date.
• Expenses that the member receives when he or she chooses to stay in a facility beyond the

THis came out kinda funky. The top should read that I am covered in network, not covered out of network

[sunny72]

My throat feels glandy. Kind of hard to swallow. I'm terrified more so that DH is going to get sick and have a fever and have no sperm for the ER. That happened for our second IUI after he had a fever for a week. No sperm. Nada.

[ara79]

heidi, my re requested that dh come in some time before our ER to drop off a sample that they will freeze in case something like that happens. do you think your dh can do that before he gets sick?

[jencat215]

oh, and there is no benefit limit on my plan either...

[sunny72]

Originally Posted by ara79

heidi, my re requested that dh come in some time before our ER to drop off a sample that they will freeze in case something like that happens. do you think your dh can do that before he gets sick?

Maybe I could call and ask, but they're so strict with the trial studies. I'm guessing they want fresh eggs and fresh sperm in case it changes any of the results.

[jencat215]

Originally Posted by sunny72

Maybe I could call and ask, but they're so strict with the trial studies. I'm guessing they want fresh eggs and fresh sperm in case it changes any of the results.

Hate to say it but you are probably right about this. I would be nervous calling them telling them you don't feel well-could they pull you from the study for having a cold or flu or fever or something?

[ara79]

jen, i am so jealous of your insurance...but happy for you.

heidi, i fogot about that aspect of it. jen may be right. sorry hun.

[hopeful2bmom]

Jen- My insurance covered it all except for co-payments too. That $2000 was my co-payment. Copayments are usually 20% of the billable amount. The non- billable amounts are amounts that the office/RE charges and does not have a contract with the insurnace provider on. The doctor can charge whatever amount they want, but the insurance companies will only allow a certain amount and the doctors know in advance what that amount is. SO, what they are charging you for those" non billable fees" is the difference. WHEW. Does that make sense?

Also, i would check with the company to see what your copays are (what percentage) for the drugs. Mine were also $1500 on top of the $2000 for the RE.

Originally Posted by jencat215

My insurance covers it all, except copays:, as long as it is in network, which this place is:


Benefit: Infertility Services In-NetworkOut-of-NetworkBenefit LimitMember CostBenefit LimitMember CostInfertility Services Inpatient services None $250 copayment per admission Not covered; member pays all charges Outpatient lab tests and x-rays None No cost Not covered; member pays all charges Outpatient medical care services and office or health center surgery None $15 copayment per admission Not covered; member pays all charges Outpatient day surgical facility services None $150 copayment per admission Not covered; member pays all charges Service ProviderIn-NetworkOut-of-NetworkPPO provider networkNot covered
This health plan covers services to diagnose and treat infertility for a healthy member who is unable to conceive or produce conception during a period of one year. These covered services include:

• Artificial insemination.
• Sperm, egg and/or inseminated egg procurement and processing.
• Banking of sperm or inseminated eggs (provided these charges are not covered by the donor's health plan).
• Infertility technologies (such as in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, natural oocyte retrieval intravaginal fertilization and intracytoplasmic sperm injection).

All services must be furnished in accordance with Blue Cross Blue Shield medical policy and medical technology assessment guidelines. And they must be medically necessary and furnished by an infertility provider approved by Blue Cross Blue Shield.

Service Limitations and Exclusions
No benefits are provided for:

• Long term sperm or egg preservation or long term cryopreservation not associated with active infertility treatment.
• Costs that are associated with achieving pregnancy through surrogacy (gestational carrier).
• Infertility services that are needed as a result of a prior sterilization or unsuccessful sterilization reversal procedure. (However, benefits are provided for medically necessary infertility treatment that is needed after a sterilization reversal procedure that is successful as determined by appropriate diagnostic tests.)
• Services that are furnished to all patients due to a facility's routine admission requirements.
• Any charges for a private room that are more than the semiprivate room rate.
• Services or supplies furnished before the member's effective date. This means that if the member is already an inpatient in a facility on the effective date, inpatient benefits are provided starting on the member's effective date.
• Expenses that the member receives when he or she chooses to stay in a facility beyond the

THis came out kinda funky. The top should read that I am covered in network, not covered out of network

[jencat215]

so amy, are you on one of those shared risk plans? not that you will need it cause you are getting preggers on the first shot!

[AviatrixRN]

Originally Posted by jencat215

April-tell me what you know about guys with big feet?!?!

Hey, I do have some experience in that arena! I call those my "formative years".

It sounds like most of you married into some big feet! No wonder you are all smiling in your pictures!

Jen..You have some great insurance..now you just have to get the clinic to get their act together. I hate all the strings you have to pull with the insurance companies. We just got our statement from Cigna..they pay 50% up to $11,000. As of now, they are not paying for our last cycle because they are showing it billed as "surgery" and we were not pre authorized. But we do not preauthorization for ivf..it was just billed wrong I guess..so now we have to have it resubmitted and all that stuff. What a PIA.

[sunny72]

Guess I won't risk calling. I'm hoping this won't turn into a bad sickness thing although DD had what seems like a poopy/stomach ailment today so maybe we caught something.

[hopeful2bmom]

Mine says it has no benifit limit but we just found out that in RI they cap it at $100,000 lifetime for IF.