FYI-Insurance

Wanted to do a quick run down on insurance.

I worked for BCBS for many yrs and hope this all helps.

Your insurance coverage is offered by your employer. They determine what coverage they buy and in turn offer to you. Any level of infertility coverage is determined by them.


Two people can each have the same insurance company and same plan ( hmo, ppo , pos etc and have TOTALLY different coverage!)

NYS offers an infertility mandate...it covers unlimited IUIS, and all diagnostic IF testing.

There are exceptions to this Mandate.

Companies that have huge amounts of employess can opt out, as well as unions, states and government jobs.

You have to call and ask if your covered under the Mandate.

IVF is company based.

Its a "rider" that a company can choose to offer or not. Its very expensive and thus not offered widely. Ususally only larger employers will offer it b/c of cost.

If you ever need help with codes, finding out whats covered, how to find out etc, please FM me, I am MORE then willing to assist you!

ETA- THINGS TO ASK THE INSURANCE COMPANY

Do I have IUI coverage?

Do I have IVF coverage-If NO...Does my company offer a "rider" to provide coverage for this?

DO I have coverage for egg storage
AM I covered under the NYS mandate for infertility treatments? If no...WHY?

Why am I exempt from the mandate?

Do I need to use an In network provider ( even if I have out of network coverage?)

Do I need to use a special Lab for labwork or SA?

Do I need to see a specific Practice or plan? ( For example..North shor un. hosp Employees MUST use a North shore Dr. for any infertility treatments)

So I need to use a Center for excellance?

Do I need to get pre approval or authorization for IUI's? For IVF?

Will the IVF anesthesia be covered?

What is my drug coverage for Infertility medications? Is it the same for IUI and IVF?

If you have a seperate Drug coverage...Ask for their phone number and call them directly.

Message edited 10/17/2008 9:32:29 PM.

Re: FYI-Insurance

You've always been a great help!

Re: FYI-Insurance

Thanks Donna

Re: FYI-Insurance

Bump

Re: FYI-Insurance

This will be a huge help to people. Thanks for posting!

Re: FYI-Insurance

The only info not on here is that NYS does not mandate that the IVF Rider be offered to small business (fewer than 50 employees). So, if you own or work for small business they cannot even get the rider option, even if they want to offer it to employees.

Re: FYI-Insurance

This is a great thread! Thanks Donna!

Re: FYI-Insurance

THANK YOU! I didn't even realize this. I better call my insurance company ASAP

Re: FYI-Insurance

Donna,

This is a great post! I wish I would have seen in the beginning! Thanks!