Has anyone else been through this with insurance? (long)

Trying not to jump the gun because it might be too good to be true....

We are "getting ready/getting ourselves together" to start IVF in October. With no insurance coverage, we applied for the grant, Integramed, and gathering our finances to figure out how to pay for this.

We are under the insurance at my place of employment.

When we were married, we decided to go under my insurance since I work for a large international company and the premiums are cheaper. DH works for a company that is very small and the premiums are much higher.

We decided, just for the heck of it, to call the insurance co that DH's place of employment uses. We obtained the group # from his HR rep. I called them today and they said they cover 10K lifetime max for infertility treatments including IVF! They also said there is no waiting period in order to have the procedures done. She said we could sign on in September, and start in October. I could have jumped through the roof with excitement but I am trying not to get ahead of myself.

I called my RE and they take that insurance.

DH is talking with his HR rep about getting us through with this insurance before the new open enrollment period begins.

Wow....now, this might not work so I am trying not to get ahead of myself. This sounds too good to be true, right? Has anyone had any experiences with this? Could we finally be actually catching some sort of a break through all of this heartache?

Re: Has anyone else been through this with insurance? (long)

It's quite possible that your DH's plan offers coverage but 10K lifetime is very little considering that IVF costs around 20K. Still, it's better than nothing. Congrats!!

Re: Has anyone else been through this with insurance? (long)

Re: Has anyone else been through this with insurance? (long)

melijane-Others know more than me but this is not exactly true-That 10K will not have to cover everything you do. BW and sonos will probably go under the regular ins. Meds will go to your prescription plan. So the only things that should come out of there are transfer, retrieval etc.---------------------------------------------------------------------------------------------i was told this from my RE office that this is what they do. only the cost of transfer and retrieval will come out of the 10k she said i would have enough to cover most likely 3 cycles but def 2 cycles and everything eles is billed through the insurance separatly.HTH i really hope this works for you

Re: Has anyone else been through this with insurance? (long)

Thanks everyone for your replies. I guess I have to ask more questions and get more information on what exactly the 10K includes. I know that at my RE's office, its $1,420 for retrieval, transfer, ICSI, bloodwork, sonos, etc. I assumed it would be $10k off of that price but I see I could be wrong. I knew I should not jump the gun....we'll see. Thanks again everyone!

Re: Has anyone else been through this with insurance? (long)

10K can go along way, because yes its only for certain things, and its only what they pay, not what the RE charges.

you will have to wiat until open enrollment though unless there is a life event (marriage, birth, or you can prove your insurance was terminated)

BUt October is right around the corner.

Re: Has anyone else been through this with insurance? (long)

Re: Has anyone else been through this with insurance? (long)

Posted by -BabyQuestions-

Posted by rose825

10K can go along way, because yes its only for certain things, and its only what they pay, not what the RE charges.

you will have to wiat until open enrollment though unless there is a life event (marriage, birth, or you can prove your insurance was terminated)

BUt October is right around the corner.

Thanks

We are thinking it might not be good to go this route since DH would also *obviously* have to pay the high insurance cost per paycheck in order to receive this benefit as well. The HR woman is going to work on the details for us this week so we'll see what happens.

Re: Has anyone else been through this with insurance? (long)

Posted by newmom

Posted by -BabyQuestions-

Posted by rose825

10K can go along way, because yes its only for certain things, and its only what they pay, not what the RE charges.

you will have to wiat until open enrollment though unless there is a life event (marriage, birth, or you can prove your insurance was terminated)

BUt October is right around the corner.

Thanks

We are thinking it might not be good to go this route since DH would also *obviously* have to pay the high insurance cost per paycheck in order to receive this benefit as well. The HR woman is going to work on the details for us this week so we'll see what happens.

Yes, but the cost for the benefit may be less than what you would have to pay for the IVF. And you can always drop it once your IVF is successful, can't you?

Re: Has anyone else been through this with insurance? (long)

Posted by Gertyrae

Posted by newmom

Posted by -BabyQuestions-

Posted by rose825

10K can go along way, because yes its only for certain things, and its only what they pay, not what the RE charges.

you will have to wiat until open enrollment though unless there is a life event (marriage, birth, or you can prove your insurance was terminated)

BUt October is right around the corner.

Thanks

We are thinking it might not be good to go this route since DH would also *obviously* have to pay the high insurance cost per paycheck in order to receive this benefit as well. The HR woman is going to work on the details for us this week so we'll see what happens.

Yes, but the cost for the benefit may be less than what you would have to pay for the IVF. And you can always drop it once your IVF is successful, can't you?

I agree with this...even if you get the grant, you are going to lay out a lot more than a couple hundred dollars in premiums.
I would switch and then switch back to yours when you are successful.

Re: Has anyone else been through this with insurance? (long)

Posted by rose825

Posted by Gertyrae

Posted by newmom

Posted by -BabyQuestions-

Posted by rose825

10K can go along way, because yes its only for certain things, and its only what they pay, not what the RE charges.

you will have to wiat until open enrollment though unless there is a life event (marriage, birth, or you can prove your insurance was terminated)

BUt October is right around the corner.

Thanks

We are thinking it might not be good to go this route since DH would also *obviously* have to pay the high insurance cost per paycheck in order to receive this benefit as well. The HR woman is going to work on the details for us this week so we'll see what happens.

Yes, but the cost for the benefit may be less than what you would have to pay for the IVF. And you can always drop it once your IVF is successful, can't you?

I agree with this...even if you get the grant, you are going to lay out a lot more than a couple hundred dollars in premiums.
I would switch and then switch back to yours when you are successful.

agreed

Re: Has anyone else been through this with insurance? (long)

I think you are misunderstanding.
The 10K covers the retrieval and transfer costs outside of sonos, bloodwork, etc. which are just covered by insurance.
In other words, you would only be paying a copay for monitoring visits and they should be covered by the insurance. Then, the transfer and retrieval will come out of the $10K IF coverage. This means you can usually get two or three transfers out of the $10K...
Ex: we have $50K lifetime coverage. I've done two stim cycles and 11 FET's and have only gone through about $25K (I think). I know for a fact that the FET's are $2K just for the transfer.

Re: Has anyone else been through this with insurance? (long)

Re: Has anyone else been through this with insurance? (long)

I just went through this with my insurance but it was the opposite. I was covered by DH's plan but I got a new job and found out that the insurance coverage here has IVF coverage! Same as your DH, $10,000 life maximum.

I just did 1 cycle. I paid a total of $30 out of pocket for 1 copayment. All of the sonos and bloodwork were covered but not billed towards the IVF maximum. My retrieval and transfer were billed to my insurance for over #11,000!!! My insurance paid a little over $3,000 and that's what my RE accepted!!! So, I sill have about $7,000 left to use!!!

However, some of my meds were not covered. It depends on the formulary (drug list) the company chooses.

The only thing you need to look into is, remember, YOUR insurance is your primary. You may run into problems here. I don't know if they would have to bill yours first and whatever isn't paid is then sent on to your husbands???? Or, will they bill your insurance and then if it isn't paid, you're responsible???? As I mentioned, my insurance covered the IVF, my DH's didn't. You're the opposite so make sure you look into this.