Insurance Questions - please help me understand

Hi Ladies!

DH & I have been TTC for about a year now with OPKs, temping, etc and since we are in our 30s we are thinking of seeing a RE. We haven't had any luck this far, and I'm just hoping that one day I get to see a 2nd line when I POAS!

We got our Health Insurance enrollment packet for 2011 and I was wondering if any one has insight they can share into what this all means. Our insurance is through DH's job for the NS-LIJ Health System so generally speaking the benefits are pretty decent.

For Infertility Treatment it says:
"Paid at 80% for up to 3 Cycles at NSUH Manhasset facility only or in the office for specific Manhasset professional Providers"

So I'm wondering ... what does that really mean for us?????

* When they say 3 Cycles, do you think that is 3 IVF Cycles or do you think they're counting IUIs too?

* How much are we actually talking if we are paying 20% out-of-pocket?

* Do you think the 3 Cycles is the lifetime max?

Any insight you gals can offer is greatly appreciated!

DH is going to talk to HR this week to see what else he can find out, and if the 2010 benefits were different.

I'm hoping that if the 2010 benefits are better, maybe we can try to get a cycle in before they change in 2011????

Thanks in advance and tons of and to you all!

Re: Insurance Questions - please help me understand

I think your husband contacting HR is your best bet at this point b/c honestly this is a bit unclear to me.
Is the 2011 insurance plan different from the 2010 plan? Are the 2010 infertility benefits better?

Re: Insurance Questions - please help me understand

Re: Insurance Questions - please help me understand

Posted by AnxiousPants

Posted by ShaunsMommy

I think your husband contacting HR is your best bet at this point b/c honestly this is a bit unclear to me.

Thanks for trying!

Message edited 10/26/2010 1:09:17 PM.

Re: Insurance Questions - please help me understand

Yes I think 3 cycles is the lifetime max. But as others have said, the only way to get a correct answer to all of your questions is to call the insurance company and ask. It's not good to interpret the policies and assume something when you could be wrong.

As for the 20% out of pocket, that's a question for your clinic. When you visit your RE, you should get an info packet that includes an estimate of all costs. This should help you.

Re: Insurance Questions - please help me understand

He should definitely talk to HR or the insurance company. They can give him more info. It does sound like it means 3 cycles is the lifetime benefit. Since it doesn't specify it may mean for IVF not IUI. For my insurance, IUI is covered as part of medical treatment and there is a lifetime infertility coverage that IVF would come out of. It may be that you can try IUI without that counting towards the 3 cycles. Good luck