insurance question..

we have GHI insurance and i wanted to find out what kind of coverage we had regarding infertility treatments..

we are covered 100 percent on all iui's,and as many as we need..which is great!

then it said we have 3 ivf's in a lifetime and we pay 25 percent of cost

is that normally what people get..i just felt like 3 was so low and it got me worried

tia

Re: insurance question..

Every insurance is different. On GHI, we get 3 IVFs and 3 FETs.

As far as insurances go, I actually think that's pretty good. When we checked out my DH's insurance, it was 6 total IUIs and IVF combined. Lots of insurance companies have a price limit of 10k or 30k of IF coverage, just for example...... Then there are some policies that don't cover infertility AT ALL!

One thing to make note of though... They require 12 IUI cycles before moving on to IVF unless you meet a certain criteria... or if your doctor can prove it's necessary and can try and override it.

Unfortunately I don't think there's one insurance company that has *perfectly ideal* coverage for infertility... but like I said... some people don't get coverage at all! All in all .. it's not bad. However, I will def be changing my tune on that one if I don't get approved for IVF in the next week!!

Re: insurance question..

when I first started, I had oxford freedom and had a 10K lifetime max, which would not have gotten me far. Then DH got a job with the County and we now have Empire NYSHIP which gives us a 50K lifetime max. By going to a Center of Excellence, after countless IUIs and IVF cycles, conceiving DS, and two failed cycles TTC#2, we still have a little over 16k left. If we never had this insurance, we would never have been able to afford to conceive DS...I dont know how those without insurance do it The insurance you have at least seems reasonable. Out of the six or so insurance options DH was given, this was the ONLY policy that even offered infertility insurance.

Message edited 2/4/2011 6:34:44 AM.

Re: insurance question..

I have GHI, and I have no IVF coverage. It really varies from plan to plan.

Re: insurance question..

Hi,

I also have GHI which covers 3 IVF's. What they don't spell out is that it also covers 3 FET's associated with the 3 IVF cycles so that is technically 6 bites at the apple. Just double check to make sure yours includes the 3 FET's too. I think its a pretty good policy except for their ridiculous 12 IUI requirement for those under 35. I think it is 6 for those over 35 before you can move on to IVF. The good news is that you will pay 25 percent of the contracted rate and not the out of pocket rate. My 25 percent is $1,200. I first thought I would have to pay 25 percent of just over 13,000.

I just want to add that if you have a choice of policies, take a look at some with the lifetime max's. I made the mistake of thinking that the insurance co deducted the full price of the treatment. Instead, they only deduct the contracted rate. Had I known, I likely would have picked Empire with a 50,000 lifetime max. For example, it costs just over $13,000 for an IVF cycle at my current clinic if you pay OOP. The contracted rate is just under $5,000. I could have gotten many more IVF cycles in than three had I known and then some.

This is assuming that the cost of meds is not deducted from one of these lifetime max policies. If meds are deducted, they could potentially cost more than the contracted IVF rate.

Bottom line, the GHI policy is a very good one compared to what most have, but if you have the option to pick one with say a lifetime max of 30,000 or more that does not deduct meds from that max, it might be worth looking into.

Message edited 2/4/2011 8:59:29 AM.

Re: insurance question..

I think your insurance coverage is awesome. Previously we were covered under DH's company. They had Aetna and no IF coverage. I didn't know that until we got a lab bill (just for our testing) that was almost $2k . I was sooo angry .

We switched to my company's insurance. I have Oxford Freedom which has a $10k lifetime max for IVF. All my iuis and meds were covered so far (I just paid the co-pays).

Now that we are moving onto IVF, we still have to pay $2500 for the cryopreservation of the embies (insurance does not cover this). I really need this IVF to work. We only get one shot covered and I am super nervous about having to do this again and paying out of pocket which will already add to all the stress we have.

It's so unfair. As if IF wasn't enough, we all have to worry about insurance!!!!!

Re: insurance question..

I worry about my GHI coverage everyday. It is good coverage, but it's still scary. My first IVF cycle failed and we had no frosties. My second cycle, we did a freeze-all, so I am working on my FET now. If this cycle doesn't work, I have one more chance. We picked up my DH's coverage as of January 1st because I'm terrified of running out of coverage. We have a $10,000 max coverage with his, but we pay an extra $300 a month for his coverage. I know I am very lucky to have coverage, but I am so scared I will run out before I have a baby. I told my DH he will need to find a new job and get new insurance.

I'm sure you will be fine. I know you haven't even started IUIs yet. Try to be positive and don't worry too much until you have to.

Re: insurance question..

Like the girls said all plans are different. Just verify your benefits so you know what to expect. I can't believe infertility benefits still aren't standard, I mean they cover alot of other stuff! It makes me sick actually! They'll cover an abortion but not the opposite if someone wanting to try to get pg. I once had a policy that wouldn't cover the bcp but would cover up to 4 terminations in a calendar year, seriously?! I'm not debating abortion just giving an example.
We are lucky, our policy covers 20,000 PER YEAR of anything infertility related including cryopreservation. My meds come out of my prescription plan. What's scary is that even w good ins we still lay out alot of money for 10% co-ins and copay on meds since we've been trying!

Re: insurance question..

As other girls have said.. they're all different, even within the same insurance company. It all depends on the specific coverage of the company plan you're on.

I have Aetna and i have full invertility coverage of everything, except for IVF

Just as an fyi.. i had to get pre-certification from Aetna before they would pay for anything If related. They have a whole IF division that handles all that. You can't just call the regular number and talk to a rep, you have to go through the IF people and get pre certified.