IVF insurance question

Hi folks,

I am considering starting IVF after many unsuccessful IUI attempts. The one thing that is holding me back a little bit is some insurance concerns. I am incredibly lucky to have a good insurance plan (ny state, empire plan for state employees). It includes a 50k lifetime cap for ivf. One or two people have mentioned to me that their insurance generally only counts obvious ivf things (like egg retrieval, and embryo transfer) against the cap, and that other things, like blood/sono and meds don't count towards that cap. So, in other words, 50k has gone a long way for these people, thank goodness.

Has this been other folks' experience with ivf and lifetime caps (and perhaps the empire plan in particular)?

thanks for reading, and good luck to all of you!!

bk.

IVF insurance question

I have UHC, but it all depends on how the clinic bills your insurance, meaning what coding they use... my IUI took a little over $400 off, i keep forgetting to call my insurance to see how much the IVF cycle took off... but from what i could tell only the procedures ER, ET & the procedures related to them... no blood or sonos were used against it.

ETA: i only have 10k lifetime on my plan.

Message edited 10/10/2012 10:06:16 AM.

Re: IVF insurance question

$50k sounds excellent to me - my plan is $25k (through United Health Care).

Good luck!

Re: IVF insurance question

Thanks guys... I wish this process was more transparent. I'm slightly scared of calling my insurance company (I know, this is ridiculous, but I'm afraid they'll tag me as a continued financial drain... which let's be honest, after 5 iuis I probably am). I have to call and ask if the iuis have already counted against the cap; I assumed they wouldn't, but I should check.

IVF insurance question

i wouldn't worry about what's included with a $50k cap. i had a $30k cap and was told i could get at least 3 fresh cycles and a few frozen out of that. luckily i only needed one fresh to conceive my DD. when it was all said and done about $8k was paid out for that cycle.

IVF insurance question

Hi folks,

Just in case anyone else has this question as well... I just talked to my insurance company and they said that all IVF procedures (including GIFT, FET, transfer, retrieval, assisted hatching, co-culture) count against the lifetime cap, but that all meds, sono/blood work does not count against the cap.

good luck to all,
bk.

IVF insurance question

Anything that the doctor codes as infertility/IVF related will count towards your $50k. Everything else should be covered under your regular medical coverage.

So for example, after your cycle you have a blood test to determine pregnancy. This is not IVF related anymore and should not be counted in that $50k.

Message edited 10/10/2012 1:37:02 PM.

Re: IVF insurance question

It really depends upon how your plan is written. Your best bet is to call your insurance company to get details.

Good Luck!

Re: IVF insurance question

I have the same ins. as you.

Meds, consults, monitoring, lab testing, etc. are all covered under your general plan.

The $50k special IVF coverage only pertains to the IVF procedures of retrieval, embryology, and transfer.

If you go to a "center for excellence"--and many of the practices (RMA, Cornell, RSofNY, LIIVF to name a few) have this status--you will pay no copays and your ins. negotiated price for the IVF bundle is generally between $7k and $8k.

Message edited 10/10/2012 4:06:37 PM.

IVF insurance question

Thanks folks! I was at rsofny for a while but was really unhappy there, for lots of reasons. Now I'm with Dr. Zapantis and must say it's so nice to feel like I'm getting more thoughtful care. I know his isn't a center of excellence but I trust them more than rsofny and like the more personalized touch.

Wishing all of you all the luck in the world!!

Bk