Infertility coverage... is this good?

I just wanted to get everyone's opinion on this coverage to see if it's good or not? If we have problems conceiving in the future my doctor said I wouldn't be a good candidate for IUI, that I would have to go right to IVF. This is what coverage I have. Also, can anyone help me understand what they mean with Level 3 cost? Why does it say 50% Copayment package price? What does this mean?
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Infertility Benefits
The benefit structure of the Duke Select and Duke Options health plans requires patients receiving infertility services to pay a copay based on a packaged group of services. Care must be provided at Duke Medical Center. Employees are eligible after two years of service.

Package One
In vitro fertilization (IVF)
Patient pays $3000. *

Level 1 Care:
Diagnostic Tests:
· Semen Analysis (when the male is covered)
· Documentation of ovulation (either a mid-luteal phase serum progesterone or an endometrial biopsy)
· Hysterosalpingogram
Treatment: Clomiphene citrate, letrozole, tamoxifen for approximately 4 ovulatory cycles (more cycles if a conception is
established but not carried to viability)
· Intrauterine inseminations (usually coupled with clomiphene citrate)
· Treatment of insulin resistance in women with polycystic ovary syndrome with insulin sensitizers (metformin,
troglitazone, etc.)
· Treatment of anovulation secondary to hyperprolactinemia with bormocriptine
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Package Two
IVF with ICSI.
Patient pays $3500. *

Level 2 Care:
Diagnostic Tests: (Performed as indicated with the appropriate pre-certification)
· Same tests as in Level 1
· Laparoscopy (with hydrotubation) which may be converted to a therapeutic procedure
· Office or OR hysteroscopy which may be converted therapeutic procedure
· 3-D Sonohysterography
· Semen profile (if the male is covered)
· MRI scan
· Screening for antiphospholipid antibodies (for the covered individual(s))
· Screening for cyctic fibrosis
Treatments: Therapy will be undertaken (requiring pre-certification as with comparable procedures done for noninfertility
indications) for those conditions for which a clear evidence-based approach is warranted.
· Lysis of pelvic adhesions when found during procedure (existing known pelvic adhesions subject to Level 3
Copayment)
· Hysteroscopic resection of a uterine septum
· Surgical resection or ablation of endometriosis if found during procedure (if condition known in advance
treatment subject to Level 3 Copayment)
· Abdominal cerclage
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Package Three
A surgical procedure such as myomectomy or the treatment of endometriosis.
Patient pays $3000.

Level 3 Treatments: 50% Copayment Package Price. Please Contact Reproductive Endocrinology for Details.

Myomectomy (when infertility is the indication)
· Neosalpingostomy for tubal obstruction
· Ultrasound monitored clomiphene citrate/IUI
· Gonadotropin ovulation induction (limited to 3 per lifetime)
· Controlled ovarian hyperstimulation with intrauterine insemination using gonadotropins (limited to 3 per
lifetime)
· In vitro fertilization limited to 3 per lifetime, including:
Ø IVF with ICSI and/or assisted hatching
Ø IVF with donor oocytes (patient is responsible for donor fee)
· Sperm donation with patient responsible for cost of sperm
· Office visits and follow-up visits associated with Level 3 services
e. Exclusions From Level 3 Treatments.
· Reversal of previous voluntary sterilization
· Infertility care if either of the partners has a history of a voluntary sterilization reversal
· Posthumous reproduction
· Posthumous sperm collection
· Donor sperm with directed donation of non-cryopreserved sperm
· Directed sperm donation NOT from the selected sperm bank
· Gamete intrafallopian transfer
· Zygote intrafallopian transfer except with severe cervical stenosis
· Gestational surrogacy (third party surrogacy)
Drug treatments for stimulating ovulation may be covered on a limited basis under the Prescription Drug Program with
50% coinsurance when purchased at a participating pharmacy using the pharmacy card.
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Package Four
Controlled Ovarian Hyperstimulation (COH).
Patient pays $1000. *

Package Five
Frozen Embryo Transfer.
Patient pays $500.
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* The drugs that are approved for use in the COH fertility packages are Repronex, Follistim and HCG. Patients will be responsible for 50% of the cost of the drugs in addition to the package price.

Note: The patient should use the Medco Health prescription card at a participating pharmacy to purchase infertility drugs.

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Sorry this is so long... I am just clueless as to what is good coverage. Thanks for looking, I appreciate it!

Message edited 11/18/2008 8:52:33 AM.

Re: Infertility coverage... is this good?

if thats all one coverage ( all the packages), its a very good policy.

50% co pay means you pay 50%.

Level 3 are the surgeries etc listed.

Re: Infertility coverage... is this good?

Yes, it's all the infertility coverage they offer. The only catch is that you have to be with Duke for 2 years as an employee and use Duke Infertility doctors. I don't know if that's good or bad.

I was just curious after reading posts on here as to what the costs are. I have no idea with the difference is with IVF w/ICSI, etc. I just know what IVF is.

I also don't really know how much the meds cost and all either.

If we ever needed to go that route I wanted to go through NCCRM (North Carolina Center for Reproductive Medicine.) They're known for having the highest IVF success rate in the country. At least that's what they say!

I was just curious. Thanks!

Message edited 11/18/2008 9:26:18 AM.

Re: Infertility coverage... is this good?

Sounds like pretty good coverage. I don't have insurance for IVF, and mine cost $8k. I do have prescription drug coverage, but even with that, all my drugs cost about $600.

ICSI, at my RE, costs another $2k I think.