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Insurance coverage question

Posted By Message

Kissy331
My two miracles!

Member since 5/06

17826 total posts

Name:
Kristen

Insurance coverage question

I am not sure if this just got worse or not but I called our insurance, CIGNA Open Access plus In-network. This is what she told me:

$40 co-pay per visit
No precertification needed
IVF is not covered including In-Vitro, GIFT, ZIFT or anything similar.
Surgical Procedures $100 deductible then plan covers 100%
Testing in the office, only $40 co-pay
Outpatient Deductible 100
Infertility drugs NOT covered

I asked specifically about IUI & she could not answer if it is covered. What do you think?

Message edited 2/11/2008 10:57:17 AM.

Posted 2/11/08 10:46 AM
 
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MrsPornStar
Partners in crime

Member since 10/05

14656 total posts

Name:
Mama

Re: Insurance coverage question

IUI may be covered, since many doctors consider it an in office visit. I know that with my insurance, IUI does not count towards my IVF benefits.

Posted 2/11/08 10:58 AM
 

dm24angel
Happiness

Member since 5/05

34581 total posts

Name:
Donna

Re: Insurance coverage question

What type of company do you have insurance through.

Call them back and asked if the NYS Mandate for infertility is covered under yoru plan.

NYS has a mandate that you must be covered for IUI's ...Basic testing

BUT some companies are excluded fromt hat including Government companies, Unions and very very large ( over 200K employee) companies.

Posted 2/11/08 11:54 AM
 

meghanmetz
LIF Adolescent

Member since 5/05

525 total posts

Name:
Meghan

Re: Insurance coverage question

I also have Cigna open access plus, and honestly, everytime I called them, I just got frustrated.

Do you have a Summary Plan Description or an actual plan description through your/DH's employer? Whenever I called to talk to them they knew nothing about my actual plan and the "extras" that are included by my employer.

What I ended up doing is getting a list of EVERY code that the doctors office would/could use and sat on the phone with them forever going through the codes and seeing which would/wouldnt be covered or need pre-authorization.

Good luck, insurance is a blessing, but such a pain sometimes.

Posted 2/11/08 12:09 PM
 

dm24angel
Happiness

Member since 5/05

34581 total posts

Name:
Donna

Re: Insurance coverage question

Also when anyone is confused, you should always ask for a supervisor( I worked for insurance for yrs)...Sometimes you may get a new rep or one who just isisnt looking in the right place.

Posted 2/11/08 12:14 PM
 

Domino
Always My Miracle

Member since 9/05

9923 total posts

Name:

Re: Insurance coverage question

Another alternative is to speak with the RE you plan on using. They work with all the insurance companies day in and day out and could probably get an answer for you much more easily.

Posted 2/11/08 12:20 PM
 

Kissy331
My two miracles!

Member since 5/06

17826 total posts

Name:
Kristen

Re: Insurance coverage question

Posted by meghanmetz

I also have Cigna open access plus, and honestly, everytime I called them, I just got frustrated.

Do you have a Summary Plan Description or an actual plan description through your/DH's employer? Whenever I called to talk to them they knew nothing about my actual plan and the "extras" that are included by my employer.

What I ended up doing is getting a list of EVERY code that the doctors office would/could use and sat on the phone with them forever going through the codes and seeing which would/wouldnt be covered or need pre-authorization.

Good luck, insurance is a blessing, but such a pain sometimes.



Thanks a bunch, I am going to do this. I was just so confused & when I asked specific procedures, they had no idea. I guess the codes are the best thing in the world bc it is clear-cut...

Posted 2/11/08 12:23 PM
 

meghanmetz
LIF Adolescent

Member since 5/05

525 total posts

Name:
Meghan

Re: Insurance coverage question

Posted by Kissy331

Posted by meghanmetz

I also have Cigna open access plus, and honestly, everytime I called them, I just got frustrated.

Do you have a Summary Plan Description or an actual plan description through your/DH's employer? Whenever I called to talk to them they knew nothing about my actual plan and the "extras" that are included by my employer.

What I ended up doing is getting a list of EVERY code that the doctors office would/could use and sat on the phone with them forever going through the codes and seeing which would/wouldnt be covered or need pre-authorization.

Good luck, insurance is a blessing, but such a pain sometimes.



Thanks a bunch, I am going to do this. I was just so confused & when I asked specific procedures, they had no idea. I guess the codes are the best thing in the world bc it is clear-cut...



Np - same thing with meds. I had to go through TELDRUG for all of the meds, and they're even worse off. I had specific IF benefits, so any drugs not covered under my Rx program are covered under my medical program. I was constantly moved back and forth between medical, RX, and Tel Drug. If your drugs are covered, order them early in the game. These people had me in tears several times.

Posted 2/11/08 12:34 PM
 

Bops
My 3 wishes

Member since 12/07

13625 total posts

Name:

Re: Insurance coverage question

I have Cigna (HMO) and it has to be the WORST plan around and even they cover IUI...It took me quite the run-around asking phone reps names at Cigna etc. to finally get a straight answer...Your RE's office financial co-ordinator may also be able to find out for you...Also with my plan, injectable drugs were not covered but oral etc... were (and of course no IVF)...good Luck !

Posted 2/11/08 1:59 PM
 

DRMom
Two in Blue

Member since 5/05

20223 total posts

Name:
Melissa

Re: Insurance coverage question

I thought NYS companies had to cover IUI and fertility meds....isn't it part of insurance law??

Posted 2/11/08 2:07 PM
 
 

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