IVF Question - no-insurance

Trying to word my quesiton. I have insurance that has covered everything up until IVF. When I had my IUI's they covered Gonal-F and Ovidrell. So, I'm wondering, since I am using Gonal-F with IVF, if my insurance might pick up some meds. Anyone know anything about this or have any advice? It would be really cool if insurance would pick up some of the meds. But, I would guess if they find out the reason they woudn't. NO idea.

Re: IVF Question - no-insurance

My insurance covers unlimited medication, lab work, tests, sono's, and IUI's but has a cap on IVF. The actual IVF procedure including surgery, anesthesia, embryologist, etc. is what is capped for me. You might want to give your insurance a call for clarification. It's possible that your meds may be covered.

Re: IVF Question - no-insurance

I am in the same situation. From what I have gathered you need to talk to teh finance person at your clinic and only have them submit the stuff they know will get covered without mentioning IVF. You could also call your prescription plan and ask them what injectibles are covered without mentioning IVF

Re: IVF Question - no-insurance

My insurance did.

I was covered for infertility including meds & 3 IUIs. But not IVF. My IVF protocol included gonal-f & ovidrel and they were both covered under insurance. As a matter of fact, I think only two of the drugs for my IVF protocol were not covered. My total med's bill for the cycle (including co-pays) was $384.

Good Luck!

Re: IVF Question - no-insurance

My insurance doesn't cover any of the medication.

Re: IVF Question - no-insurance

Double post

Message edited 2/29/2008 6:04:25 PM.

Re: IVF Question - no-insurance

Re: IVF Question - no-insurance

Thanks. My DH and I own our own business and we have fewer than 50 employees (we have 4). So, no one will offer IVF coverage to SB. I tried. I am the plan admin I would change to anything that would cover us. But, we have good coverage with Oxford.

My IVF coordinator put in our meds already this morning. I guess I'll see whats covered. Dreading the call.

Re: IVF Question - no-insurance

Re: IVF Question - no-insurance

Posted by MrsJoeG

Posted by melijane

Posted by karenk71

My insurance doesn't cover any of the medication.

There is a NY State mandate to cover drugs and IUI unless you work for a company with less than 50 people or a religious org. as far as I know. You should look into that.

Here is the text from the state mandate:

New York

Individual and group health insurance policies are prohibited from excluding coverage for hospital, surgical, and medical care for the diagnosis and treatment of correctable medical conditions otherwise covered under the policy solely because the condition results in infertility (N. Y. Ins. Law §§ 3216(13), 3221(6), and 4303(s)).

Group health insurance policies must provide coverage for infertility diagnosis and treatment to people age 21 to 44 years. Coverage may be subject to copayments, coinsurance, and deductibles that are consistent with those established for other policy benefits. Coverage is limited to people covered under the policy for at least 12 months. Coverage may exclude IVF, GIFT, ZIFT, reversal of elective sterilizations, sex change procedures, cloning, and experimental procedures (N. Y. Ins. Law §§ 3221(6) and 4303(s)).

Insurers must use standards and guidelines no less favorable than those adopted by the American Society for Reproductive Medicine in relation to the (1) diagnosis of infertility, (2) identification of experimental procedures, (3) required provider standards, and (4) determination of appropriate medical candidates by the treating physician (N. Y. Comp. Codes R. & Regs. tit. 11, § 52. 17(35)).

*dusting off my attorney hat*
This mandate requires insurers to cover treatment and diagnoisis of medical conditions which result in infertility. Unfortunately, infertility itself is not considered a medical condition and therefore, insurers can get out of paying for IUI/IVF and drugs for IVF. This mandate requires them to provide coverage for such conditions as endo, varicoles etc. Thats not to say some drugs may not be covered. I am in the same situation and just that some of my meds are covered! I am going to try to get my clinic to word my scripts so as not to mention IVF

Re: IVF Question - no-insurance

Posted by melijane

Posted by MrsJoeG

Posted by melijane

Posted by karenk71

My insurance doesn't cover any of the medication.

There is a NY State mandate to cover drugs and IUI unless you work for a company with less than 50 people or a religious org. as far as I know. You should look into that.

Here is the text from the state mandate:

New York

Individual and group health insurance policies are prohibited from excluding coverage for hospital, surgical, and medical care for the diagnosis and treatment of correctable medical conditions otherwise covered under the policy solely because the condition results in infertility (N. Y. Ins. Law §§ 3216(13), 3221(6), and 4303(s)).

Group health insurance policies must provide coverage for infertility diagnosis and treatment to people age 21 to 44 years. Coverage may be subject to copayments, coinsurance, and deductibles that are consistent with those established for other policy benefits. Coverage is limited to people covered under the policy for at least 12 months. Coverage may exclude IVF, GIFT, ZIFT, reversal of elective sterilizations, sex change procedures, cloning, and experimental procedures (N. Y. Ins. Law §§ 3221(6) and 4303(s)).

Insurers must use standards and guidelines no less favorable than those adopted by the American Society for Reproductive Medicine in relation to the (1) diagnosis of infertility, (2) identification of experimental procedures, (3) required provider standards, and (4) determination of appropriate medical candidates by the treating physician (N. Y. Comp. Codes R. & Regs. tit. 11, § 52. 17(35)).

*dusting off my attorney hat*
This mandate requires insurers to cover treatment and diagnoisis of medical conditions which result in infertility. Unfortunately, infertility itself is not considered a medical condition and therefore, insurers can get out of paying for IUI/IVF and drugs for IVF. This mandate requires them to provide coverage for such conditions as endo, varicoles etc. Thats not to say some drugs may not be covered. I am in the same situation and just that some of my meds are covered! I am going to try to get my clinic to word my scripts so as not to mention IVF

Thanks for the clarification. I was told by my insurance co that they covered what was required my NY mandate and my meds are covered. But it does not shock me at all that they were wrong.

I think you will be OK with the meds as long as they don't submit any claims having to do with IVF. Your meds go through a separate plan. I am in the same boat but have read online that many clinics will split up what they sumbit so you can use at least some of your benefits.

Re: IVF Question - no-insurance

Posted by MrsJoeG

Posted by melijane

Posted by MrsJoeG

Posted by melijane

Posted by karenk71

My insurance doesn't cover any of the medication.

There is a NY State mandate to cover drugs and IUI unless you work for a company with less than 50 people or a religious org. as far as I know. You should look into that.

Here is the text from the state mandate:

New York

Individual and group health insurance policies are prohibited from excluding coverage for hospital, surgical, and medical care for the diagnosis and treatment of correctable medical conditions otherwise covered under the policy solely because the condition results in infertility (N. Y. Ins. Law §§ 3216(13), 3221(6), and 4303(s)).

Group health insurance policies must provide coverage for infertility diagnosis and treatment to people age 21 to 44 years. Coverage may be subject to copayments, coinsurance, and deductibles that are consistent with those established for other policy benefits. Coverage is limited to people covered under the policy for at least 12 months. Coverage may exclude IVF, GIFT, ZIFT, reversal of elective sterilizations, sex change procedures, cloning, and experimental procedures (N. Y. Ins. Law §§ 3221(6) and 4303(s)).

Insurers must use standards and guidelines no less favorable than those adopted by the American Society for Reproductive Medicine in relation to the (1) diagnosis of infertility, (2) identification of experimental procedures, (3) required provider standards, and (4) determination of appropriate medical candidates by the treating physician (N. Y. Comp. Codes R. & Regs. tit. 11, § 52. 17(35)).

*dusting off my attorney hat*
This mandate requires insurers to cover treatment and diagnoisis of medical conditions which result in infertility. Unfortunately, infertility itself is not considered a medical condition and therefore, insurers can get out of paying for IUI/IVF and drugs for IVF. This mandate requires them to provide coverage for such conditions as endo, varicoles etc. Thats not to say some drugs may not be covered. I am in the same situation and just that some of my meds are covered! I am going to try to get my clinic to word my scripts so as not to mention IVF

Thanks for the clarification. I was told by my insurance co that they covered what was required my NY mandate and my meds are covered. But it does not shock me at all that they were wrong.

I think you will be OK with the meds as long as they don't submit any claims having to do with IVF. Your meds go through a separate plan. I am in the same boat but have read online that many clinics will split up what they sumbit so you can use at least some of your benefits.

Yeah its such a B*tch! I know some of the meds are super expensive. I think gonal F is one as long as I can get them to cover the most expensive ones I will be happy

Re: IVF Question - no-insurance

I'm going with Freedom and they called me yesterday. Freedom put the order through insurance. I haven't heard anything yet though. they took my credit card for the co-pay. Keeping fingers crossed big time.