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.

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.

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.

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.

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.

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.

Re: Insurance coverage question

Re: Insurance coverage question

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 !

Re: Insurance coverage question

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