IVF and GHI

(Side note) I feel like I'm writing in secret code with all these abbreviations. Scary part is I understand all the acronyms now

I just had my 4th IUI the day after xmas. The doctor wanted to discuss what approach we would take if it didn't work. She mentioned IVF. The finance department wasn't in because of the holiday so I couldn't find out what my insurance covered.

Does anyone with GHI know how they are with covering IVF? I keep forgetting to call and now its Friday night, they're closed and I'm wondering because I'm feeling very discouraged!!

Thank you!!

Re: IVF and GHI

i am sure we have the same coverage since we love our trash men

so for us they will pay 75 percent and we have a 25 percent co insurance

it covered everything from sono and bloodwork to transfer and retreival ect etc

i think they only thing she told me was not covered was the storing of embryos

they also want 12 iui done before they will pay but our doc and i am sure other docs do as well does something,i cannot think of the name for the life of me,where they ask the insurance to bypass the other iui bc the patient needs ivf

i was also told dh needed 2 sa,i needed a hsg and they need to see bloodwork and sono from cd 3

good luck! once we start in jan i will prob have better answers for you

Re: IVF and GHI

Thanks Gina!!

I hope they can bypass the 12 IUI. I thought it was 6....we've only done 4. I used up my coverage for the injectables a lonnnggg time ago so hopefully they arent too much $$ if there are any. Did she mention how much the storing is?

I have to research the cost if we're gonna have to pay 25%. Then again, paying for the meds, injectables, and blood/sono copays adds up anyway.

Re: IVF and GHI

WOW...12 IUIs....in 2007, it was 4 IUIs....I am a teacher so I have the same insurance as your DH......what wasn't covered were my co-pays and the anathesia for the retrevial (that was about 500)

Good Luck!


ETA: The next time your dr writes the script for injectables, make sure they write it for more so that you don't do your script allowances......

Message edited 12/30/2011 8:50:08 PM.

Re: IVF and GHI

Re: IVF and GHI

we only did 8 and they r paying for ivf so i think they will do it for you too

and yes i wish i knew that too about the injects before!

Re: IVF and GHI

GHI recently updated their medical policy and changed it back to 6 IUIs before IVF. You can go to the Emblem Health website and search for the policy yourself! Its very informative but of course every contract is different and has its own limits but they all follow the same basic medical policy.

Like others have said, even if you don't do the 6 iUIs you can still do IVF depending on your situation and what your RE submits for review. FM if you have any questions!

Re: IVF and GHI

It depends on your specific plan. I'm not a NYC employee, and my GHI plan doesn't cover IVF at all!

Re: IVF and GHI

GHi is VERY strict when it comes to IVF. I had done a few iui's and then had an ectopic and they still wouldn't approve me for IVF even with the doctors pushing for me. When I found out I had a completely blocked tube that's when they finally approved me.

Re: IVF and GHI

I have GHI.

Never did an IUI...straight to IVF. They paid for most of it. I paid for about $1900-2100. I am not sure exactly. I also needed PGD, they did not pay for that... but most don't.

I have done 2 fresh transfers and used the medications they order 1 time. I think the script thing is annoying!

Re: IVF and GHI

Hi,

I have GHI under the teacher's plan as DH is a teacher. Like others above...it's 75% covered for IVF and 25% co-pay. It used to be 12 IUI's before IVF if under 35, if over 35...6..I believe. I only did two IUI's after my Dr requested a waiver based upon my age. I believe that if you have male factor issues or tubal issues..you can bypass the IUI requirement by having your Dr do a waiver. My meds are through the Union through Pica and Medco. As was said..I get 3 rounds of each inject only. Which is why people should be careful using this allowance up on IUI's which use far less injects.

Anwyay, although it is too late to order the max amount of injects in your case, ...try ordering another injectible. For instance, I used up my 3 cycle limit for Cetrotide...but they approved me for another 3 cycles of Ganerilix which is the same drug essentially. It might be worth trying if for instance you have used up your coverage for Gonal-F...maybe they will give you three cycles of Follistism...essentially the same thing.

Re: IVF and GHI

Thank you everyone for your responses! Ellie, I hope it is 6. Then I would only have 2 more.

Thank you for the tip on the injections. For some reason, I'm thinking it might 3 injectibles completely, but its worth checking out!!

Re: IVF and GHI

Here is the link to the medical policy listed online for providers. Of course these policies only apply if you do have IVF coverage and every plan does have different limits and not all of what is on the policy will apply to your contract, but if you do have IVF coverage this is the policy they follow. The policy has some interesting information regarding what is required to get approval for IVF including what is required for waivers.

I'm not sure where to find the info regarding the injections....but i hope this helps.

Policy

For me, I had to get a waiver because I only did 1 IUI. I have endo so that was the reason I got the approval and was able to go straight to IVF. Good Luck!

Message edited 12/31/2011 5:45:56 PM.