Hi ladies. I was just curious to see how some of you are paying for your IVF. I have been calling my insurance company to get some insight on what I am going to have to pay and I am getting really confused! Between my lifetime maximun, deductable and co-insurances, I am lost!!! I need to give them a call back and see if someone can explain it better to me. It's looking like it's still going to cost me a lot of money to have it done. I live in Illinois, but my insurance is Blue Cross Blue Shield through Iowa (my home office for work is in Iowa).I am a little depressed right now because of it all. I was just curious to hear some stories about how some of you have paid for it. Also, have any of you gone through a program where you get refunded money if it doesn't work?
In Illinois insurance is suppose to pay for your infertility treatment up to certain limits. But sounds like you have a self funded plan. Ask insurance next time if their self funded. If self funded they don't have to pay for IVF.
Sometimes you have a fertility benefit but it only covers certain limits For example you might just have a fertility benefit that pays a maximum of $2500 a calendar year, but they only cover artificial insemination and not cover IVF.
Most times insurance regardless of plan pays for lab work, ultrasounds and diagnostic testing to determine what your promblem is.
When you call back your ins - specifically as them if you have a fertility benefit Then tell them to give you the benefit in detail.
In general deductibe, coinsurance and lifetime max is what applies to any of your medical costs. It could be distributed diferently amoung your benefits.
If they say you have to pay $200 ded and 10% coinsurance that means if you get a bill for $500, you will have to pay $230.00 of that bill no matter what medical service is for (that is xray or office visit).
Specifically ask if you have an infertility benefit or if infertility is covered under your plan also check if your plan is self funded. Since your in Illinois, infertility coverage is mandated by the state. So if you don't have it with this job, maybe get a new one with group benefits that aren't self funded - yeah i know easier said than done, but you're lucky you live in Illinois and you have a better chance at getting insurance coverage for infertility than many people.
To specifically answer your question, our insurance pays for my infertility coverage. We have two insurance - one thru me and one thru hubby. So we just have a copay with each doctor visit and copay with drugs.
If you get your benefit, post it and I can help you out. I will check board today and monday or you can send me a private messgage. I work in the insurance health care industry.
I can't really remember everything the gal was telling me. I called on my lunch break, so I haven't had time to call back today and get a better understanding of everything. She told me that I have a $15,000 lifetime maximum for infertility treatments. The something about my deductable and co insurance does not apply to my out of pocket maximum, which is $2,000. I am just really confused! I called my husbands insurance and they do not cover anything on infertility. So no help there! I work for a pretty good and pretty good size company. My office is the only office located in Illinois. I knew that Illinois was to cover infertility, but since my insurance is based out of Iowa, it doesn't benefit me. I really need to call my insurance back and have them explain it to me better so I understand what is going on and what I will have to pay. I called about 6 months ago and the gal I talked to then gave me the info that I would only have to pay my out of pocket maximum, which is the $2,000. That doesn't sound like that's the case.
okay that makes sense - what the are telling you is you're going to have to pay a percentage of your infertility treatment and ins. company will never pay that benefit at 100%. But it's good you have $15,000 for infertility treatment! If you use in network doctors, that's going to go a long way for you too!
Assume that your coinsurance is 10% and the ins. pay 90% , the most you will be paying towards infertility treatment will be $1666.66 (that's the 10%). Basically this is equivalent to $16,666.66 in medical costs. Insurance will pay 90% which is $15,000. Once the insurance pays out $15,000 you have used up all your benefit.
When they tell you it doesn't apply to your out of pocket (OOP) maximum, she just means that the 10% you pay for insurance will never go towards OOP.
If this was a run of the mill inpatient hospital bill, the coinsurance goes towards OOP, then insurance will pay 100%. Again with the 10% coinsurance. Say you had an IP hosp bill of $50,000, you pay 10% up to $2000. After you get to $2000, that's all you'll have to pay. Hospital pays part of bill at 90% and 100%. So you don't get stuck paying $5,000.
I hope this helps. It sounds like you have a GOOD benefit. I don't know if the drugs are covered, but all in all the contracted rate for IVF might be $6000, the most you'd pay is $600 if you coinsurance is 10%.
Find out if the infertility drugs are paid under your prescription plan and check to see if they are limited to the $15,000 too. The fertility drugs can eat your benefit up quickly! Do price checking.
Luckily I got pg on my 3rd IUI and didn't have to go the IVF route, but it was my next step. When I thought I might have to do IVF my plan was to borrow the money from my TSP (same as 401K). I don't remember all the details but I figured it out.. at the time I was contributing 10-12% in my TSP.. If I borrowed $10000 against my TSP and then lowered my contribution to 5%.. the total amount that would be taken out of my check (5% contribution + loan payment) would be about the same..
Something you might look into if you need to.
Also, when BCBS says they don't cover fertility meds that can be misleading.. (I have BCBS federal).. BCBS does not pay for the meds but the meds portion of your coverage is actually by another company.. so you need to find out if that company covers the fertility med... For BCBS federal it does cover the meds but all BCBS policies are not the same..
Here's what we did...between my insurance and dh...no fertility covered. But my clinic would send them the bill for b/w and u/s since those could be deemed "female necessities". For meds and all fertility procedures, though, we did have to pay out of pocket. We used what we had in savings (not something we had been saving up for...fertility treatments! and had just bought a house...so our savings was pretty small) so we put it on a 0% interest CC and if PIF at our clinic they give 5% discount (doesn't seem like much, but every bit helps!) and then we tightened the belt and used my paycheck to pif before the interest went up. I wasn't wanting to wait until we had enough money to PIF on our own (felt my age didn't give room for that!) and I was ready to get the IVF going. Also, some clinics will do a Shared Risk program where you pay a set amount for a set amount of cycles and if they don't work you get a % back (since they are saying they can get you pg!) You could ck into that, too.
So w/ out ins, and all in all between 3 IUI's and 3 IVF, meds, donor eggs, etc...we paid about 25K. Sounds C*R*A*Z*Y but looking at my 22 month old WORTH EVERY SINGLE PENNY!! And I would do it again in a h/b!
Good luck. Sounds like you have good insurance and ask many, many questions!
Also...you can deduct on your taxes if you reach a certain amount of med bills.
Copyright 1994-2016 MedHelp International. All rights reserved.
MedHelp is a division of Aptus Health.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.