IVF Tips for Success
We've Been There!
How We Did It - IVF Insurance Tips
This page is more like a personal story or blog where I really want to share some very helpful hints and tips I learned over my 5 years dealing with IVF, doctors, insurance companies, employers, etc. If you would like to skip to the good part just scroll down to here's where this gets useful and informative: Here goes:
I have been self employed since 1998, and I run my business as a one woman show. Since I am just one person, no insurance agent would sell me a group policy that would have the IVF rider available. In order for a business to be able to sign up for a group health insurance policy with a big insurance company such as Bluecross Blueshield (for example), the company must have at least 2 eligible employees. Well, my husband opened up a shop and became self employed himself right in the middle of our fertility journey. He wasn't getting any fertility benefits through his employer anyway so it just didn't matter. We had just begun IVF with one doctor with no coverage, so everything was coming out of our pockets. I remained insured on his old company's cobra with Aetna so I would be covered during maternity should I become pregnant. I did become pregnant, but it was ectopic. The cobra was great and covered most of the expenses of this tragedy. A few months later I decided the cobra was too expensive so I applied for an individual policy through the same insurance, Aetna. Guess what: they denied me. Know why? Because I had been to see a fertility doctor within the past 10 years. FYI: most insurance companies will not insure you at all if they find out you have been involved in fertility treatment within the past. They will not allow you to get insurance for 10 years. Wanna know why that is? Because they assume you will become pregnant with a high probability of a complicated pregnancy and/or premature birth baby that will need millions of dollars of medical treatments. True.
Well, I managed to get insured with Cigna off of the website: ehealthinsurance.com. I signed on using my maiden name since I had been doing the fertility under my married name, and I had been admitted into the hospital with an ectopic pregnancy under my married name. Well, it worked, and it wasn't detected. I got a great individual insurance policy this way. If you are ever turned down for a simple healthcare policy through an agent due to infertility treatment in your past, try using your maiden name through a website such as ehealthinsurnace.com. This is definitely not a plug for this website, but they do make it easy. No questions asked. Provide them with an easy way to pay for your insurance policy such as autodraft from your checking account and this team of robots is glad to approve you. I received my ID card in the mail less than one week after being turned down by an individual agent selling me Aetna over the phone. Use the robots on the websites.
So, I was saving money, but this still didn't solve my problem which was that I didn't have fertility coverage. I had heard that a well known ladie's clothing store called Talbot's gave their employees a great insurance package including fertility coverage. I decided to apply, and I was interviewed and offered a job. I backed out because I could not see myself in this position for numerous reasons: I am an artist, I don't dress from there and never have, I can't work evenings after 11 years of self-employment, etc. Plus, I could see this being a real trap. I would need to remain there selling clothes until 9pm every night in order to keep my insurance during the pregnancy. I mean, it wouldn't be so easy as to just work there until I'm pregnant and quit. I would need maternity insurance as well. Individual healthcare policies do not offer this as an option. Since my husband and I were now both self-employed individuals we were stuck with individual healthcare policies which never offer maternity or fertility coverage.
The cobra I had given up was just too expensive, and following my ectopic rupture I knew it would be a year before I would attempt any fertility treatment again. During the next several months,we continued to investigate our options.
Here's where this story gets useful and informative: Then we had a light bulb moment when we learned from a local insurance salesman that a group insurance policy at a legitimate company only requires 2 eligible employees. I quit painting and joined my hubby at his business. We applied as a business with 2 employees and we were quoted $324 per person based on our ages. We decided to ask about an IVF Rider. It was like PULLING BIG HORSE TEETH! Trust me, though, you can get coverage even if you are a small company! We did! I found out a lot of basic information, but they were very tight-lipped about exactly what it would cover in respect to medications, procedures, etc. We took a chance and demanded to have this on our policy. It added a 45% upcharge to the existing premium quote of $648, for a grand totall of $940 for both of us to have a wonderful healthcare policy including maternity and fertility!!!!!!!!
Of course, a thousand dollars a month sounds steep, but we took a chance and guess what, we are now 8.5 weeks pregnant and I will be dropping the fertility coverage at 10 weeks. That means we paid a total of 5 months of the 45% premium upcharge which equals about $1500 in expense. We got $8000 worth of meds for about $164, and we got IVF for $535. So, add $164 for meds plus $535 for the procedure and we came out pretty good compared to the actual cost of roughly $20,000 without insurance. Even if it had taken several tries, we still would have come out way ahead. We had already been down the road of paying out of pocket, and this wasn't our first time. I took the things I had learned from all our previous attempts: 2 IUI's, one failed IVF, the ectopic rupture, and 2 FET's, and I applied what I had learned. This knowledge along with a new and wonderful doctor and regular acupunture and support of my family and friends combined with the reduced stress due to the fact that this time it wasn't costing us out of pocket all culminated into SUCCESS! I'm 40 and going to be a mom again! I have an 11 year old son who is ecstatic about finally becoming a big brother :o)
If you are self employed and you have at least 2 employees, seek out an agent who sells group insurance policies to small businesses. Engage in discussion about getting a minimum of 2 employee group policy. Once you have a quote for the healthcare portion including maternity coverage, ask them about what they offer for infertility IVF coverage. Don't close the deal with them until they provide you with as much information as possible pertaining to their IVF coverage. Go with an agent who has access to Bluecross Blueshield and/or United Healthcare.
Like I said, it was difficult getting adequate information from my sales agent or anyone else at the Benefit Mall for that matter. I had to send numerous e-mails and texts and threaten to go elsewhere with our small group healthcare policy. It all worked out, and I can say that Bluecross Blueshield of Texas has excellent coverage when you add on the IVF Rider. I can only recommend BluecrossBlueshield or United Healthcare because these are the two differenet agents I shopped. They both gave the same vague info and it was very comparable. United Healthcare actually had a better price, but it was too late for me to begin dealilngs with them because I was ready to begin IVF and I already had purchased the BCBS with IVF Rider. Here's the difference between the two: BCBS quotes the same identical price for males and females AND they include the 45% upcharge on the males as well. It is like a blanket price for all employees. United Healthcare had called me a little too late for my treatment schedule, or I would have bought UHC Insurance for our 2 person company. Here's why, they quoted a price for each employee based on their actual healthcare risks. Since, any males on the roup policy obviously wouldn't be using the IVF Rider, the 45% didn't apply to the males on the group policy. This makes a lot more sense, but I didn't have the luxury of switching. Below I have included the information I was able to obtain from the sales agent at Benefit Mall. I have included my questions.
Good Luck, and feel free to e-mail me directly if you have any questions about how we did it:
Click here to see the vague IVF Information I received from my agent at Benefit Mall prior to purchase.
After I received this vague document in response to my inquiry about what their IVF Rider will cover, I sent this e-mail back:
ME: What you sent does not go over the covered items for IVF. This talks about requirements to qualify once the benefit accepted by the plan. This does not go into any depth of what is covered and what is not such as medications, ultrasounds, egg stimulation, egg retrieval (out0patient surgery including anesthetic), egg transfer, bllodwork, cryopreservation of unused embryos, and the list goes on. The things one would need to know:
1. How much of the medications are paid for by the plan/rider for in vitro fertilization.
2. How much of the lab tests including blood work and ultrasounds are covered by the rider.
3. How much of the required doctor's visits and consultations are covered by the rider.
4. How much of the out-patient procedure of having the eggs retrieved from the ovaries is covered by the rider?
5. How much of the anesthesiast's fees are covered by the rider.
6. How much of the embryo transfer into the uterus another out-patient procedure is covered by the rider.
7. How much of the necessary cryopreservation of all unused embryos for future use is covered by the rider.
8. How much of the semenalysis is covered by the rider.
9. How much of the follow up doctor's appointments with the RE and OB/GYN are covered by the rider, this would be doctor's appointments, blood work, and ultrasounds.
10. What is the maximun benefit available if the rider is purchased for the plan?
11. Some policies allow up to 3 IVF and 3 FET or frozen embryo transfer procedures. Some policies allow up to a certain dollar amount such as $10,000 or $25,000. SOme even have unlimited tries until a successful pregnancy and healthy baby is achieved and/ or the patient decised to stop trying to conceive.
12. Finally, HOW MUCH DOES THE RIDER COST??????
I was not given enough information by anyone I am now sending this e-mail to in order to make an informed decision about the rider which is available on our plan.
Benefit Mall response:
Good Morning,
It is a 45% load for the invitro rider. I showed both plans with and without the rider. See attached quote.
I have sent her list of questions on to BCBS for some help with the answers. Without a policy in place I am not sure if they can answer many of the them.
My general knowledge of the rider is that it only covers the implantation of the fertilized egg, but I am checking.
Thanks, Laura
This is an ignorant response because she said "my general knowledge of the rider is that it only covers the implantation of the fertilized egg, but I am checking".....Well, no insurance policy in the world can promise implantation, right? I was a little put off by this answer so I plugged on...
Benefit Mall Rep's update:
Per my account manager at BCBS: ( I am not sure if these answer her questions by the number, but hopefully this will address most her questions.)
This is the information that I have on the Invitro Rider.
1. Injectables are subject to deductible and coinsurance. In-vitro drugs for PPO product would be covered same as any other medical service. They are not standardly covered under Prescription Drug benefit. If a doctor sends a member to the pharmacy for the drugs, the member will have to pay the full price and then send paper claim to pay under the Medical benefit. The claim will initially deny the drugs because they will show as Rx.
The member will have to contact Member Customer Service (800-521-2227) to get the claim adjusted.
Injectable drugs would be covered under medical, if approved by Utilization Management.
2. There is coverage for the four conditions listed in the Rider.
3. Artificial insemination is not covered.
4. Does not cover embryo storage & freezing.
5. Must be married at least 5 years. Yes, it must be documented.
6. There is no $$ amount allowed.
7. I do not know if there is a limit on attempts.
8. Subject to same benefits as Maternity Care, deductible and coinsurance.
These are the PPO In-Vitro benefits.
Thanks, Laura
This is the total info I was able to get after bugging them to death and nearly cancelling the entire deal due to their lack of adequate information. I decided to go for it, and as it turns out BCBS covers 80% and they covered almost all of the medications. At first, they will require you to pay out of pocket for the drugs, and then you will need to submit a reimbursement request form stating that these medications were medicaly necessary to complete the covered procedure of IVF. You may even need to bug them twice before you are reimbursed, but they should pay almost all of the medication costs.
