Preimplantation Genetic Diagnosis-Baby's Beginning

My experiences of concieving our first child using preimplantation genetic diagnosis

Friday, July 21, 2006

Insurance blurrence customer schmervice

Gee...thanks for nothing. We emailed our insurance asking what exactly would be covered and what wouldn't be covered for the PGD-IVF procedure some time ago. Our email was very precise and detailed, and we stated that we had read through the coverage discription and wanted to confirm that such and such was covered, and asked about such and such because the coverage discription didn't specifically say anything about it. But all they did for their reply was copy and paste the whole coverage discription. Yeah, that was helpful.

So, to the best of my knowledge that I can gleam from the coverage discription, they should cover all the normal IVF type stuff, but they probably won't cover the PGD procedure, and they only will pay for egg freezer storage for one year, so if we want to keep it longer than that we'll have to pay for the next years ourselves. Roughly, I estimate that about 70% of our expenses will be covered by insurance, leaving 30% for us to pay out-of-pocket. (If anyone's interested, our insurance is Blue Cross.) I'm still waiting for replies to some other emails before I'll know approximatly how much the total cost would be.


Anonymous AK said...

I know I already left a comment on one of your other posts, but thought I'd jump in here as well. I have Blue Cross (as does my sister with the same diagnosis). Your Blue Cross coverage all depends on the plan your employer has picked. For example, my BC coverage under my old employer covered NOTHING- no "infertility" coverage, and no PGD coverage at all. Under that policy they deemed PGD "experimental", citing articles written in the mid 1990s. My current BC policy covers all of the PGD, and it does not come out of my alotment for "infertility" coverage (we have 10K per LIFETIME for IVF). PGD is considered diagnostic, and is billed as such, rather than as a "treatment". If you have infertility coverage you can and should fight them to also cover your PGD- either by reminding them that it is diagnostic, or by challenging their outdated references.
While researching weather or not you have coverage for PGD, you need to have the ICD-9 procedure codes. The BC representatives you contact by phone or email won't have a clue about PGD or how to research it as part of your policy unless you give them the codes.
A bigger problem than researching the PGD coverage is convincing them to cover your IVF. Even if IVF is included in your policy, they may give you a hard time about skipping IUIs. Most insurance companies will cover IVF only after you've had a certain number of failed IUIs. My sister's BC actually approved her for PGD, but told her she had to have 3 IUIs under her belt before they'd pay for the IVF!! I helped her fight it, and she was able to finally get coverage (I still have her letter that she sent to BC to fight it if you're interested). My BC under my husband's policy is not giving me a tough time about covering the IVF, but are requiring a letter from my RE to be approved by their medical review board first.
Please drop me an email if you need any of the ICD-9 codes, or any of the BC bulletin numbers that address PGD.
Good luck with everything!!!

Thursday, January 04, 2007 6:56:00 p.m.  
Blogger PGDMom said...

Thanks for the great info! When I contacted them, they simply said no to the PGD portion of the IVF, and I didn't think fighting it was possible. I'm definitely going to try to fight for this, especially since in my case the genetic diagnosis is medically necessary because of my disorder.

I hadn't heard of the IUI requirement before, either. They didn't mention that in their reply, but like you said, the replying person wasn't exactly "all knowing". I hope that won't be a problem for me, since our genetic testing is medically necessary.

Thanks again for the great tips!

Sunday, October 21, 2007 11:49:00 a.m.  

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