States with mandatory IF coverage

[tlew12778]

I'm wondering how much your IF treatment cost you if you live in a state with mandatory IF coverage. You don't have to give totals or anything, per treatment costs and drug costs work for me as well.

I'm asking bc I was just dx'ed with PCOS. I know that this does not mean I will necessarily need IF treatment in the future (we are not going to TTC for another couple years), but it's obviously a possibility. I am trying to figure out if it's worth it for me to stay in a country where IF is covered basically 100% or if we should move back to the US to a state (NY) where there is mandatory coverage (we'd be moving back to the US just to be closer to my family). I don't really understand what "mandatory coverage" includes.

I know it depends on who your insurance provider is. I'm just looking for a general idea.

Thanks!

[scout]

I *think* my treatments (one IUI, three rounds of Clomid, HSG test, endo biopsy, TONS of bloodwork and u/s) should have been around $20,000. I don't know the exact number, but I think I only paid about $2000 total for everything....if even that much. I wish all states had mandated IF coverage.

My state (Illinois) covered all diagnostic testing, and three rounds of IVF.

[~queen~]

I am in MD and they only cover 3 rounds of IVF per live birth at minimum 50%.

If you work for the Fed Gov, then they only cover 50% of each IVF attempt. That equated to about $3500 for everything, meds included.

[kat]

Here's a link to information about the Illinois law. The amount of coverage will vary from plan to plan, because they must treat it equally to "other" conditions (and how any one plan treats conditions obviously will vary).

http://www.ins.state.il.us/HealthInsurance/infertility.htm

By the way, note an important caveat at the top. "Self-insured" programs need not follow the Illinois law (only where the insurance company is actually acting as the insurer, not just the plan administrator). For example, I work for a university in Illinois. We had Cigna (and now have BCBS) as our "plan administrator," (meaning they did all the paperwork, etc.), but the program was actually self-insured by the university. As a result, the Illinois statute doesn't apply to us -- and if it wanted to, the university could've denied all infertility coverage without violating the law. As it turned out, the university *does* (did, in my case) cover a good percentage of the infertility treatment, but its coverage was not as good as what would otherwise have been required by law. I'm not complaining, however, b/c I know how expensive our IVF would've been without any coverage!

Bottom line: you cannot assume that just because you're moving to a state that "has mandatory coverage," that your employer would necessarily be covered by the law. Not all of them are, so you'd want to check that out, too.

Good luck!

[tlew12778]

Thanks ladies.

So basically the range of answers goes from "cheap" to "they don't cover anything"... great :rolleyes:. I guess I can't say I'm surprised. If an insurance company in the US can find a caveat to not cover a treatment, I am sure they take full advantage of it.

We'd be moving to NY... possibly CT. I know that CT only requires insurance companies to "offer" IF treatment coverage, which doesn't mean they actually cover anything I think.

Grrrrr.

[scout]

Kat brings up a good point. Remember that even if you live in a state with mandatory IF coverage, if the insurance policy is from a different state or if the company has fewer than 50 employees, you may not get the IF coverage.

[Freckles]

Remember that even if you live in a state with mandatory IF coverage, if the insurance policy is from a different state or if the company has fewer than 50 employees, you may not get the IF coverage.

We are in IL, but the company my husband works for is headed in another state that does NOT have the mandatory coverage, so the IL laws do not apply unfortunately just as Scout mentioned, so keep that in mind. The costs can add up fast.

Here is a link to give you an idea of patient costs:

http://www.embryo.net/fertility-pages/fee.html

[firebird]

Just some info on CT. I was on the resolve website the other day and they had an article that CT just passed some legislation regarding Infertility coverage. I think it goes into effect this fall. www.resolve.org

I am in MA which is another state that has mandatory coverage.