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Blue Cross Blue Shield in MA

post #1 of 6
Thread Starter 
I'm looking for input from anyone in Massachusetts who has BCBS for insurance. I currently have Harvard Pilgrim and LOVE it, but it looks as though I may not have that option in the near future and will have two BCBS plans to choose from (HMO Blue and Blue Choice Value or something like that). So....if you have BCBS in Massachusetts, how do you find it to be for infertility coverage? What's been covered for you, and what hasn't? I'm trying not to panic here and I know I need to get a full explanation of benefits for each of the plans I'm being offered, but I'd love to hear your experiences.
post #2 of 6
I have not dealt with the infertility part of it, but I had BCBS MA until last year, where we switch to BCBS IL. I just can vouch for their excellent customer service and responsiveness on the phone. Whether IF treatments would be covered or not would depend on the plan negotiated with BCBS. I would suggest calling them-- IME, they give accurate explanations of the coverage.
post #3 of 6
Luckily for you....you live in a state that mandates coverage for infertility.

Massachusetts became the first state in the country to pass a law that legally defined infertility as a medical condition and mandated that health insurance companies provide coverage for infertility treatment. Today it is one of only 15 states that mandates coverage for infertility issues.


This state's law requires health maintenance organizations and insurance companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment. The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."

Benefits covered include:

* Artificial insemination;
* In vitro fertilization;
* Gamete Intrafallopian Transfer;
* Sperm, egg and/or inseminated egg retrieval, to the extent that those costs are not covered by the donor's insurer;
* Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility; and
* Zygote Intrafallopian Transfer (ZIFT).

Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs. (Annotated Laws of Massachusetts, Chapters 175,§ 47H; 176A,§8K;176B,§4J; and l76G,§4, 211 CMR 37.00).
post #4 of 6
Hello friend! I have BCBS of MA Network Blue. This is the only thing IF-related that has been lucky for me. I have had ZERO problems, I am completely shocked. I even got reimbursed for PGD in a timely manner; I had to pay out of pocket and then self-submit for it (lab was out of network, but this is okay because IVF is considered differently so it was covered), we very clearly qualified for it based on BCBS medical policy but I thought I was going to have to fight for that one. I will email you some things I have.
post #5 of 6
Eva~Do you know what other 14 states are practicing that law for IF treatments?
post #6 of 6
Thread Starter 
I know that MA mandates coverage - but how much and exactly what is covered varies from plan to plan.

I did get a chance to speak with the BCBS rep who is dealing with the plan for the school district in which I work and the coverage is exactly the same as Harvard Pilgrim. The only change for me will be higher copays. Not much to complain about there!
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