Kaiser or Blueshield for fertility treatments?

[myfairbabies]

I currently have health net insurance, but my husband's work is getting rid of it and we need to pick another one. We can only switch insurance companies once a year (every November, to start in January) so we need to make a decision soon! I would love to have a VBAC at Kaiser Walnut Creek, and see the midwives there. I don't want to go to John Muir, or all the way to Alta Bates, but this is dependent on us actually having a baby next year. We've been trying for almost a year and am scheduled to see an RE next week for our first appt so we haven't had any testing yet. I seem to have normal cycles, and we have a 3 year old that was easy to conceive. It seems that I'm hearing Kaiser is not great for fertility treatments (no IVF, limited coverage for drugs and treatments) but I was wondering if anyone has gone through this with those insurance companies. Any opinions on which one would be better? Thank you!

[pokeyAC]

Your husband should ask specifically what his companies plans cover for fertility and IVF.  It depends on the employer.  There are many different plans.  My Kaiser plan covers 50% for fertility, but I know someone who has 80% coverage.  Mine doesn't cover IVF, but some do.   However, you can get the drugs and do the monitoring through your RE which could save a lot of money on the total cost.  I am happy with my care.  The doctor and nurses have been great 99% of the time.  With Kaiser you can email your doctor and nurses.  I also like that everything is in one place.  The Dr's office, the lab, and pharmacy are all near each other.  You never have to search around for a pharmacy or a lab to get something done.  I think that's convenient.  Good luck with your choice and with getting pregnant!   

[SilaMarila]

Again, it depends on the employer and it depends on the plan. You will have to look at each plan closely. We have an Anthem Blue Cross PPO and have %50 coverage on infertility up to a lifetime total of $5,000 excluding IUI and IVF. They have covered all tests trying to diagnose and underlying condition and all of my prescriptions. Most of my ultrasounds/monitoring has come from out of pocket as well as all of my IUIs.

When choosing an RE make sure you chose one that works with your insurance and can bill them directly. Even though they make take insurance, they may not have a contract with your insurance company and you will have to handle all of the billing yourself (that was hell and one of the reasons we ended up switching REs). Also, if you live in an area where you can "shop around" and see what different REs are charging for treatments your Ins doesn't cover, that can be a way to save $'s. For example, my RE now charges $110 for a monitoring u/s, my first RE charged $160.

[myfairbabies]

Thank you both for the input, it's very helpful! We love our current RE, so if we switch to Kaiser I will be sad we won't get to use them anymore, but maybe we'll be pregnant by then. So far I am totally normal, so hopefully it won't take too long with their help.
 

[Pookietooth]

I had Kaiser when I was getting fertility treatments back in '01-02, and the coverage I had then was for the meds and monitoring, and also covered an IUI but not IVF. I think this is pretty typical but when I had United, it was another story. Not sure about BlueShield. At Kaiser, I saw Dr. Janie Hirata, along with another in the same building in Oakland. My oldest was conceived with an IUI and Repronex. It was a bit of an assembly line, but then most fertility clinics are. I have heard that other REs will do the IVF with Kaiser just covering the meds, but I don't know for sure. You should not only check what the two plans cover, but also, if you do use Kaiser, find out if they will still do everything but the IVF there (I didn't go that route that time). Good luck!

[orangekoolaid]

hi.  does your employer offer a healthcare flexible spending account?  We've used that to pay for our treatments and it's saved $$$ since my plan doesn't offer it (I currently have Healthnet also)