Coverage for IUI (or other artificial insemination) thru kaiser permanente?

[Sewitseems]

We are wondering if any lesbian has has had success at covering part of her iui (or other artificial insemination) thru kaiser permanente( even if just thru flexible/non kaiser, opt2&3 benefits)? All input is appreciated as we are planning !N

[easttowest]

Nothing of real value to add since we haven't needed medical intervention yet, but I have Kaiser, and the plan is to add my wife in January if we are not successful by then. As far as I can tell, fertility treatments are covered 50%. Obviously others might have real experience, but from reading my plan, that is what I know.

[pokeyAC]

Hi there and Welcome!  I have Kaiser, and I did IUI's there.  My plan also covers 50%, but some plans cover more.  If you are not sure, you can call member services and they will tell you what your plan covers.  First, you have to get a referral to the fertility department from your regular doctor.  I don't know where you're located, but we had to attend and Art of Fertility orientation class before we could see a doctor.  They talked about fertility and about how the process works in the office.  They give you lab sheets to get your bloodwork done on cycle day 3 and around cycle day 21, 22, or 23.  Once you do the tests, they schedule an appointment for you to meet with the doctor and go over your health history.  Then you can get started. They may suggest starting on Clomid right away, but if you don't think you need that kind of help, just tell them you only want them to do the IUI's for now.  If you decide to have an HSG, a test to see that your tubes are clear, be sure to find out how much it will cost you first.  Mine was a lot more expensive than I thought it would be.  I have heard you can get it done cheaper somewhere else.  At first I wanted to do everything naturally, but when I decided I needed some help, I was glad I was already in the system.  The doctor and nurses have been really sweet. 

I'm not sure about the benefits you mentioned above, but you can definitely pay for IUI with flexible spending accounts.  Also, depending on where you are, you may be able to find a midwife who can do IUI at home for you.  If you have any questions, just let me know.  Good luck!

[maryeliz]

I think that the specifics of what your plan covers will also depend on state law and what the insurance company is required to cover in your state.  Have you already looked at your long benefits brochure?  That should give you the basics of what is covered under your insurance.  In my state/with my insurance, IUI were only covered with a diagnosis of infertility and if the woman uses her husband's sperm-obviously that was not us.  We self-paid, but I was able to use my insurance for my initial RE consult, bloodwork, and meds.  We chose a global fee program at the RE (a set price for the cycle) and we also got financial aid that equaled a 20% discount.  I think these programs are pretty common at the larger RE practices.  If you have chosen a fertility clinic to work with, they may also have a financial person who can walk you through what your insurance will and will not cover-usually they are experts.

Personally, I don't know anything about the appeal process, if your insurance says they won't cover the iuis-but I wish you the best of luck!
 

[pokeyAC]

Just wanted to add that I did not have to prove infertility because I am a lesbian.  I had no problem getting right into the Kaiser program.

[Sewitseems]

Maryeliz, Do you have Kaiser and what state are you in? Thanks for your response, just trying to clarify.

[Sewitseems]

Thanks pokey, that's how I understood it and may contact u with more questions,

[maryeliz]

No, I don't have Kaiser-hope you get good news from them!

[Sewitseems]

Pokey- I am not able to send msgs out. Please send me a pm with your contact info. Thanks, Sarah