Group, The ACA and In Vitro Fertilization (IVF)

[brooks]

Client is in early 30's an age group where everyone is having babies. Client wants babies but needs some help. She wants to undergo in vitro fertilization (IVF). Friends have suggested client drop her group insurance then enroll for insurance via marketplace. Friends indicate benefits are better for IVF in Illinois (and several other mandated states) through ACA.

IVF's are $20K each. Her group plan caps IVF's at $15K. ACA plan would give her up to 4 IVF's totaling potentially $80,000.

Client switches to ACA plan. Client would pay $300 month premium. $3,600 annually. Her maximum out of pocket is $5,000. $5,000 annually. Client would spend roughly $8,600 to have 4 IVF attempts. Any one of which would be $20,000 normally.

Friends may be on to something. But seems too good to be true. I've got to be missing something.

 

[tonyisme]

NFP natural family planning may work for her and her husband and save her a ton a ton of money

 

[somarco]

Only 15 states mandate IVF and coverage will vary by state.

Here is the language for IL

Coverage is limited to four completed oocyte retrievals, except if a live birth follows a completed oocyte retrieval, then two more completed oocyte retrievals are covered.

IVF is not a medical necessity, so I am unsure why it is covered at all.

 

[tonyisme]

Brooks ...experience tells me its risky moving an insured client to another plan when you know it will be a guaranteed claim...be careful and if it were me..i would stay out of this. NFP should be tried first if they havent done it already.

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If the male has been sterilized some forms of this surgery can be reversed. It is better to find out the underlying reason for the difficulty of having children before changing health plans. This is only my opinion. I had a friend who had the surgery reversed if somebody has been sterile. There are special physicians who do this.

 

[brooks]

Brooks ...experience tells me its risky moving an insured client to another plan when you know it will be a guaranteed claim...be careful and if it were me..i would stay out of this. NFP should be tried first if they havent done it already.

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If the male has been sterilized some forms of this surgery can be reversed. It is better to find out the underlying reason for the difficulty of having children before changing health plans. This is only my opinion. I had a friend who had the surgery reversed if somebody has been sterile. There are special physicians who do this.

Tony,

I'm not sure I understand the response. I thought Natural Family Planning (NFP) gives a married couple a way to space out childbirths and limit the total number of children? She wants just the opposite. She wants children.

Client is 33. Husband is 38. She has no children and wants a family.

She explained the problem. Something about the sperm not being able to penetrate the egg. She will not be able to have a child without help.

 

[tonyisme]

I am trained in NFP and have practiced it and the husband and wife need to work together to achieve either conception or spaced out child births. NFP works Unless there is a medical issue that has not been disclosed on this thread. OBGYN s who are practicing their Catholic beliefs will know what I'm talking about and can prescribe methods. But a supporter of the in-vitro industry will not care about NFP.
I really had no idea these procedures were 20 K Wow.

 

[kgmom219]

ivf is not a medical necessity, so i am unsure why it is covered at all.

..............preach it!!!!

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She explained the problem. Something about the sperm not being able to penetrate the egg. She will not be able to have a child without help.

If the sperm cannot penetrate the egg, she probably needs GIFT or ZIFT. Not just IVF.

Run away. The best advice you can give her is to talk to someone (doctors office? Support group?) who specializes in getting these covered. This is an E&O claim waiting to happen.

 

[tonyisme]

Here is a couple of websites which you might consider sharing with your client who is considering invitro ..this may help

http://ldysinger.stjohnsem.edu/THM_544_Marriage/08_Fertility/03_NFP_basics.htm


http://www.fam-sensiplan.com/about-me.html

 

[drtaffy]

Tonyisme - Have you heard of Taking Charge of Your Fertility by Toni Weschler? I read it before getting pregnant. Really good resource.

 

[tonyisme]

This looks like THE book based on Amazon reviews. I'm 51 and wife 52 but seems like it would be a great resource.
$17. VS $20,000 is worth a try and some patience. I know there are a few pediatricians who have stopped prescribing birth control due to the side effects.