Cash pay for IVF; will BCBS cover future related services?
This is kind of long and confusing so I apologize in advance. I have BCBS of Massachusetts and luckily my plan does cover infertility services. My husband and I have to pursue IVF given lack of response to other measures. SO IVF has 2 main components. The first is the retrival and fertilization of eggs and the second is the transfer of the fertilized eggs into the body.
My doctor sent the prior auth for the retreival only because BCBS requires a separate auth to be sent for the second part (the transfer) after the retreival part is completed. So my doctor asked for authorization to do the IVF defined as "a procedure where eggs are fertilized outside of the body" and Intercytoplasmic sperm injection (ICSI) defined as "insertion of sperm into an egg" The approval came back as partially approved bc BCBS did approve the IVF, but denied the ICSI. IVF can be done without ICSI but our doctor's office requires the ICSI which cost $14,000. We were told by our doctors office it makes sense to do cash pay which would only be $10,000 and covers everything. This was a much better deal bc if we went with insurance we would have to pay the $14,000 for the denied ICSI and the other $2,500 to get to our deductible. So we are going with cash pay for the retrieval. However there is then the second part of IVF which is the frozen embryo transfer. Our plan states "Frozen Embryo Transfer is covered when the following criteria are met: • Embryos were created during a BCBSMA approved IVF cycle, OR • Embryos were created while patient under insurer other than BCBSMA AND member meets infertility criteria on this policy (either at time at freezing or prior to transfer) Not covered services include but are not limited to the following: • Frozen embryo transfer (FET), or use of thawed eggs/sperm if not initially approved by BCBSMA OR if infertility criteria above were not met at time of freezing or at time of transfer."
Here is my question…will our insurance still cover the frozen embryo transfer if we pay cash for the retrieval? Technically the IVF was approved but we just chose to go cash pay because of the lack of coverage for ICSI. I can't seem to get any answers from my insurance until the auth for the transfer is sent. I'm trying to be proactive and honestly I'm anxious about it bc if the insurance doesn't cover the transfer, that is another $4,000 out of pocket each time. Any help or guidance is appreciated.
submitted by /u/Helpful_Enthusiasm66
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