Insurance question (HPHC-Harvard Pilgram Health Care)

Insurance question (HPHC-Harvard Pilgram Health Care)

Joined: December 14th, 2011, 8:57 pm

July 14th, 2012, 6:51 pm #1

I have an chance to change my health insurance to HPHC (Harvard Pilgram Health Care) next month. I am with BCBS of MA now and got denied for IVF service due to previous (in 2010)Day 3 high FSH level, even though I passed CCCT test(Day 3 & Day 10 FSH level are normal) last month.BCBS of ma make decision based on "highest ever" Day 3 FSH level. I did some research on HPHC here,and it is said: You have to take CCCT test after you reach 40, I can pass CCCT test, and just worried the insurance will find my previous FSH number. Anybody here know if HPHC make decision based on highest ever FSH level or not? Since I have infertility problem for 3 years, will they reject to pay for my IVF based on preconditional situation even though I can pass the CCCT test? Thanks!!!
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Joined: December 14th, 2011, 8:57 pm

July 14th, 2012, 8:41 pm #2

I am the one who posted above. (no content)
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Joined: March 5th, 2011, 3:53 am

July 15th, 2012, 1:05 am #3

I too have HPHC. Im not sure if anyone can tell you whether or not they will find your previous FSH. If you use the same doctor/health care provider, and they have access to the records, I cant imagine that they wont see it. However, I dont know what there policy is. I do know with HPHC HMO, there is a caveat (although Im not sure if it is just for over 42 or not) that you have to have evidence of response to stimulation ie producing a specified number of follicles at a minimum size. If you have a different version of HPHC the requirements could be different.
I am in Boston as well. Would be good to keep in touch if you are in the city (or close).

D
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Joined: December 14th, 2011, 8:57 pm

July 15th, 2012, 2:35 am #4

Thanks for your help. I am 40.2 years old and had a high FSH in 2010. A few ladies talked about benefits of HPHC back in 2008, and they believe HPHC is much better than the other MA insurance companies regarding to FSH cutoff. I saw a doctor in Brigham women's hospital in 2010 and he submitted my high FSH level to my insurance, even though I changed my provider, since I am still with the same insurance, they have my medical record. and they use "highest ever" FSH level to make decision. So I want to change my insurance. BTW, I am seeing DR. Check in NJ now.
Keep in touch.
Below is the link to HPHC insurance,
http://www.network54.com/Forum/53068/me ... olicy-long
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Joined: March 5th, 2011, 3:53 am

July 15th, 2012, 3:40 am #5

I think if you change insurance, it might be good to change your provider (not dr check), but maybe your reg gyn ****/he might submit all previous results. But I could be wrong. I do think you are wise to change insurance if thet will get you coverage. There is little chance that i could pass the ccct but I am hoping to give it a shot. I also hoping HPHC will at least cover meds.

let me know how it goes.

D
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Joined: December 14th, 2011, 8:57 pm

July 15th, 2012, 2:56 pm #6

Are you over 40? Does insurance know you have high FSH? For my insurance(BCBS of MA) if they knows, even though you pass the CCCT test, and they will deny you based on your past high FSH level for sure. For HPHC, it maybe OK, so I need figure it out. I heard for some MA insurance companies, after they know your have high FSH level, if you can have 3 normal FSH levels later, they still pay your IVF cycles. so it all depends on insurance.
I benefit a lot from this forum, and I wish I came here early. My email : li0077@hotmail.com
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Joined: March 5th, 2011, 3:53 am

July 16th, 2012, 4:56 am #7

Im 43. I dont know if any insurance knows I have high FSH. bc HPHC is new to me, and Im changing everything (inc php), im hoping they dont know. Luckily, Dr Cardones office will not submit this result, so i can try for another time.

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Joined: December 14th, 2011, 8:57 pm

July 17th, 2012, 4:17 pm #8

There are some tricks to reduce FSH, make sure do some research on this forum first before you do CCCT test. I did call the insurance coordinator of the infertility clinic I go,but she has not return my call yet. You can ask the insurance lady in Dr. Cardone' office, and she may knows if HPHC cares about your previous high FSH if you can pass the CCCT. Good luck!
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Joined: December 14th, 2011, 8:57 pm

July 18th, 2012, 4:23 pm #9

and they won't go back to find a previous high FSH number and deny you. DarriasD, Try your best to pass the CCCT.
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Joined: March 5th, 2011, 3:53 am

July 21st, 2012, 2:25 pm #10

thanks. Ill ask Dr cs office to bill me personally for the FSH lab from this month.


email staylorne at gmail dot "youknowthe commercial one"
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