Massachusetts Ladies – please help with selecting insurance

Massachusetts Ladies – please help with selecting insurance

Rose
Rose

April 17th, 2012, 7:33 pm #1

So, Im approaching the open enrollment period at my job and wanted to make the most out of what is left in my IF coverage. Im now 40 yrs old so feel the resistance with getting approved from by Tufts (my current insurance)

I work for the state and looks like there are pretty decent plan offered but I dont know which one is best. Has anyone heard of the indemnity plans? There are a few being offered and Im not sure what I should even be looking for the best coverage. Anyways, here are the 3 indemnity plansif you have any experience with any on them, I would love some feedback.

UniCare State Indemnity Plan / Basic
UniCare State Indemnity Plan / Community Choice
UniCare State Indemnity Plan / PLUS

Rose
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Erin
Erin

April 17th, 2012, 10:13 pm #2

Hi Rose- I'm from MA but don't have any experience with the Unicare Indemnity plans. I always go with the most expensive/highest coverage plan, which I'm guessing is the "PLUS" plan- is that a PPO? It would be important to know if it is and would cover you going out of state for care since, IMHO, the best clinics for women with high FSH are out of state. I'd also suggest getting the document that spells out the infertility policies for each plan from HR and look at the over 40 and FSH requirements since I believe MA law says the insurer can still deny coverage on those 2 bases if they choose. Hope that helps- good luck!
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PhoebeMass
PhoebeMass

April 17th, 2012, 10:29 pm #3

So, Im approaching the open enrollment period at my job and wanted to make the most out of what is left in my IF coverage. Im now 40 yrs old so feel the resistance with getting approved from by Tufts (my current insurance)

I work for the state and looks like there are pretty decent plan offered but I dont know which one is best. Has anyone heard of the indemnity plans? There are a few being offered and Im not sure what I should even be looking for the best coverage. Anyways, here are the 3 indemnity plansif you have any experience with any on them, I would love some feedback.

UniCare State Indemnity Plan / Basic
UniCare State Indemnity Plan / Community Choice
UniCare State Indemnity Plan / PLUS

Rose
You should definitely post on the Over 40 board - first and foremost.

I have been through a lot of insurance issues in Mass.

Two numbers matter: E2 and FSH. Can't "undo" any testing that has been done so far.

I had a positive experience with Harvard Pilgrim at your age. We then switched to Blue Cross Blue Shield. It was more difficult and their levels were more stringent.

I'm so sorry that I don't have any experience with the Uni plans. Frankly, if you know any colleagues that have had similar issues then I would ask them. Or a trusted HR person.

It's great to have coverage in Mass IF you can get by the E2 and FSH mandates that each insurer individually sets....if you don't it is really frustrating.

Good luck, Rose. If I can answer anything with BCBS or Harvard Pilgrim I'll do my best to remember. We are now self-pay based on age. 45.
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Rose
Rose

April 18th, 2012, 3:45 pm #4

Hi Phoebe,

thanks for the suggestion.

I also have a choice of Harvard Pilgrim but I am exploring my options to see if Harvard or one of the indemnity plans would be better. I cant discuss this stuff at work or with HR (political reasons) so all my research needs to get done on the side.

Tufts gave me a hard time as soon as I turned 40my last IVF (#5) was denied for reasons, which were not even trueits like the people who review this stuff are blind of something. Luckily my RE fought for me and I won the appeal and they covered it. Now, Tufts has tagged me so every little thing related to IF coverage gets denied. Also, they recently added new language in the policy, which states all IUIs now require prior authorization and with my luck, they will deny deny deny coverage.

As for the other plans, I have trying to get info by calling the customer service department and so far, I am not having any luck.

Rose
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PhoebeMass
PhoebeMass

April 18th, 2012, 4:33 pm #5

There is so much information on there. One person was able to get the down and dirty, inside, docs from BCBS. Just search deeply and you'll find some info on there. I just can't recall the Uni plans ever being discussed. But give it a try and you may find something.

Harvard Pilgrim seems to have the least stringent rules than all the other big ones. But I don't know anything about Uni.

Congrats on getting a reversal of an appeal with Tufts!

Which RE do you use, if you don't mind me asking. And FSH / E2 levels.

Good luck, Rose. It's well worth it to do your homework, as you know. Oh, also ask your RE's insurance person - they will definitely know. Can't believe I forgot to mention that.
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Mrs. McIrish
Mrs. McIrish

April 18th, 2012, 5:36 pm #6

Hi Phoebe,

thanks for the suggestion.

I also have a choice of Harvard Pilgrim but I am exploring my options to see if Harvard or one of the indemnity plans would be better. I cant discuss this stuff at work or with HR (political reasons) so all my research needs to get done on the side.

Tufts gave me a hard time as soon as I turned 40my last IVF (#5) was denied for reasons, which were not even trueits like the people who review this stuff are blind of something. Luckily my RE fought for me and I won the appeal and they covered it. Now, Tufts has tagged me so every little thing related to IF coverage gets denied. Also, they recently added new language in the policy, which states all IUIs now require prior authorization and with my luck, they will deny deny deny coverage.

As for the other plans, I have trying to get info by calling the customer service department and so far, I am not having any luck.

Rose
I have T.ufts as my secondary carrier and they won't pay for anything IF-related for me unless I use DE (I am 38 but my IVF's were disastrous so they cut me off). I am also looking at H.arvard Pilg.rim to switch to. My DH also works for the state and it looks like we have the same GIC choices!
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Rose
Rose

April 18th, 2012, 8:37 pm #7

Hi Rose- I'm from MA but don't have any experience with the Unicare Indemnity plans. I always go with the most expensive/highest coverage plan, which I'm guessing is the "PLUS" plan- is that a PPO? It would be important to know if it is and would cover you going out of state for care since, IMHO, the best clinics for women with high FSH are out of state. I'd also suggest getting the document that spells out the infertility policies for each plan from HR and look at the over 40 and FSH requirements since I believe MA law says the insurer can still deny coverage on those 2 bases if they choose. Hope that helps- good luck!
...and, I don't know the difference between them. As mentioned before, I am not making any headways when trying to get info by calling the insurance company. Thanks so much for your input.
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Rose
Rose

April 18th, 2012, 8:48 pm #8

There is so much information on there. One person was able to get the down and dirty, inside, docs from BCBS. Just search deeply and you'll find some info on there. I just can't recall the Uni plans ever being discussed. But give it a try and you may find something.

Harvard Pilgrim seems to have the least stringent rules than all the other big ones. But I don't know anything about Uni.

Congrats on getting a reversal of an appeal with Tufts!

Which RE do you use, if you don't mind me asking. And FSH / E2 levels.

Good luck, Rose. It's well worth it to do your homework, as you know. Oh, also ask your RE's insurance person - they will definitely know. Can't believe I forgot to mention that.
...that is a good idea and thanks for suggesting. I went to Cardone, who did my IVF 4 & 5. The 4th one resulted in a BFN and for the 5th one, I got sick so all 4 embies had to be frozen. I am now trying to find an insurance plan that would allow me to do an FET or cover IUIs. My tufts plan now requires an authorizaton for all IUIs and the likelihood of me getting approved is very slim.

I don't mind at all sharing my stats...my E2 tends to be on the high side (above 100) on CD3 but my FSH is usually under 10. Most liekly, the FSH is being supresseed since these both tend to affect one another. Overtime my cycles are getting shorter and I am ovulating sooner and sooner. So, there is definately some ovarian reserve issues going on.

Rose

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rose
rose

April 18th, 2012, 8:56 pm #9

I have T.ufts as my secondary carrier and they won't pay for anything IF-related for me unless I use DE (I am 38 but my IVF's were disastrous so they cut me off). I am also looking at H.arvard Pilg.rim to switch to. My DH also works for the state and it looks like we have the same GIC choices!
it is unfair becuase it could be the RE's protocol that can cause a bad IVF outcome but you as a patient ends up suffering with the insurance company. I'm hearing positive things about Harvard so I might investigate further.

Did your husband ever look into the indemnity plans? They have such high premiums so I wonder if they are any better.

Rose
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Mrs. McIrish
Mrs. McIrish

April 18th, 2012, 9:01 pm #10

No, we never looked into the indemnity plans at all. I have some other medical issues and use my coverage a lot so I don't want high deductibles for that reason.
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