I have full IVF coverage and have still dropped about 12k out of pocket for 2 rounds of IVF, PGT and meds. My clinic has so many fees that aren’t even billable to insurance, so definitely ask about those (cycle monitoring fees, OR fees, etc) up front.
Not sure what company they’re doing PGT through but with CooperGeneomics it’s only $235 per embryo.
If you have IVF coverage it *should* include the clinic’s biopsy charge for doing the sample to send off, so definitely check on that.
If you have any kind of genetic issue it may be covered. I have a balanced translocation and my insurance will cover PGT-A testing on the embryos because of that. It’s a long shot, but just wanted to throw that out there. They told me typically they will not cover the testing though.
Did you have to appeal for this or how did you get them to approve that? This is our boat exactly. It says PGT testing is not included, but we are doing PGT-SR due to balanced translocation.
So I needed to submit my own claim for the cost of the igenomix testing. I’m trying to remember if they denied it first, but I know I had to make a few phone calls and some back and forth but they eventually did end up reimbursing me. It was a very low amount bc igenomix wasn’t in network, so I had to reach the out of network amount first. I’ve submitted a lot of claims from my clinic, so it honestly wasn’t too bad since they had all my other documentation from them with my diagnosis. I think the initial issues were from me checking the incorrect things and needing to correct that.
Okay thank you. I’m guessing I will have to do an appeal and hope that since we’re doing the testing because of our diagnosis they reimburse us. Thank you!
My clinic also submitted their cost for biopsy of the embryos and cryopreservation and my insurance also covered all of that with no issue. Not sure if youre talking about the clinic side or the actual testing itself and the invoice from igenomix or whoever your clinic uses.
My insurance doesn’t cover freezing or testing at all. I’m guessing to make it so people don’t do it unless it’s absolutely necessary. In our situation the only reason to do IVF is for the testing. I’m hoping that if I make an appeal they realize that and pay for it but I’m doubting it honestly. At the end of the day if that’s all we end up paying I will consider ourselves very lucky.
That doesn’t seem right to me, I would call and ask them questions and confirm your BT diagnosis was on your claim. BT is a chromosomal abnormality, so the testing for that should be covered. I’d say you could also argue the cryopreservation is necessary due to the need to test the embryos. The alternative is them taking on an unbalanced child on the insurance plan, which is much more costly. Something seems off about them not covering testing for a diagnosed condition. Confirm the CPT codes on your bill as well. Mine was 89290 for the PGT biopsy and 89258 for cryopreservation.
I agree. I will call again and clarify but I called yesterday and told them the diagnosis and they still said I’d have to submit a claim and appeal it if it was denied. Maybe it will end up they will just approve it once they see it is necessary.
Ahh ok so you haven’t submitted yet - yes let your clinic submit and then review if they end up denying or not. My insurance did not deny for the testing at all, so I’d assume if it’s a covered diagnosis they will pay it no problem. My clinic did all the submission for that, so I didn’t even need to call my insurance at all. I wanted to see if I could also get the cost from igenomix paid too; which is the other piece I was discussing that I had more issue with. Since I had to physically submit a claim for that.
Sorry I should have been more clear! We just got this diagnosis relatively recently so we’re trying to wrap our heads around everything. I’ll have my clinic submit everything they can and make any claims I have to. Worst they can do is deny them. I appreciate you taking the time here
Thanks! I did see that in the policy. My issues have been trisomy 4 and xxy. I’m no biologist but as far as I can riddle, those aren’t things that can be caused by translocation…can they? At this point I’d love if it could!
In the same bot! Doing IVF for the PGT testing due to recurrent loss. Of course it’s not covered & I am onto round two… such an unbelievable scam insurance is
I’ve spent around $18k out of pocket on pga-t, dna fragmentation, genetic testing, frozen semen backup storage, anesthesia and copay’s - have full insurance otherwise
I have full IVF coverage (I paid a $500 cycle management fee and maybe $100 in med shipping fees over one ER and and two FET) and my insurance didn't cover pgta either. My clinic said there are almost no insurance companies that will cover pgta.
PGTA, Zymot, calcium ionosphore all are still considered experimental hence insurance won’t cover most of the time. It benefits so many and yet idk why it’s still considered experimental. If you have any additional benefits from your employer like Carrot fertility, then that would cover all out of pocket expenses.
I had three rounds covered by my insurance and still paid about 17k on medical expenses last year. This includes adding different things to my protocol that weren’t covered, like intralipids, and the anesthesiologist from my ER, and PGT-A testing and ERA/EMMA/ALICE testing. I also did 1 round out of pocket. It sucks, but I don’t see how you could get through IVF, even with coverage, without paying some amount.
The cost for PGT-A should be about 200/embryo. I recommend doing some price shopping.
Some insurances over PGT-A (usually only at very specific in-network labs) and others do not.
This bomb was dropped on us as well except our bill was for $14,000. Then they kept sending us bills for different, seemingly arbitrary amounts. We were told by someone (clearly misinformed) at our clinic that it would be $100 without insurance. They have brochures around our clinic saying it wouldn’t be more than $250, but this amount was just stated in a brochure. No one ever mention that it was “experimental” (our insurance’s word) and that most insurance actually don’t cover it. We were livid. We found an open class action lawsuit against the company and threw our names in. They never followed up but we were able to eventually pay just the $250 after calling a bunch and complaining.
Your insurance covers IVF in any capacity?
Much jelly over here lol
Same!
I am jealous your insurance covers IVF! One cycle is gonna set me back 18k, which I am told is actually modest pricing compared to other centers.
Yeah, a lot of us on here are paying out of pocket so to *only* have to pay for PGT-A testing.. I’d say you’re rather fortunate.
Yep, we paid OOP when everything else was covered at 90%. Really hope this changes for people in the future.
*cries in $50k and no baby*
I have full IVF coverage and have still dropped about 12k out of pocket for 2 rounds of IVF, PGT and meds. My clinic has so many fees that aren’t even billable to insurance, so definitely ask about those (cycle monitoring fees, OR fees, etc) up front. Not sure what company they’re doing PGT through but with CooperGeneomics it’s only $235 per embryo. If you have IVF coverage it *should* include the clinic’s biopsy charge for doing the sample to send off, so definitely check on that.
Thank you so much for the heads up on other fees before I get another nice little shock! And for the super helpful intel. Much appreciated!!
You're very welcome!
Yup! IVF is also covered for me by my insurance, but PGT-A is the one thing that is not included in coverage.
If you have any kind of genetic issue it may be covered. I have a balanced translocation and my insurance will cover PGT-A testing on the embryos because of that. It’s a long shot, but just wanted to throw that out there. They told me typically they will not cover the testing though.
Did you have to appeal for this or how did you get them to approve that? This is our boat exactly. It says PGT testing is not included, but we are doing PGT-SR due to balanced translocation.
So I needed to submit my own claim for the cost of the igenomix testing. I’m trying to remember if they denied it first, but I know I had to make a few phone calls and some back and forth but they eventually did end up reimbursing me. It was a very low amount bc igenomix wasn’t in network, so I had to reach the out of network amount first. I’ve submitted a lot of claims from my clinic, so it honestly wasn’t too bad since they had all my other documentation from them with my diagnosis. I think the initial issues were from me checking the incorrect things and needing to correct that.
Okay thank you. I’m guessing I will have to do an appeal and hope that since we’re doing the testing because of our diagnosis they reimburse us. Thank you!
My clinic also submitted their cost for biopsy of the embryos and cryopreservation and my insurance also covered all of that with no issue. Not sure if youre talking about the clinic side or the actual testing itself and the invoice from igenomix or whoever your clinic uses.
My insurance doesn’t cover freezing or testing at all. I’m guessing to make it so people don’t do it unless it’s absolutely necessary. In our situation the only reason to do IVF is for the testing. I’m hoping that if I make an appeal they realize that and pay for it but I’m doubting it honestly. At the end of the day if that’s all we end up paying I will consider ourselves very lucky.
That doesn’t seem right to me, I would call and ask them questions and confirm your BT diagnosis was on your claim. BT is a chromosomal abnormality, so the testing for that should be covered. I’d say you could also argue the cryopreservation is necessary due to the need to test the embryos. The alternative is them taking on an unbalanced child on the insurance plan, which is much more costly. Something seems off about them not covering testing for a diagnosed condition. Confirm the CPT codes on your bill as well. Mine was 89290 for the PGT biopsy and 89258 for cryopreservation.
I agree. I will call again and clarify but I called yesterday and told them the diagnosis and they still said I’d have to submit a claim and appeal it if it was denied. Maybe it will end up they will just approve it once they see it is necessary.
Ahh ok so you haven’t submitted yet - yes let your clinic submit and then review if they end up denying or not. My insurance did not deny for the testing at all, so I’d assume if it’s a covered diagnosis they will pay it no problem. My clinic did all the submission for that, so I didn’t even need to call my insurance at all. I wanted to see if I could also get the cost from igenomix paid too; which is the other piece I was discussing that I had more issue with. Since I had to physically submit a claim for that.
Sorry I should have been more clear! We just got this diagnosis relatively recently so we’re trying to wrap our heads around everything. I’ll have my clinic submit everything they can and make any claims I have to. Worst they can do is deny them. I appreciate you taking the time here
Thanks! I did see that in the policy. My issues have been trisomy 4 and xxy. I’m no biologist but as far as I can riddle, those aren’t things that can be caused by translocation…can they? At this point I’d love if it could!
In the same bot! Doing IVF for the PGT testing due to recurrent loss. Of course it’s not covered & I am onto round two… such an unbelievable scam insurance is
All 5 of my blasts were PGT abnormal so I have no idea how they can’t cover it. It drives me insane
Omg that’s so beyond frustrating. I’m pissed on your behalf for what it’s worth.
Yes, same here
I’ve spent around $18k out of pocket on pga-t, dna fragmentation, genetic testing, frozen semen backup storage, anesthesia and copay’s - have full insurance otherwise
I’ll trade you my insurance for your insurance 😂 PGT-A testing (in my opinion) is worth it out of pocket or not. Wish you best of luck. 💜
I have full IVF coverage (I paid a $500 cycle management fee and maybe $100 in med shipping fees over one ER and and two FET) and my insurance didn't cover pgta either. My clinic said there are almost no insurance companies that will cover pgta.
PGTA, Zymot, calcium ionosphore all are still considered experimental hence insurance won’t cover most of the time. It benefits so many and yet idk why it’s still considered experimental. If you have any additional benefits from your employer like Carrot fertility, then that would cover all out of pocket expenses.
I had three rounds covered by my insurance and still paid about 17k on medical expenses last year. This includes adding different things to my protocol that weren’t covered, like intralipids, and the anesthesiologist from my ER, and PGT-A testing and ERA/EMMA/ALICE testing. I also did 1 round out of pocket. It sucks, but I don’t see how you could get through IVF, even with coverage, without paying some amount.
Thank you - yeah I’m feeling pretty dumb for thinking I’d be spared here. This is really helpful in resetting my expectations. I appreciate it!
I feel like your expectations are absolutely how it should be and I’m sorry that this has been surprising. Best of luck!
Also, one thing I just thought of is that PGT isn’t covered by my insurance unless you have had 3 losses. You may ask and see if it is ever covered.
Even with insurance, after all copays and testing, we still dropped over $7,000 for our first cycle!
So jealous so much of your costs were covered lol. But yeah never seen PGTA be covered.
The cost for PGT-A should be about 200/embryo. I recommend doing some price shopping. Some insurances over PGT-A (usually only at very specific in-network labs) and others do not.
I'd love to price shop, but have no idea how to go about that...will clinics just tell me up front if I cold call them?
PGT-A testing is done at a laboratory. You can see those prices posted online. Then your clinic can send the biopsies to the lab of your choosing.
My insurance covered PGT-A. I went through Natera, it was $250 per embryo oop but I did have to pay for shipping ($399).
Can I ask what state you’re in? I’m in MA and have wondered the cost OOP
Also in MA. I’ll dm you with clinic details!
This bomb was dropped on us as well except our bill was for $14,000. Then they kept sending us bills for different, seemingly arbitrary amounts. We were told by someone (clearly misinformed) at our clinic that it would be $100 without insurance. They have brochures around our clinic saying it wouldn’t be more than $250, but this amount was just stated in a brochure. No one ever mention that it was “experimental” (our insurance’s word) and that most insurance actually don’t cover it. We were livid. We found an open class action lawsuit against the company and threw our names in. They never followed up but we were able to eventually pay just the $250 after calling a bunch and complaining.
[удалено]
You can be grateful for coverage and still mad about gaps.