Health insurance excludes infertility care after sterilization reversal, KindBody benefits documents don’t mention sterilization, and I’m not even sure if the Kindbody benefits are "health insurance" so I’m not sure how one plan affects the other
I generally consider myself pretty well versed in how health insurance works but I'm lost when it comes to the interaction between our health insurance benefits and our Kindbody benefits. I'm concerned that if our health insurance specifically excludes us from coverage for infertility care that Kindbody will also reject our claims. For the sake of simplicity lets ignore the issue of coverage for fertility medications and just focus on monitoring and procedures.
Kindbody is both a provider of benefits and the fertility clinic we're using.
Our Kindbody benefit summary is:
"Up to $25,000 per lifetime benefit for fertility services including IUI, IVF and medically necessary egg/embryo/sperm preservation. Up to $15,000 per lifetime for fertility medications through KindbodyRx (dispensing pharmacy is Schraft's Pharmacy). Additionally, up to $10,000 per lifetime for the reimbursement of eligible donor services. (See note below)
Both medical and pharmacy benefits are subject to the cost share as described in your Destination Wellbeing Aetna, CareFirst BCBS or Cigna medical plans. Eligible donor services may be subject to tax.
Note that any prior fertility and fertility medication utilization will go towards the lifetime maximums."
The note after the first paragraph reads: "Fertility service and medication claims will run through your medical plan and are subject to applicable medical plan deductible or coinsurance."
There are no listed exclusions.
The section of the document that covers diagnostic testing says: "In the instance where major medical does not cover your services, your Kindbody Benefit Coverage will cover the following services" No other section of the document (though at this moment I'm only worried about treatment cycles) has a similar preface.
Onto our medical insurance plan documents.
In the plan document for our health insurance under the title
"The following exclusions are specific to the corresponding services listed in the Description of Covered Services. [Insurance] will not provide a benefit for:"
It lists both
"No AI/IUI benefits are available when the Member or the Member’s partner has undergone elective sterilization with or without reversal."
and
"No IVF benefits are available when the Member or the Member’s partner has undergone elective sterilization with or without reversal."
Our treatment plan
My husband has previously had a vasectomy. After consulting with our RE and urologist we've decided we're going to have the vasectomy reversed and after he's healed and has adequate sperm we'll begin IUI cycles. If there is no return of sperm or if his numbers are never adequate for IUI we'll do IVF.
It's clear as day that our medical insurance won't cover IUI or IVF at all. What I'm wondering is if being excluded under our medical insurance means we'll also be excluded under KindBody?
Yes, I'm in communication with both benefits providers but they're moving very slow so I'm interested in hearing opinions. I feel like there's probably information here that I'm not processing so if the answer is obvious and I'm just missing it I apologize.
Imgur screenshots
submitted by /u/Prokinsey
[comments]
