Kaiser, BCBS, IVF, head is swimming about costs and coverage.

I’m currently insured through my wife’s Kaiser plan. It’s a very good HMO plan with very low out of pocket costs. Unfortunately, it covers literally nothing for IVF.

I have the opportunity to get BCBS of MA as my primary insurance, and her backup insurance.

her: Kaiser, BCBS backup

me: BCBS, Kaiser backup

Kaiser is “out of network” for BCBS. And is “20% after deductible” for non network.

The BCBS insurance will be much, much more expensive for me. But it looks like it actually covers IVF and IVF meds. So even with the higher costs, our total costs would be much lower doing IVF, or so I think?

I could use some help with some scenarios. If my understanding is correct.

For me:

I get care at kaiser. I owe up to my deductible PLUS 20%.Kaiser, as my backup insurance, would cover the 20%

Effectively, I can continue to see my Kaiser doctors, and my total costs would be $1000/2000 deductible, to a yearly max of $3000/6000?

Or I can just stop going to Kaiser entirely, and go in-network for BCBS, though I have a great set of doctors at Kaiser now.

For IVF:

Wife still goes to Kaiser for the IVF. Literally none of it is covered.

Kaiser estimates about $25-30,000 for the procedure, meds, etc.

The amount of money rolls over to the BCBS backup insurance.The 20% after deductible will be the driving cost UP TO but not exceeding the $6000 family out of pocket limit.

Effectively, IVF treatment will cost a maximum of $6000, due to the family out of pocket limit.

See also  Illinois state or Federal law with keeping New Health Insurance Plan?

Is this correct?

Please correct me if I’m incorrect in my assumptions. This issue is a minefield at the house, and is pretty confusing.