Hello all, I am based in NYC and just joined city government. All the city health plans have to cover fertility services because of state law, but all of the plans seem to require a diagnosis of infertility before you can access any of those services.
The legal standard for infertility for a single woman over 35 (I am going on 39) is “failure to establish a clinical pregnancy after…six months of regular, unprotected sexual intercourse or therapeutic donor insemination.” I have a medical record that shows two failed IVF transfers but no record of IUIs, so it seems like all of the insurance plans may force me to do 6 months of IUIs.
The plan I really want to select, Anthem Blue Access Gated EPO, is in network with my preferred clinic but the clinic cannot tell me if they would force me to pay for those IUIs out of pocket since technically I don’t meet the legal standard for infertility UNTIL I fail 6 months of IUIs. Anthem also will not tell me and sends me to Win Fertility. Win Fertility will not even talk to me, because I do not have an Anthem plan yet (they also seem generally horrible).
Does anyone here have experience as an SMBC employed by New York City government? What was your experience with the offered health plans, particularly the recent ones?
if you have experience with the Anthem Blue Access Gated EPO (which used to be BCBS) — did they cover your initial IUIs to prove infertility, or force you to pay out of pocket?
also, did anyone use a track record of failed transfers to successfully skip the IUI requirement? Technically I have been failing to conceive for a whole year, it has just been through IVF, not IUIs.
Any insight on navigating the NYC government offered health plans would be much appreciated and thanks for your time if you have read this far.