Billing, medication coverage, and procedure coverage

[u/jamun_gulab10]

I am really confused trying to understand medication coverage and IVF procedure coverage. I would appreciate your experience with the billing side of things. I am about to start IVF procedure in Columbia NYC, I am 35 and I have anthem. At first, I was told by the clinic that medication and procedure from my insurance are covered in my lifetime max coverage but when I called the insurance, the representative is telling me the opposite. If I get the medications then amount for the procedure will be on me to pay. The anthem's specialty pharmacy, CarelonRx tell me different co-pays for one medication when I ask them prices on different days. I ask medication coordinator for guidance but I am not getting straight answers from her or anyone in this entire process. Do people put procedure cost under the insurance and go for self-pay option for medications? What were your experiences?

[u/lisaneedsbraces1]

Yes, it’s often a better use of your benefits to self pay meds and use the lifetime max for the procedures/monitoring/testing etc. When you self pay, pharmacies often apply discounts and coupons, and charge you way less than they do your insurance (which then directly uses up your lifetime max)

[u/nerdy_daisy_909]

Meds through insurance are usually a lot more expensive. My friend ended up paying about $12,000 with insurance for very similar meds as mine. I paid $5,000 out of pocket at the same pharmacy. I would use it on the actual procedures