Wednesday, October 22, 2008

insurance is a scam

I feel as lost as I did in July, when C and I first learned we had no sperm. We knew nothing of the costs and logistics of the one obvious solution- donor insemination. We didn't know where to begin or who to turn to. We had this devastating news and no way to respond productively.

This morning, I called my employer's HR department and the customer service folks with the insurer offered by my employer. My employer is based in Ohio; I am in Massachusetts. Massachusetts has a fairly generous state mandate concerning infertility treatment. Ohio mandates diagnosis only. I called to find out if the insurer had to obey my local mandate or the mandate provided where my employer is based. Neither. It turns out that, even though our insurance is handled by a major national brand insurance company, the company is considered self-insured and therefore EXEMPT FROM ALL STATE MANDATES!

I must say I'm glad we didn't put our efforts on hold wating to switch to my employer's health insurance. That would have been even more frustrating than finding out after months of IUIs that the switch would do us no good.

I fell apart this morning, in my office. I slunk off to the restroom for a while, but in an office this size there's really nowhere to hide. I am pretty certain that this month's IUI did not succeed. We have two more vials of donor sperm that we can use for a November insemination, but then I really don't know what to do next. I am terrified of pointless debt, and if we invest in IVF or additional IUIs, there's still no guarantee.

Back in July, when I spoke with the patient coordinator at the RE's office, she mentioned supplemental insurance that I could buy to cover just infertility. I'm waiting for her to call me back. I spoke with my employer's insurance company about purchasing additional individual coverage, but none is available. They told me to call my employer, but I really don't see the point in that- they're not going to re-do the 2009 options just for me, and I am tired of letting strangers into my personal life. I called Fertility Lifelines for advice and learned about their IVF scholarship program. That's a possibility, but it can take as long as a year to find out if I've been selected. What do I do in the interim? I'm already 40 years old. I can't just sit back and wait!

One more IUI cycle. We'll use clomid again. I'll ask the MW if there's anything else I should do/take/avoid. I bought a Yoga for Fertility DVD and a bag of FertiliTea. I don't know what we'll do next if November's IUI fails, but I'll try to figure out if there's any benefit to switching insurers. My plan covers diagnosis of infertility, so it may still be worthwhile to change, but it'll cost me $900 over the course of the year (plus deductibles, co-pays, etc.).

3 comments:

lovecomesfirst said...

Insurance stinks. I pay a ridiculous amount of money every month and it only covers a small range of things unless I reach my 8,000 deductible. How awful that you are lucky enough to be in a state with good IF coverage but your insurance isn't included!

November is a good month to get knocked up, I have my fingers crossed for both of us!

I Believe in Miracles said...

Check RESOLVE too.

IrishNYC said...

It really is such a joke. (and I feel like I'm going comment crazy on you!)

Our insurance was rejected for Clomid (and HCG shots) at two different pharmacies, claiming it wasn't covered. I later found out that NY state law mandates that if your insurance includes prescriptions, they are required to cover fertility drugs. I just sent the insurance company documentation for a refund, so I'm curious to see what happens. Like yours, our insurance is through a union, so now I'm hoping that there isn't some loophole for that.

And an FYI in case you don't know (I learned after my last Clomid cycle) - both Target and Walmart offer Clomid for $9/cycle.