Lilypie - Pregnancy

Thursday, May 14, 2009

Insurance

Can I just say, to those of you who have infertility insurance coverage, that you are some very lucky gals?

Even though I work for the State of California, I stupidly decided to go with my husband's insurance and give up my fantastic insurance options through my job. I don't have the option to get it back until 2010 (unless I have a baby, of course). Let me just say that I have no idea what the infertility coverage through my work insurance options is, because I dropped my insurance way before I knew we were infertile. Still, I don't think it can be worse than my husband's options.

My husband is a co-owner of his business - he owns around 45%, the other major partner owns 45%, and then there is a third guy who has about 10% ownership. The reason why this matters is that any company expenses are paid halfway by us. Including the employer's share of the insurance premiums.

We're switching insurance right now. Our old insurance had a $2000 lifetime limit for infertility, and our clinic is out of network. I still haven't submitted our claims, so I don't know if it will cover anything we've done. I really need to do that soon.

Our new insurance ... sucks. If we do the HMO option, we get around a $1500 lifetime limit, BUT it doesn't cover IUI or IVF! (But it does cover GIFT?! Who makes this shit up?) Um ... really? WTF does it cover, then? Ultra-sounds and meds?

If we do either the PPO or HMO option, there is an "optional rider" my husband's company can purchase. It has a lifetime limit of around $1500 to $2000 (depending on the plan), and will cover 50% of costs for 6 unmedicated IUIs, 3 medicated IUIs, and I think one round of IVF (up to a maximum of $1500 to $2000, which is to say a fraction of what we'll have to pay). But premiums for the entire company for a year will easily cost MORE than the benefit for us. Considering that just about everyone in the company either already has kids or is a young single guy - we'd be paying the premium for everyone pretty much to cover only ourselves.

To make it worse, to get the optional rider, we'd be basically telling everyone in the company that we're infertile, AND underhandedly having the other partners pay for our (useless) infertility insurance. So it's not really an option.

So there you have it - basically, no coverage at all. Really, what's the point of even having infertility coverage in these plans? For appearances?

Does anyone know how to get involved in political reform? Isn't this kind of thing an absolute crime? Really - anyone out there in the state of California who knows how we can fix this? On the other hand, after the recent octuplet incident in our fair state, I'm guessing this would get shot down before it got off the ground.

Oh, and to add insult to injury - the insurance agent told us that our premiums were so high BECAUSE WE'RE OF CHILD-BEARING AGE. I didn't know whether to laugh or cry.

8 comments:

  1. $1500 lifetime maximum....guess they don't realize that one cycle even of injectables and IUI cost more than that...sigh- insurance. That being said, I am one of the lucky ones in NJ where it is mandated, but it is only mandated for companies that have more than 25 benefited employees as I think it would cause "undo financial strain" on smaller companies, or something of that nonsense. I am glad J. works for a company big enough to require the coverage.
    I am sorry things are tough!

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  2. I have NO ideas to help you with your insurance questions. I'm insurance duh, sorry! Oh I do have a question though. Can you and your husband get a secondary insurance plan to cover SOME of the costs for IUIs and IVFs? I don't know if that's even possible, I was just asking. That sucks, I hope you can find a solution soon!
    *HUGS*

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  3. Yeah, I hate the TWW, so I am glad it is going quick.
    For me we went straight to injectables because my RE felt at my age...39, staring at 40 next month....that we shouldn't waste our time. He told me, at my age on my own I have a 5% chance of getting pregnant each month, with clomid, only 7% and then with injectables 20-25% so it seemed clear to us what we should do. I think clomid is great for those who don't O on their own or need a boost, but for those who do, it might not be as effective. That last part is just my opinion from my online research :)
    Hope that helps, if i didn't answer something, feel free to ask more!
    btw- the meds with insurance for the injectables cycle were $1000, without insurance over $3500....yikes!

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  4. Right there with you. We do have insurance, but it's a $2000 lifetime limit for IUIs - which doesn't help me in the least and $10,000 for IVF. My company switched insurance companies the first of the year and lucky for me it's the same limits. This time they are supposed to cover meds, but...I'll believe it when I see it. I tried to convince my husband to move to Chicago instead of Los Angeles to take advantage of the mandated insurance, but I failed. If you figure out where to write letters to - let me know. Resolve.org might have the info we need!

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  5. Resolve.org definitely has the info you need if you want to write to political leaders. Insurance is so, so frustrating. I'm sorry that stress is adding to everything else.

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  6. Let me guess. Anthem? I had them and of all the things I submitted (I didn't submit any of my IVF expenses) they paid for nothing. No labs, nothing because the doc was out of network. Even though I had a $2000 lifetime limit and a $1500 med limit. Oh, wait they paid for the Lupron.
    Insurance sucks so freaking bad. It makes me nuts what is and isn't covered. Also fighting with insurance companies is crazy. I'm sorry your coverage isn't better. I hope that you find some way for things to work out.

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  7. Well, a $2000 lifetime coverage is $2000 more than I have. My insurance pays for diagnosis of IF (with a copay) but nothing for treatment of IF. Anything we do has to be out of pocket.

    One idea that can help slightly is to use health savings accounts. This is also something you can't change until 2010, but you can set aside money through your employer (pre-tax money) to pay for qualified health expenses. And IF is a qualified health expense, so you get some benefit through lower taxes.

    If you want to do something politically about this, start by calling and emailing your state and federal representatives. The more people who say this is an issue, the more they will listen. I've gotten involved with the Democratic party since the Obama campaign and have lots of connections with political folks and am now invited to events where policymakers are. I do live in my state capital, so that does help this of course. But getting involved in whatever political party leans your way would give you more info on how to enact change.

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  8. You're so right. Insurance sucks. The insurance at my job covers nothing related to IF. They are supposed to cover diagnostics, but guess what? They didn't. The company that I work for is in a male-dominated industry, so I don't think it will ever change. We're really lucky, though. E's old job offered fertility coverage. We're paying a craptastic amount each month to keep me on that policy through Cobra and we can only keep it for about another 9 months. It doesn't cover drugs or any of his testing (chromosome testing was frickin' expensive), but we're hoping to come out ahead.

    With democrats running the show we might have more of a chance at getting some kind on change. Let me know if there's anything I can do to help. I live in the conservative Midewest so I won't hold my breathe on it happening here, but I'm willing to try to write letters or something.

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Thanks for sharing your thoughts!