The wonderful land of health insurance

So let’s talk about money.  Specifically, how effin much of it we need to even be able to attempt fertility treatment.  There’s blood work, scans, surgeries, medications, and on and on.  When all is said and done, a person can be looking at being thousands of dollars in the hole even before they conceive a child, who will then also be expensive.  And that’s the positive scenario!  The less positive scenario is that after spending a small fortune you may end up in the same exact place you started – childless.

I have insurance, which I get from my company and I pay into.  This is great and has been put to good use in the past.  Last year I had a preventative colonoscopy since my mother is a colon cancer survivor.  The bill was over $6k, but because of insurance I only had to pay around $350.  Sweet.  Then infertility strikes.  In researching costs, I come across a NJ state law that mandates insurance companies to cover three rounds of IVF treatment.  This is awesome!  So I thought.  Turns out, this law is not only very obscure, there are a ton of loopholes.  Of course, my company through which I obtained my insurance fell into one of those.  You see, if a company has less than 50 people and is considered a small business, they can opt out of this insurance coverage for their employees.  Similarly, if a company is self-insured, as most large companies are, they can also opt out.  My company falls in the latter category.  So basically if you are a small business or a big business you do not have to comply with this state mandate and do not have to provide infertility insurance coverage for your employees.  That doesn’t leave too many other businesses, does it?  It actually seems that the majority of companies fall into one of these two categories (big or small), so I’m pretty sure there are not too many companies providing infertility coverage compliant with the law.  FRUSTRATING!

Let’s go back to before I knew any of this.  I was psyched!  I thought I would be covered under the law.  So when I check my insurance coverage online and look under IVF, there were the dreaded words in all capital letters – NOT COVERED.  How could this be?  So I called my member benefits representative and ended up calling the insurance company as well.  Not only did they not know why this benefit was not covered, they had never even heard of this law!  In other words they were useless, and were also rude and dismissive in the process.  I pretty much found all the above information out myself.

Another thing that really irks me about my insurance coverage is that they pay for all diagnostic testing (infertility or otherwise), but now that I have been actually diagnosed I’m on my own.  I’m glad I had all my pre-IVF procedures covered of course, as I know there are many people who do not even get that.  But it’s kind of a slap in the face.  It’s like ok, now we know what’s wrong with you!  But now eff you now we won’t help you anymore!  Haha!  You suck!  Not to mention they cover pregnancy and child care, but how am I supposed to take advantage of that when I can’ t get pregnant in the first place?

Since we were told by my RE that IVF is our best bet, we decided to go through with it.  Unfortunately we did not have thousands of dollars just lying around, so we are participating in the Attain IVF program.  This program you pay for multiple rounds of IVF and receive a discounted cost.  We also had to finance this, thankfully that was available to us.  So this program covers most of the costs of IVF, with exception to medications that we have been paying out of pocket.  Our package includes 2 fresh IVF cycles and 2 frozen.  Unfortunately our first cycle was cancelled, but that still counts as one cycle.  We are starting our second cycle in about a week.  The “good” thing about this program is if this second cycle is cancelled as well we can withdraw from the program and get the balance of our money back.  That is the only comforting thought I can think of if this next cycle fails.  At least we won’t have to rub salt in the wound by having to pay installments every month on a treatment that we didn’t even get to try (the retrieval and transfer process).  I went in for my day 3 blood work yesterday morning and things were not looking great, so cancellation is a real possibility.  I’ll get into that in the next blog.

All this just brings me back to my original point that fertility treatments are crazy expensive.  I am so thankful I live in a time where these procedures are available to me, and now with programs such as Attain IVF and more financing options these procedures are more readily available to regular, middle class people.  But it’s still not easy.  It just adds one more stress on top of an already stressful and draining situation.  I am thankful to all the people working to try and change laws and create laws such as the one in place here in NJ.  Loopholes and all, at least it’s s being addressed.  Next step is to close these loopholes, and there is still a long way to go though.

Sending peace and love to all my fellow bloggers, I think we can all use some.

xo

 

9 thoughts on “The wonderful land of health insurance

    • scrambledeggsandsundry says:

      It’s really frustrating. I hate the excuse that infertility treatments are technically not a necessity, so why should it be covered? Well having children and getting pregnant is also not a necessity, but that is covered! Along with a variety of things that are not medically necessary. Just seems to be a double standard. Thanks for reading!

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      • Awaiting Autumn says:

        Ya like my friend works in insurance claims and she said it’s basically categorized like a boob job! Even with a medical diagnosis, still not covered. I have faith that future generations will see change and more support, but unfortunately we will have to endure the financial hardship for them.

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  1. babyareyoucoming says:

    Definitely a slap in the face. In British Columbia, diagnosis is covered, but treatment is not. We know what’s causing our IF, but now we need to reach into our pocket to pay for treatment. Our insurance also specifically says NOT COVERED under fertility drugs, but birth control is covered. What makes it more frustrating is the wait. I don’t know how long waits are to see specialists where you are, but we’ve waited about at least 3 months for each diagnostic appointment.

    There are provinces in Canada that will cover a few rounds of IVF, but unfortunately, ours isn’t one of them.

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  2. scrambledeggsandsundry says:

    That’s terrible, I’m sorry you have to go through this as well. Luckily for me the wait to see specialists really isn’t very long. My parents live over seas and they have universal health care and they also have to wait months to see their doctors. That would really drive me crazy!

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  3. clwalchevill says:

    I live in one of the states were fertility treatment coverage is not mandated by law. Hence we knew from the beginning that anything related to infertility (diagnostic testing, treatment, etc) would not be covered. It is beyond frustrating to know that we spent close to $30k out of pocket on infertility only to have these procedures result in a diagnosis that is potentially life threatening and will require a lot of preventative care. But I also know that insurance is a multimillion dollar industry that is constantly looking for a way to not pay. And the fertility industry is also a money generator. Frustrating indeed.

    One thing we did luck out on was having a RE who knew how to navigate insurance. While we were originally told a lot things wouldn’t be covered, she knew how to circumvent that with certain codes and language. She ended up saving us a few thousand dollars on tests and drugs. May be worth a discussion with your RE.

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  4. chels819 says:

    You’ll be glad you went with Attain! I wish we had gone with it (“it will work right away, I am sure!”) and then after our first miscarriage our application became much less desirable. 😦 Praying this second cycle is it for you! XO!

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