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i'm sorry, what was that?

Saturday, August 23, 2008

*warning: language

part 1

while i was checking out @ my annual, the nurse asked me if i'd like her to call my insurance company & ask what my "infertility care" benefits were. knowing they probably weren't great , i decided why not, i'll spare myself the frustration. right?


i received a letter in the mail from my dr's office about a week later. here's a summary:

"...we were told you have limited benefits and are not fully covered for infertility treatment....Excluded services will include IUI's, sperm wash and HCG injections."

it gets better...

"These charges (see above) must be paid at the time of your visit and will be discounted 20%. To assist you in planning, we have enclosed a fee schedule."

forget frustration! i was (am) livid! so, what better thing to do when you are livid and your eyes are popping out of your head but call the insurance company? oh what a lucky day it was for the rep on the other end of the line. this was our conversation:

me: i just got a disturbing letter from my OBGYN's office. i have a couple of questions regarding my "infertility care."

rep: ok. what can i help you with?

me: all of it.

rep: i'm sorry?

me: i want a full explanation as to why you don't cover anything other than the diagnosis of infertility. please explain my coverage, or lack thereof, for fertility drugs and treatment.

rep: well, we do cover the long as they're not used directly prior to and to aid an IUI or IVF.

me: what? you'll cover them as long as i don't use them for IUI or IVF?

rep: yes.

me: and why don't you cover IUI or IVF?

wait for it...

rep: because both are considered experimental.

me: you're shitting me?

rep: i'm sorry. what was that?

me: you've got to be SHITTING me!?! ((( EXPERIFUCKINGMENTAL?))) in 1978, the first successful IVF baby was born but IVF history goes back further and even further is when the first IUI was performed (see here). so you tell me? how the hell can IVF and IUI still be classified as "experimental"?

rep: i can't answer that ma'am. but our coverage changes annually; feel free to call back to see if it's been updated. i'm truly sorry ma'am.

me: yea, me too.


part 2

i've been slowly compiling research on infertility. i've read that 1 in 6 couples are infertile. ONE in SIX. that means there is someone in your life who is infertile. that means this is not an uncommon diagonsis. that means this isn't some obsure condition. what that means is that infertility treatment needs to be mandated and insurance companies need to be forced to offer coverage just like any other medical condition!

shortly after i had that conversation with my insurance company, i was reading Infertility Diaries, a blog on Redbook's website, written by Jen from Maybe If You Just Relax. Jen did a post about the lack of coverage for infertility treatments. Jen is very lucky in that she does have some coverage. Here's an excerpt that thru me for a little loop-de-loop & gave me whiplash:

So imagine my surprise when I get my explanation of benefits...
Total Charges for IVF #1: $14,650
Total Paid by Insurance: $4,750
Total Patient Responsibility: $350

are you reading that correctly? do you see that? do you see that for ME, an infertile without coverage, i would have to pay upwards of 15G's for ONE cycle of IVF. but those motherf'ers...i mean, insurance companies, only have to pay $5K?

oh, yea. i'm bending over alright. assholes.

but being the person that i am, i look to the brighter side of things. i like to think of life as a glass half full...which is why i'm ever-so-thankful that my OBGYN has offered to give me a 20% discount.


to be continued....yes, there's more.


m said...


I wish any of this were news to me. My insurance covered NOTHING. Even with some "creative coding" for tests done by my RE and my gyn, pretty much everything we've gone through has come out of pocket (well, charged on credit cards; our pockets are pretty bare).

There are a few states that require infertility coverage, but not many. There is a piece of legislation in Congress now that would mandate coverage, but it doesn't seem to be moving very fast. And even then, more "experimental" or "non-traditional" procedures like using donor eggs or sperm would not be covered. I've been checking to stay up to date on the whole infertility/insurance fiasco. But in the meantime, I guess we just have to go for the discounts where we find them. I mean, 20% is still 20% you don't have to pay, right?

Totally don't blame you for getting angry. Don't even get me started about the absolute lack of accountability in the insurance industry. Ri-frigging-diculous.

Jen J said...

I can't say much more than I understand and feel your pain. It's completely unfair. Bet your Insurance company pays for Vasectomies, Tubal Ligations & other forms of sterilization.


I wish it were different.