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Dealing with Insurance

I am so tired of dealing with insurance companies. Granted, I am grateful that my hubby’s employer provides us with great insurance, but still…figuring this stuff out is a nightmare.

Just as I am starting to understand the business around insurance…….I get thrown for another loop. I am so tired of hearing about deductibles, co-payments, in-network, out-of-network and blah blah blah. Does anyone else get overwhelmed figuring this stuff out? Or is it just me, all alone here? Why aren’t there any classes on learning how to use and work with your insurance? Instead I feel like I’ve been thrown to wolves and I’m trying to survive on my own. Not easy folks…not easy.

At the moment I am battling with my insurance to get my acupuncture appointments covered. My appointments have been put on hold until I can get this figured out…just when I need them the most…two short weeks before my stims is supposed to start. My insurance is denying the codes that my acupuncture office is using and they are not sure they can switch the codes now. What…none of this was talked about before I started. All I knew was that my insurance covered the appointments, I had a $20 co-pay, and I could visit up to 15 times. (This was all verified by the office) Now, they are denying it. I have no control over the codes that are used…so frustrating.

You know what else is frustrating….the fact that insurance doesn’t cover IVF. I so full heartedly wish that my insurance covered IVF, but it doesn’t. Just like so many others..I am paying for all the IVF expenses out of pocket. And, that is not easy (as most of you know). It’s freaking expensive. At first glance IVF looks expensive, but then you get down to the nitty-gritty and realize it’s even more expensive than originally thought.

What’s not included in the expensive package that I paid are the pre-appointments, storage for frozen embryos, CCS testing (also known as PGS or PGD), the medications, and the random procedures that may pop up. Even before I can start my first round of IVF I am forking over thousands to make sure my body is even prepared for what’s about to come. A mock embryo transfer, IVF classes, meetings with a genetics counselor, multiple ultrasounds, and much more. It seems endless.

I really don’t understand why more fertility treatments aren’t covered by insurance. In any other case insurance would cover a procedure to fix something that is broken. So, why don’t they understand that part of my body is broken and needs to be fixed. I don’t view IVF as an elective procedure. I see it as the only way that I can grow my family and get my body to do what it was built to do, carry a child. I have tried to conceive naturally and that has resulted in 4 lost pregnancies. Isn’t that enough to convince an insurance company that my parts aren’t working? That they are broken.

According to RESOLVE only 15 states in the US provide coverage for infertility treatment. Each state has different requirements as to what they cover and the reasons as to why they will cover treatments, such as endometriosis, blocked tubes, etc. So, in most cases I wouldn’t be covered anyway, since I have unexplained infertility. Also, not all of these states do provide coverage for IVF.

In the end I am grateful that I have coverage for the basics. If it wasn’t for insurance I would have paid around $14,000 for my polypectomy, not just the $1,100 that I ended up paying. I just wish that more states and more insurance companies understood infertility and would set up policies that helped us.

XO

10 thoughts on “Dealing with Insurance

  1. My state is one of those with an IVF mandate, but there’s a giant loop hole: all insurance companies in the state must offer a plan with IVF in it, but your employer doesn’t have to purchase that plan. So basically it does us no good.

    There’s a lot of injustice in infertility.

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  2. I am so feeling for you…..we just spent 2 hours going back through claims because something came up from December that may not be covered. And we are just doing the simple stuff of IUI. I cannot even begin to imagine dealing with IVF. The stress of this crap on top of it all is crazy. I do not understand why unexplained infertility isn’t always covered.
    By the way, I also can’t believe that even with your insurance coverage you still had to pay out 1k for the polypectomy. Being a Brit I’m still getting used to the US system of insurance – I just assumed that Americans had some kind of lesson at school on what everything means in the healthcare insurance world!! I don’t think we all truly appreciate our NHS.
    If I ever win the lottery, I want to set up a fund for research into unexplained infertility – I know the money wouldn’t go far in today’s world of healthcare.

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    1. Thanks for reading. I wish we had a class on how to understand our confusing world of insurance. I’m 30 and still have to call my mom for help or have my hubby call his HR personnel to help us understand. I think that’s a great idea if you win the lottery. 🙂

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  3. This is one of the times where I am thankful for my Canadian medical. It’s not always perfect, and in fact it’s pretty much screwed me when it comes to fertility stuff and we ended up going to the USA, but at least I don’t have to deal with insurance companies!!
    I hope you sort it all out!

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