Friday, April 29, 2011

Busting an Infertility Myth:  Infertility treatments are covered by insurance


For National Infertility Awareness week, which ends tomorrow, RESOLVE is asking bloggers to "Bust a Myth" about infertility. I've chosen to talk about the myth that infertility treatments are covered by insurance. Resolve's "bust" to this myth can be found here . Below is mine:

Myth: Infertility Treatments are covered by insurance

Fact: Not in my state and not in most others in the U.S.

I live in a state where infertility insurance coverage is not mandatory. My HMO has a little coverage and I burned through it many years ago. It consisted of a LIFETIME maximum of $4000 towards infertility treatments, which ran out with my first IUI after initial doctor visits and all of the fun testing one goes through (day 3 bloodwork, HSGs, invasive ultrasounds...). If you look back on my history, that was a long time ago. Oh, and I forgot to mention the 50% co-pay for infertility treatments, so really it amounted to $2000 of lifetime coverage, not $4000. We've been paying 100% out of pocket ever since IUI #2.

Now, Tidy and I are fortunate enough to have well enough paying jobs and not too many other financial obligations other than a mortgage and some student loans. Because of this we haven't had to put ourselves into long term debt for the treatments we have done up to this point. But, by "afford", I mean that we are able to come up with enough money to pay for the treatments, but we are not able to save for our other long term goals nor able to improve the house that we bought with a family in mind over 4 years ago. The basement remodel, new windows and other upgrades and fixes are on hold... indefinitely. We do not have an endless supply of cash just sitting around to try one treatment after another and if those fail, move on to adoption, which is also no drop in the bucket.

So, over the last 3 years, because we are now paying 100% out of pocket, here are some of the tactics I've taken to help save on little bits of the cost of 5 IUIs, 4 IVFs, 1 laparoscopic surgery and endless amounts of doctor appointments, blood draws and other invasive tests along the way:
  • I've asked others who have had success with unused meds to donate them to my cause and have stock piled half used pens and vials of follistim, gonal-f, menopur, lupron and progesterone.
  • I've researched and found a clinical trial to get an IVF cycle AND MEDS free of charge. However I did have to drive 160 miles each way to the clinic, sometimes 2 days in a row, pay for parking, take 2 weeks off work and impose on my sisters in the city to participate in it. So, "free" may not be quite accurate. Additionally, the protocol wasn't optimal for my body, as many clinical trials have standardized protocols, so it was basically a disaster and an emotional nightmare.
  • I've cried and whined to my primary care doctor to get certain tests run through her so is covered under anything other than the category of infertility and I didn't have to pay the $2-3K for immune workups that other labs charge. I also had to convince an OB in my network to order an exploratory laparoscopy for "pelvic pain" with out any other real indication of need other than multiple failed IVFs and a suspicion of endometriosis. I felt very manipulative.
  • I've maxed out my health spending account at work for a few years to get some money tax free. Currently my paychecks are about $250 smaller than they would be otherwise.
  • I've taken out at least two 0%-interest credit cards and put large sums of $$ on them in hopes of paying it off before interest starts accruing. I am ruining my credit history just because I don't have insurance coverage for infertility treatments, not because I am financially irresponsible.
  • I've considered looking for a job in a different state that does have mandatory IVF coverage but there's no way we could sell our house right now in this market with the things that need to be upgraded and fixed.
  • I've risked having multiples by transfering up to 4 embryos back into my body because with out coverage, and lack of funds to do another IVF or a different path for quite some time, I'd rather get more bang for my buck (ie, hope for twins), or at least increase the chances that it will work. Here's a great article that says how insurance coverage for IVF will actually help the health care system save money in the long run, because single embryos transfers would be the norm and the health care system wouldn't be as burdened with such a huge increase in multiples births that require expensive pre-natal, neo-natal and ante-natal care.
These "creative ways" to save us a little money and get more information about why we haven't been able to conceive yet don't even begin to include the emotional costs on me, Tidy and our relationship that comes along with this great financial burden and struggle to understand what our next steps should be.

And that brings up one last point. We're at the point of our 4th failed IVF cycle, but we really have NO answers. I make pretty decent "looking" eggs and they fertilize well. My uterus is healthy looking. The only other thing that could be wrong is either my body is rejecting the embryos for some unknown reason, or our embryos are chromosomally abnormal. We can't really test for the first and to test for the second (genetic testing on the embryos) will require and additional $6000 on top of a regular IVF cycle. We also have no gaurantee that the embryos would make it long enough to get to a stage where they can be tested. So I'm faced with ASSUMING our embryos are abnormal and jumping into a donor egg IVF cycle. There is, however, always the possibility that it's not my eggs but my uterus. So our next step, which could end up costing about $30K is a HUGE gamble. If we did have some insurance coverage, we would have done the genetic on the embryos sooner and had a bit more knowledge to help us make our decision. Right now, I still feel like I'm stumbling around in the dark.

So, no, infertility treatments are NOT covered by insurance, but more of them should be. And I can make a good case for it.

To end, here are a few great links about Infertility 101 and also National Infertiltiy Awareness Week background.

11 comments:

Krista said...

Thanks K. I'm not posting anything on my blog due to real life friends, but my beta is tuesday. I'm doing better tonight, I left work after a half day and talked to my husband's best friend's wife for awhile....I think she talked me off the ledge...for now!

amiracle4us said...

I agree completely. We have been blessed with my parents and grandparents funding most of our cycles, otherwise, we would be taking out credit cards as well. Hoping this is it and our dreams come true so we don't have to think about ....whats next. What is next is a crying baby in our arms!

Baby Steps said...

You are my hero~

How are you feeling by the way???

xo

Marissa said...

Excellent post!

And yeah...our tax return from last year, *and* this year, were both slated for new windows (we've got 50-year-old single-pane...), and they've both gone to infertility instead. Good times.

Maria said...

Excellent post, Tippy! Get this: My state DOES have mandatory infertility coverage, but because T's company is self-insured, they are not bound by that law. So, guess what? Debt for us! Woo-hoo!

cgd said...

great post !!!
I always try to imagine what this process would feel like without the financial complications, still hard but sooo much easier....

jill's infertility document said...

This is an excellent post! I hope it is read by many!

MuteMockingbird said...

Great post! I live in a state with mandatory coverage, but through some loophole that I don't understand my employer does not have to provide coverage so even when they say six states require some coverage, that doesn't mean everyone in that state has coverage.

Heather said...

it's so harsh sometimes these things boil down to money..
thank you for your brilliant post. You really nailed all your experiences and that makes it more real. Right now I am praying for a miracle to afford IVF, otherwise it will have to be IUI.

SillyDotty said...

Everything you wrote is all so miserably true. Your posts are always communicated with so much honesty.

BTW - I think California IS a mandated state, but all that means is they cover infertility diagnostic services only. Insurance does not need to cover IUI/IVF meds, which is a huge expense. Also, it does not cover "ART" which includes IVF because the eggs are fertilized outside the body. The IUI procedures are covered, but injectable meds are not. We are still obligated to pay for most services OOP.

Mangopuppy said...

Excellent post. Actually, in CA, the "mandate" is that if a company has 50 or more employees, the insurance company is mandated to "offer" coverage to the employer, but of course, the employer has no obligation to accept it, leaving his / her employees basically screwed, along with anyone working for a smaller company, self employed, etc.

DH and I paid everything OOP, amounting to about 50k.