Dag Nabbit! Insurance Company!!

[Marisa6826]

Jonathan's company just switched from United Healthcare to Aetna as of yesterday (1/1). We started going to the Reproductive Endocrinologist a few weeks ago so that we would be able to get a leg up on all the pretesting (United doesn't require referrals).

I got a call from the "financial advisor" at the RE's office this morning and was told that our "brand" of Aetna coverage (QPOS II) doesn't include any reproductive treatments except diagnostics and corrective surgery.

When I called Aetna a couple of weeks ago the idiot CS rep I got told me that my coverage was fine and didn't require ANY referrals. Well, he was wrong. I called twice this morning and was told both times that the policy covers NOTHING - not even the injectable medicines - except the Dx and surgery.

The financial advisor started telling me that the IUIs run approx $2700/cycle excluding meds and the IVFs $8000 - also excluding meds. She tried to persuade me to go for the IVF since it is - and I quote - "More bang for the buck". I told her I wasn't interested in IVF since not only is it more expensive and invasive, but that the IUI worked last time with Sophie.

My BIL is the director of fertility at a major NYC hospital so he can hook me up with the meds for free, but the rest of it will be out of pocket for us. Fortunately, we opted to take the max out for our flexspend account - because as it turns out my OB/GYN isn't taking ANY insurance other than Empire BC/BS.

I'm beginning to not want to answer my phone anymore....

-m

[trumansmom]

Oh Marisa! I'm so sorry. Just dealing with all the complicated stuff of going to an RE is hard enough, but to have to add insurance complications and the financial burden as well is just too much! I'm just so sorry.

Isn't it amazing what we are willing to put ourselves through to have children? And of course, it's worth it.

Sending happy thoughts your way. Hope things get better soon.

Jeanne
Mom to Truman 11/29/01 and EDD 4/23/04!

[NEVE and TRISTAN]

Marisa,
I am so sorry to hear this, the world of insurance is something I have yet to really grasp to beable to offer any advice. I know we have some insurance gurus here so I hope someone can steer you here.

I was wondering if that builder (I think he was a builder your old employer) (???) that begged you to help him at work could offer you some trade off maybe you can help his business (and stay at home) in some compacity where he can insure you via his company. That was the first thing that came ot my mind...

Is there an OB/GYN that you can find that takes your insurance or are you that set on yours...

Keep us posted...and I'll try to brain storm...
Neve
AKA "mama2be"-forgot password
and Baby Boy Tristan born @UNC
Feb 25, 2003
Brother to 3 pups "gees" and 2 kitties

[lukkykatt]

That stinks! I only have experience with commercial insurance, so can't really help you out on the insurance side. I did want to point out though, that your instincts on the procedure seem right on to me. I saw an RE at Hopkins with my first pregnancy and his philosophy was to start out with the least invasive procedure and to work your way up. I'd just listen to your doctor if you are happy with him/her and ignore the "medical advice" of the financial advisor!

Good luck, and keep us posted!

[nathansmom]

Marissa-
Email me. I may be able to help you out. I know a few things that I learned from our RE. I'm going to try to get ahold of them today and double check all the information.

[pritchettzoo]

That really bites.

Isn't Aetna the insurance company doing all the PR ads on television? The one where the sweet couple names their baby Hope? Maybe they used all their money on tv babies and have no money left for the real ones. (I may be mistaken about the company...)

BTW...the only other person I've ever "heard" use dag nabbit is my dad--thanks for the chuckle. I hope Miss Sophie is getting used to her alternate sleeping arrangements!

Anna
Mama to Gracie (9/16/03)

[Momof3Labs]

It's not about the insurance company, it's about Jonathan's employer. They are the ones who chose a plan for their employees without infertility coverage, and are undoubtedly saving quite a bit of money because of it. In the group health insurance world, insurance companies don't cut major benefits like this, employers do.

However, the insurance company does need to know what the plan looks like and what benefits they pay. Marisa, you might want to check with Jonathan's HR area to be sure that they cut this benefit and make sure that it isn't just an incorrect coding on the insurance company's part. If their plan provisions state that they provide infertility treatment coverage, you might be able to get at least some of your benefits paid even if that is an error.

Another thing, Marisa, is that once you go to an RE, the insurance company likes to call everything "treatment" even if it is still part of the diagnosis phase. So if you have any more diagnostic work done, you might see if you can do it through your OB.

[peanut4us]

I am SO sorry Marisa that sucks! I switeched from UH to BCBS then IBm canceled our area's BCBS in mid-pregnancy, so I went to Aetna. This year when I re-upped, we stuck with Aetna, but only because I KNOW we are not TTC! Aetna is so unfriendly to couples with infertility issues. We had UH when we went through the infertility stuff before. Sigh. I'm sorry; it sucks. Thank heavens for your BIL though. I can only imagine what you'd have to do.

Stick in there honey.

[McQ]

Suck-a-rooney!!! Just keep pressing them. Don't take no for an answer until you've checked all avenues.

Allison
~ mommy to Declan 3.24.03

[Marisa6826]

As usual, you've all come to my rescue.

Neve - My first thought was to try and get back with my old boss for my old coverage, but it's just not practical now that I've moved (or almost moved) out of town and have a toddler to contend with.

As far as Jonathan's employer goes, I will have to call them on Monday and see what they have to say. I was under the impression that it was state law in NY/NJ to cover infertililty. I guess it's only the diagnosis and surgery that's covered.

It's not that it will be a serious financial hardship, it's just that it's money that could have gone elsewhere. As I said, we've already maxed out the flexplan account, so the money will just go toward this instead of the next baby's delivery as we initially planned.

I really love my OB/GYN and have been going to him for almost 12 years. Since he's well versed in my medical history (and there's quite a bit to it), and is affiliated with my cardiologist, I really don't want to change. I have a wonderful relationship with him and he's willing to work out a reasonable payment arrangement for the next baby. I'm not worried about that at all.

It just really sucks that we thought we had this all squared away. We had Aetna when I went through the fertility treatments with Sophie and they were awesome. I just assumed like a dope that it would be the same this time around. The strange thing is that this current policy is supposed to be better than the one I used to have.

I REALLY don't want to do IVF. It just seems so "last ditch" to me. Especially since the IUI worked the second time around for me.

This current RE has already shown some resistance to me using Pergonal. I have some left over from last time around and she gave me some line about it being a "dirty" drug. I know that there are newer, cheaper versions, but this is what I have to deal with. It's only 10 vials and it's only good till February.

I don't want to have to ask my BIL for all kinds of other meds - especially since he seems to have the Pergonal on hand - and for free.

The "financial rep" said that I will have to pay for everything upfront from now on and that they will try submitting bills to Aetna anyway since they sometimes screw up and pay by mistake.

The way our flexplan spending works is that we have been issued a Mastercard just for our account. I don't have to deal with receipt reimbursement at all. At least that part will be easy. I guess it will also all be tax deductible. Woo hoo.

I know that there was a second choice for insurance with Jonathan's job that was an HMO. We specifically chose the Aetna one over Oxford since we thought it would cover all of this. We've now missed the open enrollment for Oxford anyway. That will teach us!

-m

[LD92599]

M~

So sorry to hear about this...certainly NOT what you need to hear as you're in the midst of moving.

Will & I have been thinking about you and Sophie!

Definitely contact Jonathan's employer AND the insurance company again. Seems every time I call our ins company for something I get a different answer on the same question..every time. Even now w/ DS's and DH's plan...they are telling me we're not covered for a routine ped visit...yet they don't have ANY problem cashing my checks every month, do they?!?!

{hugs}

Laura
mom to William
3.5.2003

[Momof3Labs]

Marisa, if NY/NJ state law is anything like Illinois law with respect to infertility coverage, there are loopholes all over the place. Employer size is one loophole, and a big HUGE one is that self-insured plans don't have to offer infertility coverage. My employer is quite large and self-insured, and they didn't offer it until last year. DH's employer is also self-insured (most large employers are) but fortunately offers coverage. We were pretty fortunate to have almost all of our treatment covered at 75%, and all that treatment went towards meeting our deductibles, so by the time Colin came along, we were 100% covered.

And your new plan may be "better" but that doesn't mean that it will cover what YOU need covered, unfortunately.

www.resolve.org is a good source for local info on infertility coverage and such - they have played a big role in lobbying for coverage laws in many of the states.

[parkersmama]

Marisa,
That sucks! I don't have any advice other than what's already been offered but just wanted you to know that I'm aggravated for you! I hate insurance. I know it's a necessary evil but it can be sooo annoying dealing with insurance companies. Our insurance through my husband's work is good for some things but really sucks for having babies so they have cost a fortune! We were on BC/BS when Parker was born and he cost....$20! Yep, all told. Wesley and Amy Grace came in a TON higher. :) I hope it all works out for you. Sorry you're having to deal with this!