One of 12.5%
Nov. 9th, 2007 09:43 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
judecorpAccording to Stirrup Queens, 12.5% of the population is currently experiencing infertility and recurrent pregnancy loss. That's 7.3 million men and women in this country. I am one of many.
Before I got started on this crazy babymaking journey, I was anovulatory and without a monthly cycle for over three straight years. I had tried to get a PCOS diagnosis from several doctors who did not take me seriously, and one who sent me for an ultrasound and stated that I could not have PCOS because I had no cysts on my ovaries. None of them ever did a hormone panel.
After I started taking Metformin and started having cycles, I wanted to talk to a specialist about getting pregnant. My PCOS stuff was all covered by insurance. My referral to a Reproductive Endocrinologist was covered. I live in a mandatory infertility coverage state and thought I would be set no matter what I had to do to get pregnant. At my first RE appointment, I found out that this coverage did not apply to me because even though I have a medical diagnosis that causes infertility, I did not meet the insurance company's criteria in full because I have a female partner and therefore we obviously hadn't been trying for a year to get pregnant. The insurance company wanted me to pay for 12 cycles of insemination out of my own pocket, and if those didn't work, they would consider that a year of trying, deem me infertile, and start kicking out money.
Furious, I called the insurance company and spoke to many sympathetic people who unfortunately don't make any decisions about coverage. I was ready to go ahead, get denied, and appeal. I went to my RE and told him exactly that. "Let's do it," I said, "Put it through insurance and let them deny me, and I will fight them." But, "Oh, by the way, I was previously married to a man for a couple of years and we did not get pregnant, does that count?" He told me he would put it in my file but not to hold my breath. All of a sudden, I was infertile in the eyes of the insurance company, and I was fully covered.
I took Clomid 3 times and Follistim 3 times - all covered save copays. I had 8 IUIs - all covered save copays. I had an HSG - covered; blood work more times than I can count - covered; ridiculous amounts of follicle scan ultrasounds - covered in full. My only real expense was donor sperm, to the tune of about $300 a vial. We bought 9 vials total from two different banks, and with sperm storage, shipping, and donor profiles, we probably put out close to $5000 in sperm-related expenses. But that's a drop in the bucket compared to a lot of other people in my situation. All because I used to be married to a dude and we had some unprotected sex.
I got pregnant on my third and final cycle of Follistim and IUI. If it hadn't worked, I would have immediately been approved for three rounds of IVF on the insurance company's dime. Because I have a medical condition, and had appropriate medical insurance.
And for the money we shell out in this company for insurance coverage, EVERYBODY should be so fortunate.
Before I got started on this crazy babymaking journey, I was anovulatory and without a monthly cycle for over three straight years. I had tried to get a PCOS diagnosis from several doctors who did not take me seriously, and one who sent me for an ultrasound and stated that I could not have PCOS because I had no cysts on my ovaries. None of them ever did a hormone panel.
After I started taking Metformin and started having cycles, I wanted to talk to a specialist about getting pregnant. My PCOS stuff was all covered by insurance. My referral to a Reproductive Endocrinologist was covered. I live in a mandatory infertility coverage state and thought I would be set no matter what I had to do to get pregnant. At my first RE appointment, I found out that this coverage did not apply to me because even though I have a medical diagnosis that causes infertility, I did not meet the insurance company's criteria in full because I have a female partner and therefore we obviously hadn't been trying for a year to get pregnant. The insurance company wanted me to pay for 12 cycles of insemination out of my own pocket, and if those didn't work, they would consider that a year of trying, deem me infertile, and start kicking out money.
Furious, I called the insurance company and spoke to many sympathetic people who unfortunately don't make any decisions about coverage. I was ready to go ahead, get denied, and appeal. I went to my RE and told him exactly that. "Let's do it," I said, "Put it through insurance and let them deny me, and I will fight them." But, "Oh, by the way, I was previously married to a man for a couple of years and we did not get pregnant, does that count?" He told me he would put it in my file but not to hold my breath. All of a sudden, I was infertile in the eyes of the insurance company, and I was fully covered.
I took Clomid 3 times and Follistim 3 times - all covered save copays. I had 8 IUIs - all covered save copays. I had an HSG - covered; blood work more times than I can count - covered; ridiculous amounts of follicle scan ultrasounds - covered in full. My only real expense was donor sperm, to the tune of about $300 a vial. We bought 9 vials total from two different banks, and with sperm storage, shipping, and donor profiles, we probably put out close to $5000 in sperm-related expenses. But that's a drop in the bucket compared to a lot of other people in my situation. All because I used to be married to a dude and we had some unprotected sex.
I got pregnant on my third and final cycle of Follistim and IUI. If it hadn't worked, I would have immediately been approved for three rounds of IVF on the insurance company's dime. Because I have a medical condition, and had appropriate medical insurance.
And for the money we shell out in this company for insurance coverage, EVERYBODY should be so fortunate.
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no subject
Date: 2007-11-10 03:56 am (UTC)Those were covered at 90%. Oh, and all of our meds were covered too.
We are sooooooooooooooooooooo lucky. Otherwise, we'd be up to our eyeballs in debt.
no subject
Date: 2007-11-10 04:54 am (UTC)no subject
Date: 2007-11-10 09:23 pm (UTC)I'm glad you had good insurance.
no subject
Date: 2007-11-10 04:19 am (UTC)no subject
Date: 2007-11-10 09:24 pm (UTC)no subject
Date: 2007-11-10 12:28 pm (UTC)First it says that no prenatal, postnatal, or delivery is covered. WHAT? This is confusing to me.
And of course, no "elective" drugs such as erectile dysfunction, infertility, weight loss, or smoking cessation drugs are covered at all.
I know I had crap insurance, but seriously?
Maybe I will have to check out B's insurance policy and have her add me during open enrollment...
no subject
Date: 2007-11-10 09:25 pm (UTC)Definitely find out!
no subject
Date: 2007-11-10 03:25 pm (UTC)By all accounts, we have a 'great' policy for everything BUT infertility. Maternity is covered at 100% with only a hospital copay, meds are super on the cheap if prescribed by them (& gotten at their pharmacy), doc visits are cheap-o ($15). But if you can't get preggo on your own, you need to pony up.
Stupid Georgia.
no subject
Date: 2007-11-10 09:26 pm (UTC)no subject
Date: 2007-11-11 01:09 pm (UTC)But, 50% of boku bucks is still BOKU!
no subject
Date: 2007-11-10 06:43 pm (UTC)no subject
Date: 2007-11-10 09:22 pm (UTC)no subject
Date: 2007-11-10 07:34 pm (UTC)-Lynn
no subject
Date: 2007-11-10 09:21 pm (UTC)Healthcare and whatnot
Date: 2007-11-12 02:57 am (UTC)If you get a chance...let me know what you think.