Insurance, in the Midst of Chaos

By Melissa

This week has been weird. And one thousand years long. And kind of the worst, but also kinda not so bad. I’m not ready to call this my “new normal” yet, but am gearing up to do so if needs be. Because honestly, what other choice do we really have?

Then, because I really like to pile on and make things interesting, in addition to Corona and quarantine and cancelled everything, we are also in the midst of figuring out fertility stuff and dealing with insurance. So how’s that for fun? Last week before the world turned upside down, I was going to post a video of me talking through my frustrations with insurance, and share that process. But in the first few days as things were unfolding, it didn’t seem quite okay to talk about something so personal. I wanted instead to address the topic at hand, which is why we talked about our toilet paper supply. 🙂

Anyway, not that things are back to normal, by any stretch of the imagination, but I’ve realized in the past couple days that distractions are kind of nice. So here’s an update on where we stand with fertility coverage with our insurance.

In the past, we’ve been lucky.

We have had the same insurance company for the past decade or so. And in that time, we’ve gone through quite a few fertility treatments. Luckily for us, our insurance has covered a lot of it. Now of course we still have to meet my personal deductible, which is usually a couple thousand dollars, and then after that, the insurance pays a percentage of the treatment, about 80% for diagnostic things (ultrasounds and bloodwork) and 50% of the actual procedures (IUI and IVF). So not free by any means, but we were grateful for any help or money that we didn’t have to pay.

This time around…

Our insurance has changed a bit. At first I thought it was because we chose a higher deductible plan, but Philip reminded me that we only did that for last year, and we are back to our “silver” status, rather than “bronze.” Regardless, the plan has changed. I spoke to a representative from our plan and they let me know that I needed to sign up with Fertility Solutions through the insurance. I did so, and then had a phone interview with a lovely nurse who had a myriad of questions. After explaining my background with infertility, we went over our plans for this time around. We have seen Dr. Amols for years, and have frozen embryos stored at his clinic, therefore, we will go back to him for our last transfer. It just makes sense. Or so I thought.

The nurse let me know that my insurance now only covers fertility treatments at clinics that are categorized as a “Center for Excellence.” Excuse you??? And here’s the thing, my office is not in that category. She called my insurance to see if we could appeal for coverage since I already had frozen embryos and have a history there, and they said NOPE. But here’s the real kicker, my doctor is in network! So it should be covered! And it always was previously! But this time, NOPE.

Our options…

So what the heck are we supposed to do? Well, the nurse on the phone called the “Center for Excellence” in our area and said that we could transfer my embryos to their office and do the transfer there. But here’s the thing, I don’t know the dude! I mean, I’m sure he’s good, but I don’t know his process, I don’t his medication regimen, I don’t want to go pick up a cryo-tank and be responsible for moving my microscopic baby science experiments from one office to another! The whole thing is garbage.

But, if I want my insurance to cover it, then I will have to do those things.

Or not. I could stay with Dr. Amols and his office where I’ve felt comfortable for the past eight years and pay more.

How much more? Well that’s the other thing. I have a $2000 deductible to meet anyway, so I have to pay that out of pocket one way or another. The crappy thing about doing it at my existing office is that then the rest of my OB care for the rest of the year would all be going toward my deductible rather than being covered. UGHHHH. This is garbage, have I said that?

The other thing is that before proceeding with a transfer, a hysteroscopy is required. It is where they look at the inside of my uterus to see if they need to clean it out. I had to have it before my transfer with Jade, and while it isn’t a huge deal, my doctor did it out of a hospital. And if it goes that way again, it would incur hospital charges and anesthesia and all sorts of other expensive things that wouldn’t be covered. So there’s another big unknown.

And here’s the real kicker…

I think the most frustrating thing about this whole situation, is that I’m not an idiot. I mean, I am in certain ways, but when it comes to insurance, I am not. I’m the person that READS EVERY DETAIL of a plan before signing up. I get out a calculator and figure out, down to the penny, which will be the best financial deal for our family. I’m crazy, I know. But I used to work in insurance and never want to take that knowledge for granted.

So when signing up for our plan this year, I saw the nonsense about “Centers for Excellence.” But as I was trying to dive into it, I kept hitting walls. Because I wasn’t a plan member, I wasn’t able to see who was in that category. So how was I supposed to know if I wanted to be a plan member if they wouldn’t let me see the providers?! Instead, I defaulted to the fact that my doctor was in network. We had used him for years without issue, it shouldn’t be an issue this time. Man, was I wrong. It’s just so frustrating knowing that I tried to make the most educated decision possible, and still ended up in this situation. Garbage, I tell ya.

So there’s that.

So now we have some decisions to make. A lot will boil down to what we find out from my hysteroscopy appointment, so we will kind of wait on that information. And in the mean time, I will just be frustrated with one more step of this process. Yay for baby making! Good thing I love this little family of mine like crazy. 🙂

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