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Lost on the IF Highway

Insurance Pays for IF treatments, or do they? June 8, 2011

Filed under: Infertility,Money — Lost on the IF Highway @ 11:30 PM

OK. M will be home any minute, so I have to hurry. =)  I’ve been job hunting. I originally wanted to take off work until I finished school on Sept. 5th, but I’m so worked up about the money (even though we have savings) I think it would just be easier to work.  I’ve all but been hired for a part-time bank teller job, but it’s minimum wage and no benefits with high potential for full-time WITH benefits in the future (not sure if it’s near or far future).  The extra money would help, but I still have school and I swore I wouldn’t take a job w/o benefits.   I’m definitely taking a step back going from $12.32/hour to PT min.wage.  That’s for sure!

My big thing is, I need insurance.  M has it and I don’t, and if I’m going to get pregnant and have a baby, I want insurance.  There are a FEW other jobs around here, but not many, especially not with benefits. PT with benefits would be PERFECT, but there are definitely NOT any PT w/benefits jobs around here.  Do I hold out for a job with benefits or take the PT job to ease my mind about the money?

According to my Dr. insurance won’t pay for IF treatments anyway, but that’s not what I’m reading in everyone else’s blogs.  Why is that?  Do some insurances cover IF and others do not?  When/if I do get insurance, what should I look for? What questions should I ask?

I’m back to the old POAS routine, but something weird happened last week. On Fri. night I was running a 101.4 temperature, was shaky, dizzy, and very weak, and my lower back was KILLING me.  It started around 7pm Friday and went away mostly by noon the next day.  AND I have heartburn EVERY time I eat now, can’t seem to get an appetite, and when I do eat, I get a little nauseous.  My SIL says that’s how it was when she first got prego.  I’m trying really hard not to get my hopes up!

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8 Responses to “Insurance Pays for IF treatments, or do they?”

  1. Jackie Says:

    Congrats on the hopeful new job!! It should ease some of the financial stress, even if it is less than you were making before. And p/t will probably be more flexible with your IF treatments and appointments too 🙂
    Your doctor is mostly right. Most insurance policies don’t cover infertility treatments, unless you live in a mandated state. But some will cover diagnostics at least – bloodwork, tests, ultrasounds, hsg, everything except the actual act of getting pregnant. The insurance detail booklet (or whatever it’s called) should explain in detail what is covered – if you don’t see it specifically listed under the covered procedures, then check the “not-covered” part and see if infertility is listed there. But if you’re like me and can’t read insurance policies to save your life 🙂 then call the company and ask them about diagnostics and treatment for infertility. They should know what you’re talking about.
    Good luck!

    • Thanks for the encouragement and advice, Jackie! I’m really anxious about whether or not I should accept this job. I’m not sure if I would get raises over time or if it would just stay at minimum wage. The interviewer did tell me that there is a high likelihood that I would go full-time in the future, but he couldn’t give me a time frame. He said there is a full-time teller who will definitely retire within the next two years. Two years seems like a long time to wait. I went from being hopeful about a FT job with the American Cancer Society, making BANK and with FULL benefits to biting my nails over a measly little PT job with absolutely no benefits. It’s really frustrating… But, like you said, if we ever do get the opportunity to take IF treatments, it will make the scheduling easier, which will be nice. However, without the money, we will never get our foot in the door. My doctor literally told me she will not do an SA unless we pay for it up front, because she doesn’t believe that M’s insurance will pay for it. Lovely!

  2. Rain Says:

    Yippee for work, even if it’s isn’t perfect! As for insurance, some companies offer IF coverage and most do not. My husband and I have some of the best health insurance in our area, and yet, we still don’t have the best IF coverage because we don’t live in a “mandated” state. What you should be on the lookout for is “caps”…do they have any caps on spending on testing/diagnosing/treatment? For instance, our previous insurance had an 8,000 dollar cap on how much we could spend in a lifetime on IF stuff…that included medications. If you’ve done your reading, 8,000 won’t get you very far. We now have a 15K cap, which isn’t horrible…but we’ve run through a lot of that already.

    Take some time to learn about infertility laws in your state and the states near you (if there are any). What does the state mandate from employers in regards to infertility treatments. It can be pretty dramatic from state to state.

    I wish you the best!!!

    • Rain,
      Thanks for the advice and for sticking with my blog. I know I don’t write religiously. I just don’t seem to find the time. Since M doesn’t know about it, I only write when he is at work and my sis isn’t here to snoop. For some reason, she acts as if she is M’s special agent or something, here to spy on me while he’s away. SO ANNOYING!
      Anyway… The info about insurance companies is fabulous! Thank you! I’m Insurance stupid, so I really do not understand any of it. I have read about “caps” in others’ blogs. A blogging friend of mine had a $30k lifetime cap and went through it in two years, so she switched to her alternative insurance option at her work, which had a $25k lifetime cap, and she spent all of that too. However, aside from co-pays and deductibles, she only had to spend about $3k out of pocket after they met their second cap. $55k sounds like a LOT of money to me. That’s about what we owe on our HOUSE!!!!! EEEK! I’m still praying to GOD that my doctor is right and that this will happen in time. It would REALLY help if she would do the damn SA. I really can’t believe she was so snotty about it. She said that she doesn’t believe M’s insurance will pay for him to have an SA done, so she wants us to pay for it up front before we collect the sample and THEN she will do it. She said, depending on which lab they use (her clinic uses 2-3 different labs), it could cost up to $700. I’m wondering if I can’t just find my own lab, get the order from my doctor, and pay the lab of my choosing directly. I wouldn’t even BEGIN to know how to find a lab to do it, but maybe that’s an option? I have no clue! GGGRRRR!

      • Rain Says:

        From what I know about having SAs done, M’s doctor would need to approve of getting an SA. Because your doctor is not his (unless I’m wrong). So, you need to have M’s doctor see M and talk him in getting an SA. Before you pay for ANYTHING up front (which sounds very fishy), you should check with M’s insurance. Just call the 1-800 number and ask if it is covered. Even if it’s not covered, M’s doctor may be able to code the SA differently and charge it to the insurance anyway. If you have any questions about insurance, feel free to ask. I’ve got a lot of knowledge in that area…just e-mail me.

      • Well, we go to the same clinic – which has two PA’s, an NP, an assisting MD, and one supervising physician. We both see the same Dr., but one of the PA’s is the one who usually handles routine visits, and she concentrates in women’s health and fertility. She is the one who would have to order the SA. I get financial assistance for my healthcare costs through this network of doctors (St. Mary’s Good Samaritan network). They cover about 50% of my health costs, but they get to choose which costs they will help with. They will not help pay for IF treatments, but they do help with some stuff (labs, PAP’s, etc.) related to IF. Since M has insurance, he does not qualify for assistance. So, he would have to pay any costs up front (just like he does his co-pays/deductibles). We’re in a rural area, so there aren’t any fancy IF clinics nearby. We just kind of have to take what we can get. It totally sucks, but what else can we do?

  3. Joshua Says:

    Hang in there. Five years ago, when my wife am I were two years into the IF tests and cheap treatment options (that’s a joke), we were always reading these blogs, and often angry, hurt, and discouraged. It was hard to have fertility problems as a man, and my wife did as well. We were given a referral from my father-in-law to try BeeFertile, a kit for men and women, made up of natural supplements. I would try anything at that point, and am blessed to say, that after three months of BeeFertile, we had our first ever PPT. I hope that everyone here will have the blessing of a child in their life, whichever method they use.

    • Thank you, Joshua. I have never heard of BeeFertile, but I find that I am learning something new every day. My doctor is really resistant to starting IF treatments “officially”, mostly because I am not insured, but she says it’s because she believes I’m too young to worry about it. My! How the world has changed! When my mother was 30 (having just given birth to my little sister) her doctor was telling her she needed to look into starting birth control because she was too old to be carrying a baby and starting over in her 30’s. Keep in mind that her doctor told her she was “starting late” when she had me just a few days before her 23rd birthday. I am 30 years old and many of my colleagues and friends do not have children who are my age or older. My husband’s cousin did not start trying until she was 33 years old and now has two beautiful boys (with the help of IF treatments for her first child). She was able to conceive naturally on her own after her first child. Just two generations ago you were an old maid if you were unmarried by the time you were 20. One of my best friends is 31 and is still unmarried, but she had a son at 21 and everyone told her she was “too young”. My husband’s grandmother was 13 when she got married and 16 when she had her first child. I couldn’t imagine, but I really don’t understand why everyone keeps telling me I am too young to worry about infertility. Wouldn’t it be better for us to know now, and to try now? If we try when we’re younger wouldn’t it be better than waiting until we’re older? I just don’t get it!

      Anyway, Joshua, congratulations on your success and I think I speak for all of us when I say thank you for the well wishes!


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