Posts Tagged ‘Infertility Insurance Coverage’

BabyOrBust.com Featured at ABC.com for Infertility Insurance Coverage

Saturday, November 3rd, 2012

I’m always excited to get a press request to tell more people about our BabyOrBust.com story, and the resulting sweet little Paisley Joon! Last week I got an email from Sydney Lupkin at ABC News asking if I could be available. Umm, of course I can!

See the Story Here

Sydney’s story discusses the sad truth that few people struggling with infertility will have insurance coverage for their treatment. For couples like us, male factor with multiple surgeries and procedures, the cost topped out at $20,000. Out of pocket!

Of the day we learned we’d have to do IVF, Shelton said this about this website:

“By the time we got to the car, it was a done decision,” Shelton said. “My wife is one of those people. She comes up with crazy ideas and executes them really well.”

I’ll never be able to thank him enough for saying yes. For agreeing to let me talk about his sperm on the Internet. For agreeing to scrimp and save on a gamble.

The night Paisley was born, I looked across the bed at Shelton and told him, “Thank you for her.” While my words may never completely summarize my gratitude for Shelton going along with all of this, I hope that the sassy, silly, blonde-headed miracle baby napping in my bed at this very moment says what my mouth may not ever be able to.

Thank you Sydney for a well-written article with some important information, and for including our story. And thanks Jennifer White Portraits for capturing the three of us so perfectly.

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Is your state covered for infertility?

Tuesday, June 17th, 2008

Did you know there are 15 states in this grand union progressive-thinking enough to require some form of insurance coverage for infertility/IVF treatments? Well there are. According to RESOLVE, a tremendous support resource for infertility, these states are:
Arkansas
California
Colorado
Hawaii
Illinois
Louisiana
Maryland
Massachusetts
Maryland
Montana
New Jersey
New York
Ohio
Rhode Island
Texas
West Virgina

Each state varies in the specificity of its coverage, and RESOLVE shares all of that here.

As for the other 35 states- what’s the deal? Get with it already! The legislatures for these straggling 35 states should be painfully embarrassed and disappointed in themselves. Not a single one of you can prevent a rational argument for why this isn’t covered. Infertility is a disease- most generally it’s a birth defect or genetic. This isn’t like health insurance covering lung cancer for smokers or health care during/after an abortion- or any number of other “elective” medical procedures.

Beat down the door of your HR department, too. Many companies provide financial support for adoption, but do your research, and find out if that support can be used toward your infertility treatment. RESOLVE recognizes Columbia Laboratories, Avon and Black & Decker as companies with outstanding practices for supporting its employees facing infertility and adoption.

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Mommy, where does male infertility come from?

Monday, March 17th, 2008

When a mommy and daddy love each other very much…. OK I’m kidding.

I found this article that sheds a little more light on the origins of male infertility, which is the cause for 25% of all infertility cases. Apparently it starts very early in the womb, within the first 12 weeks. During this time, the hormone levels in the womb can determine “common genital disorders, low sperm count and testicular cancer.”

This fits right in with what Shelton and I were told for his infertility. He has a natural vasectomy, basically. The Vas Defrens never developed fully into a tube, it’s just a piece of tissue. Our doctor explained that this is most commonly caused by being a carrier for cystic fibrosis.

I took a blood test, an expensive blood test that fortunately at the time was still covered by insurance, to see if I was a carrier of the gene. It was negative. So we did not spend the money to test Shelton because having only one of us as a carrier meant we would not give birth to a child with CF.

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Seriously?!

Tuesday, August 21st, 2007

Before I start, I cannot even believe I’m going to open the gates on this subject. I have a level-headed position on the subject- 99.9% of the time. It’s just one of those subjects right up there with politics and religion you shouldn’t discuss in polite conversation. And we here at BOB are all about polite conversation………… ha!

I was on my FSA provider’s Web site tonight looking through eligible expenses. The very first item under eligible expenses- meaning FSA dollars are approved by the US government- Abortion. You can get an abortion and basically have your insurance cover it.

HOWEVER!

Not only do I want to KEEP my baby… and have to go to EXTREME measures to get that baby….. my insurance company won’t have a damn thing to do with me!

AND…. AND… the US government will not acknowledge it either.

I also live in a state where it’s legal to carry a gun… but you can’t use a slot machine or buy beer on Sunday.

Right up there with how many licks… I believe this will go down as one of life’s truly unanswerable questions.

On another note- Do not even waste your breath or the muscles in your fingers sending me nasty emails about abortion.

And another note- IVF expenses are covered under FSA.

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CNN Article about IVF Finances

Tuesday, July 25th, 2006

My brother found this article on CNN Money. It’s about a couple going through IVF and the expenses involved. They offered a few tips that Shelton and I hadn’t really even thought about and thought we’d share with the rest of our little IVF club.

The four tips are as follows, but follow the above link to read the complete article.

FINANCIAL AID for Prospective Parents

1. Check your insurance for exclusions.
If your policy doesn’t mention your treatment by name and your claim is denied, you have strong grounds for an appeal. “If it’s not specifically excluded, it’s an implied inclusion,” says Pat Ferguson, an infertility medical billing expert.

2. Know what you’re entitled to.
Insurers often cover diagnostics. If you’re not reimbursed for tests, fight back. Infertility is the symptom of a medical problem, so you can make a compelling argument that testing for, say, endometriosis or fibroid tumors should be covered.

3. Carefully compare financing options.
Many infertility centers offer payment plans through third parties. Make sure you know exactly what’s covered and what’s not. Medications and pregnancy testing, for instance, are often excluded. “Shared risk” programs offer up to 100% refunds to qualified women if pregnancy is not achieved, but you may be charged twice as much for that money-back guarantee.

4. Check state laws.
Fourteen states require health insurers to cover infertility treatment (for the list, go to resolve.org, click on “Learn” and then click on “Insurance Coverage”). But there are caveats aplenty. For example, the laws don’t necessarily require employers to pay for the coverage, and all exempt self-insured plans. Before you forge ahead medically on the strength of state laws, read your policy’s fine print.

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Insurance

Sunday, July 16th, 2006

I wanted to address the topic of insurance. First of all our insurance does not cover infertility treatments of any kind. We do have pretty good insurance though. Here’s how it works:

  • The first $1500 of covered medical expenses for the year is covered at 100%
  • The next $1800 has to be claimed so we can get the insurance company’s negotiated rates, but it is completely out of pocket.
  • We do not get credit toward the $1800 for expenses that would not be covered by the insurance company, although we may still save through the negotiated rates.
  • The rest is covered under various percentages.

We like this plan even though it requires quite a bit of planning before the year begins to figure out how you will stay within budget. We do contrubute to our flexible spending account (FSA) in the amount of about $1300 for the year. This means that if we had a $20,000 surgery we would spend the $1500, then the $1300 from FSA, which insurance views as out-of-pocket, then come up the $500 (1800-1300) on our own. That would leave about $16,900, which the insurance company would cover at probably between 80% and 90%.  Of course, none of this applies to our situation because infertility treatments are not covered.

Some states do require insurance companies to offer infertility treatments. Others require the insurance company to offer the coverage to every employer, who can decide to accept or deny it. For a listing of states and a summary what is covered by their law check out this page on Fertility LifeLines.

Our Progress & Expense page has brief descriptions of our charges so far.  Next to those descriptions you may notice in parenthesis the abbreviations CBI, PI and FSA for “Covered By Insurance”, “Partial Insurance” and “Flexible Spending Account”, respectively. This is to let you know exactly what our expenses are for those of you who want to know what to expect as you go through the process and also exactly where the donations are used since they are not needed for every visit.

Here’s a quick statistic for you: “Spending on IVF is up over 50% over the last five years to over 1 billion dollars last year.” U.S. News and World Report, Sept. 27th 2004, Article: “Making Babies”

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