Tuesday, September 14, 2010

Ah, the complex relationship between infertility and insurance.  I had my open enrollment meeting today for insurance at work.  I've been on my husband's insurance plan for the past couple of years, since he has a PPO and I like the choice that PPOs offer.  Unfortunately for us, at the start of this year, his company went from a really good PPO with a smaller insurance company that still had a good network to a mediocre PPO from United this year.  I don't actually remember whether the old plan covered infertility, since I didn't have reason to look before.  At the time when the insurance switched over, we had only been trying for 5 months, and we still thought we would conceive any time now.

The first clue that this would be an issue came after DH got an EOB from his insurance company rejecting his first visit to get checked out.  Oddly enough, they accepted the second visit for him, but rejected the first.  IIRC, his semenalysis was covered, but his ultrasound wasn't.  I don't believe we've received any bills from the actual doctor's office from my visit and ultrasound.  However, we did get a bill for $635 in lab charges from my first visit.  We're working with his company's insurance broker to see if any of these charges can be covered after all.  For one thing, part of the lab charges for me are $246 for STD tests, since certain STDs can affect fertility.  Can't that also be preventative care and screening, though?  Screenings and preventative care are covered...

I looked at the insurance coverage that my company is offering starting next month.  Unlike with DH's insurance, IVF is covered under this plan.  No other infertility treatment is, however.  Our plan had been to try IUI first in terms of interventions by an actual fertility specialist.  I've raised the question with DH of whether it would be worth trying IVF earlier in the game if it's covered and IUI isn't.  I didn't expect an answer, and we haven't discussed it further, since we're not close to crossing that bridge yet.  I had just figured I'd throw the question out on the table so it could rattle around in our heads.  I wonder why a company would cover expensive stuff like IVF and not IUI, which is exponentially cheaper.

My company likes to do a high-deductible HMO and then give employees an HRA card for the deductible, paid by the employer.  They find that less expensive for them than paying for a policy with a regular deductible.  Starting next month, that would be with United.  With my company's insurance having more infertility coverage than DH's, but only of an intervention we may not need, it raises the question of whether it's worth switching from a PPO to an HMO in order to get that additional coverage.  One benefit of this HMO is that as long as a specialist is in-network, referrals for specialists actually aren't necessary.  It's not even that I want to be able to go out of network, especially since United has a nationwide network, so I'd be ok even if I was out of town.  It's more that I've tended to find PPOs to have larger networks than HMOs, as well as fewer hoops to jump through.

Another thing that makes this interesting is that this division of United that my company is using also has a savings program where their customers qualify for discounts on things that their insurance doesn't cover, like gym memberships, nutrition counseling, and infertility treatments.  The discounts range from 5-50%, but I can't look at what companies participate or what the discounts are for individual things until I'm a customer.

Oh, yeah, and my employer wants the enrollment forms back tomorrow, when the meeting was today.  DH just got home and is comparing his coverage (my current coverage) with what my employer is offering.  He's frustrated, saying it's really confusing and seems like they put a lot of fine print in so they don't have to cover anything while they sound like they do.  I started reading the chapter on Affording Infertility in the Infertility Survival Guide, but didn't get to finish it before DH got home.  He's currently reading the section of the chapter on dealing with health insurance.

Final decision: my company's health insurance is free, and we can't cancel my insurance with DH's company at this time, so unless I find a reason not to when I talk with the person I turn the form into tomorrow, I'll add it as secondary coverage.

No comments:

Post a Comment