Insurance Coverage

As I prepare for my first visit with the reproductive endocrinologist, I have been examining insurance coverage. Currently there are 15 states that have some form of mandated coverage for infertility, but that isn’t really as good as it sounds. Ohio is one of the states on the list but there are large gray areas. Ohio Rev. Code Ann. Section 1751.01(A)(7) mandates the following[1]: 

  Requires HMOs to cover “basic health care services” including infertility services, when they are medically necessary.

   Diagnostic and exploratory procedures are covered, including surgical procedures to correct the medically diagnosed disease or condition of the reproductive organs including, but not limited to: endometriosis; collapsed/clogged fallopian tubes; testicular failure

  IVF, GIFT and ZIFT may be covered, but are not required by the law.

So according to the state law nothing beyond diagnostic and exploratory procedures is required to be covered. However, insurance companies always know how to play the cards in their favor. Personally my claims for several diagnostic procedures were denied because my exclusions stated that infertility care and treatment was not covered. So although it was not treatment, they considered it care and could do as they wished.

I understand the controversy on infertility coverage, in most cases it is not a life treating disease but it is life altering. As I try to educate myself and decide what the most economical decision is for our family, I am struck by the argument of those opposed to infertility coverage. Many believe that insurance coverage for infertility will drive up premiums, which seems to me to be the most logical concern. However, reality is the opposite. “Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month.”[2]  Part of the reason for this is that those that have insurance coverage are able to make the best medical choice not only the best financial choice. Services that those without infertility coverage (myself included) chose are ones that carry higher risks once pregnancy is achieved. Often insurance companies that do not offer infertility coverage can experience higher costs related to multiple births and complications, risks that may have been prevented if other procedures were available to patients.

There were a couple of things that trigger this post. The first being that Maine is currently considering mandated infertility coverage, and I am struck by the misinformed and even hateful comments that people make against it. Many of them are too hurtful to repeat. The second is that Monday I will pay a few hundred dollars, to hear a specialist’s opinion. I’ve been spending the past few days making sure that they have every piece of information they can about me, so that I can get the most for my money. What would you do if it cost that much for you to see a doctor?   

            On a related note, I would like to point out that May 5^th is an advocacy day in Washington D.C. for the infertility tax credit. This bill would create a tax credit for those that are experiencing out-of-pocket infertility expenses.[3] Details are being finalized; you can find more information here.

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[1] http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html#Ohio

[2] http://www.resolve.org/family-building-options/insurance_coverage/insurance-coverage-facts.html

[3] http://www.resolve.org/family-building-options/insurance_coverage/infertility-tax-credit.html

Shot in the Arm

Well the fifth round of Clomid is finally over, and I have to say it went about as well as it could as far as side effects. I have come to terms with the fact that I just do not sleep well for about a week, a small sacrifice if it works. Tuesday we had yet another ultrasound to check follicle size, they were a little smaller than they would like. I was a little disappointed but had expected the worst and this wasn’t the worst so I was hopeful. Instead of doing the trigger then, I had another ultrasound yesterday. And guess what? I had 3 good follicles, 3! That means I got an expensive shot in the arm, and we hope for the best.
                Regardless, we are schedule to see the RE later this month. And it is just one of those facts that makes all of this more real. I have very few ideas about what to expect, and it will be interesting to be in a waiting room where everyone is there for the same thing. Right now when I go to the OB/GYN it is always a game of I’m not going to stare at you but I’m trying to figure out why you are here, you don’t look pregnant. I think we sometimes forget that gynecologist do more than deliver babies. But then again, I know a little bit about what it will be like. It will be similar to when I had to visit the hematologist/oncologist. You sit in the waiting room and although there are plenty of things to lighten the mood, it is a pretty depressing setting because you are only there if there is/was recently something wrong. I’m not really sure what to do about that.    

One More Round

I’m about to start my fifth and most likely final round of Clomid. One reason is that the FDA does not approve the drug for use more than six months, I understand some people have been on it longer but there are guidelines for a reason. The second is, as I said a few weeks ago, my OB/GYN has done all she can so our next cycle with be with the reproductive endocrinologist.

            To help this time around I went to see an herbalist that had been suggested to me by several people. I’ll admit going in I thought she was going to be anti-medical intervention for fertility and disagree with my path. Pleasantly, she was not. She was able to give me some supplements that help along with the medications I’m on and was actually impressed with level of care I was receiving from my OB/GYN. She agreed with me that we are probably going to need something stronger than Clomid since we haven’t had success yet. She was also able to give me a supplement for stress, which is amazing. So it looks like at the end of the month after seeing the RE we should have a new plan.

            As far as the emotional side of this disease, I’m doing alright. Jeremy and I were able to meet with a well respected friend and think some things through in a different way. At this point, infertility is becoming a way of life for us. We realize that it might be with us for awhile and we can’t put our lives on hold waiting for it to leave. This means that we both need to fully rely on God, and keep Christ at the center of everything. For me personally, this means making a schedule of my week and working towards non-school related goals. I have not done so well the past couple weeks as things have been a little out of the normal but hope I can get on track.

Even though I was not super productive last week, I was able to cross something off my bucket list. My brother and I were able to witness a space shuttle launch in person! We put a lot of time and money into it and it was well worth all of it in the end. Last November we spent a week in Florida waiting for the launch but no-go. This time, it was close. With mere seconds left in the window they were no-go but thankfully it happened. Matthew and I had LTT tickets which are for the causeway at Kennedy Space Center, the closest the public can get and it was amazing. Words cannot even capture the awesomeness of it, and I’m so glad we were able to witness it. You can watch the official NASA footage here. Now I just have to find something to cross off my list in the next year.

Before I end this entry, I want to draw attention to the fact that it is March. This means that it is National Endometriosis Awareness Month, and by national I mean recognized by the federal government. Please take a few moments to education yourself about endo at one of the following places: Endometriosis Research Center, Resolve, or Endometriosis Foundation of America. Nearly 176 million women worldwide suffer from this incurable disease and 30-40% of those also suffer from infertility. Endo deserves to be acknowledged as a disease worthy of attention and research; chances are that someone you care about is battling this disease. My personal battle has been a rough one (you can find more info in my earlier entries) and one that will continue.