Denied

Despite living in a state where infertility insurance coverage is mandated... We conveniently fit into a nice little loop hole where that is not the case. Yep - we have no insurance coverage for infertility of any kind due to my husband’s company being headquartered outside the state of Illinois. And we’re covered by a major insurance company so as far as I’m concerned this is all a load of bullshit.

Actually, as far as I’m concerned infertility not being covered at all, anywhere, is a load of bullshit. Over the past few days dealing with this I’ve fumed and fussed over all the things insurance will cover and I could go into a rant now, and perhaps I will later, but as of now I just don’t have it in me.

While I understand inducing ovulation is not covered... I don‘t understand why not. Not ovulating is a symptom of PCOS and why shouldn’t that symptom be treated as all others are? IUI, IVF, okay. But if I was healthy and not suffering from PCOS I would be ovulating... And I just want my body to do as it should. I know its beating a dead horse but it annoys me none the less. The entire health care system is so flawed, its all crap.

The kicker to all of this is that up until very recently - as in within the last month to few months - we DID have coverage. However, something changed in the mandate and now we don’t. HR is looking into it to find out exactly what changed (though I have my suspicions as stated above) but at this point I don’t see a point. Knowing why I don’t have coverage isn’t going to help me. There is an extremely small chance that we are still mandated to have coverage and for some reason its been over looked, but even HR said its doubtful.

I was aware of this when I went in for my ultrasound so I made sure to make mention that this needs to be coded for exactly what it is, PCOS diagnosis, and not infertility. However, my appointment on the 18th WAS coded as infertility (in addition to anovulation and irregular cycles) so when I looked it up online today, the $110 claim for that appointment had been denied. I immediately called my doctors office and they are going to recode and resubmit since I technically did go in for irregular cycles... And from now on I’ll be going in for treatment of polycystic ovaries... Infertility after all is just a symptom.

Right now we should be okay - since I’m being treated for PCOS my OB appointments should be covered. Metformin should be covered as well and if its not at least its cheap and on Wal-Mart’s $4 prescription list. If/when the time comes to be put on Clomid I’m not even going to attempt to push it though on our prescription plan... Since as far as the insurance company is concerned we’re not trying to have a baby, just trying to ovulate. Clomid is also on the $4 list (though it costs $9) so that won’t be an issue to cover out of pocket.

This will all become an issue if the drugs don’t work and we need to move on to injectables and/or IUI/IVF etc. But lets just hope that doesn’t happen. Its not going to happen... The drugs should work. I hope they work... They have to work. They will work, and if they don’t, we’ll just have to cross that bridge when we come to it.

I suppose this is just another hurdle to jump. As DH said, we’ll work though it and hope that this never becomes a major issue. It just sucks to have to deal with at all.