Insurance

Mommy2016

So I decided to go ahead and try to see an RE. There are only 5 in the entire state and only 2 within decent driving distance of me. I've called both and left messages and only one has bothered to call back. I missed the call and am waiting again. They both have recordings saying their waiting lists are full until February.

Anyway, I have new insurance through work and it says that it covers all diagnosis and treatment of infertility. I was on the website for the RE's office and they asked for an insurance check-list to be filled out prior to making an appointment. I called last night, and got absolutely nowhere with the insurance company. According to them, they may choose not to cover anyone over the age of 40 for infertility diagnosis and treatment. I turn 40 on January 29th, approximately one week before the next available RE appointment. They promised to have a "specialist" review my policy and contact me today. Here it is almost 5:00, and no one has bothered to contact me at all.

I just want to cry. I feel like no one wants me to have a baby but me. I'm broken-hearted at the thought of never having a baby, but I can't keep blindly throwing money I really can't afford into worthless inseminations that result in nothing but stress and feelings of worthlessness and failure.

perfectmillion

I work for an insurance company. I know that in our area (where your doctor would call that needed authorization for tests, etc) and I know that for the things I do, the ONLY person that can reject a treatment is a medical doctor. Each test/procedure has a CPT code, and when we get a request after they're entered into the system and a nurse reviews it initially to see if it meets criteria. If it doesn't it gets forwarded to the medical director.

You should be able to call and get a member advocate to help answer your questions. I know we have several of them in our area. They tend to know more than the traditional CSR who won't ever be able to see *what* says "this is fine, but this is not!" You *may* even be able to get a hold of the criteria yourself or at least find out what criteria they use.

grovehill123

One thing to consider when you get your appointment for the RE, tell them your possible situation and that you want to get started ASAP (be honest and use it) Tell them you can come in short notice (if you can) and that you want to be on their waitlist. I wish you all the best a RE is a good direction. Also check your insurance to make sure there isn't a qualifying number of days before it will start.

old mama

Can they legally deny a service based on age like that? Don't give up even if you can't get fertility treatment paid for. Most of us can't. See if they will work with you on a payment plan or most places anymore have loan interest medical loans. Mine won't touch anyone for fertility treatments but I know I would be covered for pregnancy. My dr. has been able to code a few things for me that were paid for. I might use the fact that you can't even get an answer from some places to help me choose where to get treatment. I know it's Friday but someone should have at least returned your call. I see you are from Kansas. It's quite a trip I know but Sher Institute out of St. Louis has worked wonders for friends of mine. Their initial appointment--over the phone to go over what you have done so far, set up a plan for treatment ect. is free. It might be worth just looking into it. Their drs. are great.

Mommy2016

The insurance company did not contact me today. I am seriously annoyed with them. I am also annoyed that the RE's office did not return my call when I left a specific message about the time they could reach me, though I know they are a busy place.

Thanks for the advice, both of you. My plan is to tell them I need to start ASAP because of the age thing and see if they can squeeze me in on short notice. At this point I will leave work in the middle of the day if that's what it takes. Also, I will see what I can figure out regarding the insurance. I appreciate your insight perfectmillion. I've never had to call my insurance regarding anything before so this whole thing is overwhelming. It's not actually "new" insurance, just new coverage since I switched to the higher priced plan so I could get the fertility coverage and a lower deductible. Now to find out I am paying more for nothing is really frustrating. Maybe it will all work out.

Bringing a child into the world should be a beautiful experience, and this whole process is seriously draining me both financially and emotionally. I feel like a failure as a woman, like I don't deserve what others get so easily, and like my dreams will never come true. I can't imagine going on like this for years and years...or ending my journey without a baby.

Mommy2016

old mama wrote:

Can they legally deny a service based on age like that? Don't give up even if you can't get fertility treatment paid for. Most of us can't. See if they will work with you on a payment plan or most places anymore have loan interest medical loans. Mine won't touch anyone for fertility treatments but I know I would be covered for pregnancy. My dr. has been able to code a few things for me that were paid for. I might use the fact that you can't even get an answer from some places to help me choose where to get treatment. I know it's Friday but someone should have at least returned your call. I see you are from Kansas. It's quite a trip I know but Sher Institute out of St. Louis has worked wonders for friends of mine. Their initial appointment--over the phone to go over what you have done so far, set up a plan for treatment ect. is free. It might be worth just looking into it. Their drs. are great.

Thanks for the info. I've heard great things about the Sher Institute. It is a half-day drive for me though and I'm not sure how well that would work once it came down to actually doing something. I'm worried about missing work too much throughout this process because they are enforcing this ridiculous new attendance policy.

I wish I could get some kind of financing for this, but that won't happen. My credit is damaged due to something in the past that was beyond my control. While everything is paid up now and I am working to repair my credit, it isn't going to help me in time for this.

And I am not sure how they can get by with not paying for infertility treatments for people over 40, but I don't think it is uncommon. When I was doing some research I found many places like that. Apparently it is a risk because it may never work and they'd be out all the money.

Mommy2016

I have an appointment with an RE...on FRIDAY! THIS Friday. Just 4 days from now. I am literally in shock. I called and the lady was so nice and said with my insurance they needed to get me in right away so they were able to squeeze me in on Friday morning at 8:30. I will have to leave my house by 7 to get there on time, but I am so thrilled and excited and nervous.

I hope I come away with answers and a plan to get pregnant!

perfectmillion

YAY! Good luck!