…or the lack thereof.
This morning as I was nursing Stella before heading to town for her one month checkup, I received a phone call from my health insurance agent.
First off, I am NOT happy with this guy. Throughout my pregnancy with Stella, I was on a state insurance program that would cover my “pre-existing condition” of pregnancy (read: they got to charge me a super high premium for maternity coverage), and Charlie was on Assurant. Once Stella arrived, we wanted to save money and simplify things by all being on one plan, because according to my agent, once I had a healthy delivery, the infertility diagnosis would no longer apply and cause issues with pre-existing condition b.s.
He had us cancel our existing policies effective 12/31/11 because he was “certain” we’d have “no problems” getting on the new plan through Cigna (a high deductible HSA plan that covered well-child routine visits and immunizations 100%). I, like a complete and absolute moron, believed him and followed directions.
Well, this morning, one hour before Stella’s doctor appointment, I got a call from him that they fucking denied us health coverage.
So much for a sure thing.
I just requested the “why” letter from Cigna, and BOTH my husband I were declined. He is 30, I am 29. We are both in PERFECT FREAKIN HEALTH.
You get one guess why we were BOTH denied.
Health information provided from your application and phone interview indicates history of infertility treatments by spouse in March 2011. This condition and treatment does not meet the approval criteria of our medical underwriting guidelines.
How awesome-sauce is that? So now, not only do I get denied, but SO DOES CHARLIE since he’s married to me and I have problems getting knocked up – EVEN THOUGH we have paid for every penny of the IF diagnosis and treatments out of pocket.
We had to pay out of pocket (OOP) for her appointment this morning, which thankfully was just a routine well-child visit that didn’t include any shots. It was still a $160 visit ($120 since we paid right there), but this obviously has to get resolved asap. Between a gazillion well child visits and immunization shots over the next year, the OOP expense would get ridiculous quick, plus I am obviously not comfortable with NONE of us being insured right now, not even with major medical. This is the first time in my life I’ve even gone one day without insurance, and it’s all my insurance guy’s fault.
*tip toeing around and chugging airborne trying not to get sick in the meantime*
ETA 3/7/12 – For those of you coming across this post down the road, we had to switch to a different company that would cover us (Assurant) – though we had to sign an exception acknowledging that they would not even cover diagnostic work related to fertility for AT LEAST 3 YEARS – after which time we could apply to have a waiver granted and have that covered again…though they wouldn’t have to grant that exception if they don’t want to. Such b.s., but at least we have coverage again. I just don’t understand why CIGNA couldn’t have done something similar to that waiver. Weird.
I want to scream with you. I can't get covered because of my back, so I totally get it. I also am without health insurance. I am still so sorry ou are going through this. I remember the frustration when I first had to do all this. Now I am just apathetic to the whole situation. Hopefully this guy will get his shit together and find something that works for you.
Omg!! I had no idea that IF was treated in that way!! What complete and total BS! I can't believe you have to deal with this. Hope everything works itself out – soon!
I'm a little concerned about this for future reference as well. If we ever move out of this state, we are moving to a state that mandates infertility coverage.
Cheese and crackers! I honestly don't know how you Americans tolerate your health care system. I lived in the States for only 12 years of my life and had so much trouble under my parents health care. Here in Canada it's easy breezy and so stress free. Good luck to you! So sorry you are having to deal with that!
Are you effing kidding me? Is fertility even linked to other health problems that might cost the company money? It sounds like ANYTHING can be considered a PEC then, like being stupid or fat (nothing to do with IF, obvs, but where is the rationale here???). And when is that health care reform law going to kick in? I'm so sorry. I hope you find something soon. Fire your agent?
Ohhhh man. That's awful! What the hell! I hope it gets straightened out soon!
Oh no! I'm so sorry that you're going through this! It IS maddening! One of the scariest, most nerve-shredding fears I had when I left my job to stay home surrounded health insurance. I carried us through my employer-based coverage. N worked for a very small company at that time, small enough that they didn't have to offer health coverage (something I think will change as the whole Obama health plan unfurls). This meant that we had to seek out private coverage, and we went through some SUUURIOUS harranguing over my IVF. They instantly zeroed in on the treatments, and we had to give so much information (and sometimes repeatedly) from our RE and my OB. The thing that really pissed me off about all of this is that the insurance company (An.them) did such a snoop job into MY reproductive health–my "pre-exisiting condition"–when our IF is MFI. Meaning, I had no identified reproductive issues, yet I was at the risk of having anything remotely related to my reproductive health denied. WTF? Ultimately, we went with the bare bones policy (one that did not include maternity coverage because, let's face it, the chance of a surprise pregnancy over here between the MFI and BFing, was not worth the argument or exhorbitantly increased premiums). It ended up that N found a different job and we have insurance under that job now, so fortunately it was relatively short-lived (about six months). But, it was all very worrisome. :(I hope there is a solution out there for you. Hang in there!
does the insurance policy cover IF treatments? If not, then wth does that have to do with anything? I think you should file an appeal and take it up the line… I would be completely and totally ticked off too!!! can you get back on your old policy in the meantime?
I hear you! I have insurance thru my very large company so i would expect it to be decent but it feels like I'm not insured. Last year i called and asked if IF was covered, fully expecting to need clomid at a minimum. They said they cover up to the diagnosis. So you find out you're infertile and then they wish you the best of luck. The bills have arrived from l&d and we owe about $2000. My husband said, "do we even have insurance???"
Wow that is total bullshit about not being covered because of infertility. Like you said you paid out of pocket so what is the big deal? Its not like you live in a state where it is mandatory to have infertility coverage. I hope you can get something figured out.
Oh wow 🙁 That is awful.. Insurance companies suck!!! I am on my husbands insurance thru the military and just got denied something I need for my c-section (a drain to help drain some blood from it).. It's like "you'll approve a major surgery, but you won't approve a minor thing??" So annoying!!! I don't even know what to tell you to do 🙁 I hope you get some help figuring this out, and can finally rest easy knowing you're all finally insured.. Ugh!!
OH. my. GOD! I have no words. I am freaked out for you guys and freaked out for my future self. It's total discrimination. And although it must seem like there's something that can be done to reinstate your old insurance because of the moron human error, I"m sure you've already looked into it, but it just doesn't seem right!So aggravating. I'm so sorry you have to deal with this now instead of enjoying each precious moment of your newborns life. Please keep us updated and best of luck figuring this mess out.
This really sucks! I'm sorry you're going through this. Prior to advancing with any treatments this is one of the reasons we switched out of our CIGNA plan. We now have BCBS. Someone should wack that agent in the nuts! Stupid guy and what a costly mistake!
I would be irate! I can't believe that guy assured you everything would be fine and then it blows up in your face and he has nothing to lose. I sure hope you get things figured out soon!
Who is this 'guy'?? Hr etc?
I have a million thoughts on this, but won't go into it all. I just don't understand how you can deny someone for coverage because of something that you DON'T EVEN COVER!!!!! WTF How does IF equate to added expense for them?
WTF does IF have to do with insurance coverage??? This pisses me off to no end. And I would be kicking that insurance guy in the nuts. I hope you get this figured out!!
OMG that's awful!
I am in TX and am an IVF survivor with a beautiful miracle boy (15mths). I had a friend who did IVF too. She left her teaching job to be a SAHM with her twins. She was denied private insurance b/c if IF treatment and they told her it would be pre-existing for 3 years. She fought it and got letters from all doctors, but continued to be declined. But, was able to get the kids covered just not her. She applied for her husband and kids only next time. It really sucks! Not only does insurance not cover IF treatment because in the words of my insurance "it's elective treatment". I mean who the F**k elects to put themselves emotionally and physically through hell to become pregnant. We spent $22k out of pocket the year we conceived our miracle. Now you can be punished again for it when looking for private coverage. Ask your doctors office, but in TX the state offers a program for immunizations if your insurance doesn't cover them and it's like $15 a shot. CO may have a similar program (it's not medicaid) just a special immunization program. Good luck! Insurance companies can SUCK IT!!
So ridiculous that IF is not covered by insurance (as though it's not a "real" medical problem), but still considered a preexisting condition. Hypocritical much? Healthcare in our nation is obviously super flawed, and this is one example of many….
I just threw up in my mouth. That is absolutely ridiculous.I don't get why he won't be coverable? That's unfair. (Well, it's unfair in any event). I don't get it. You should email RESOLVE. They need to get on this. You paid for all of your treatments out of pocket, anyway. (I'm going to stop rambling now, I'm kind of pissed off.)
I hate health insurance "denied" issues but have seen them over and over with IF treatments and other basic stuff that should be covered. It makes me so mad to think about and sorry you're having to deal with this stress right now!Another note- I'm also researching a delayed vaccine schedule and I have a couple of websites that I'm reading and using for reference. http://www.toomanytoosoon.org/cave.html and some articles at mercola.com Please let me know if you decide on a plan and I will do the same.
what an ass hat!!! i hate the private insurance industry they can al rot in hell!
Oh wow! I HATE learning lessons – especially COSTLY ones – the hard way!!!! For the love. I remember the first time I went without insurance and I felt so vulnerable! Bah! I PRAY everything works out! It will, just the timing!
Hey Josey, I love reading your blog! I have been wondering-what is the latest on the insurance debacle?
I'll add this above in the post as well, but basically, we had to switch to a different company that would cover us (Assurant) – though we had to sign an exception acknowledging that they would not even cover diagnostic work related to fertility for AT LEAST 3 YEARS – after which time we could apply to have a waiver granted and have that covered again…though they wouldn't have to grant that exception if they don't want to. Such b.s.