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PART I. ADMINISTRATION OF THE GOVERNMENT
TITLE XXII. CORPORATIONS
CHAPTER 175. INSURANCE
PROVISIONS RESPECTING DOMESTIC COMPANIES
Chapter 175: Section 47H. Infertility, pregnancy-related benefits
Section 47H. Any blanket or general policy of insurance, except a blanket or general policy of insurance which provides supplemental coverage to medicare or other governmental programs, described in subdivisions (A), (C) or (D) of section one hundred and ten which provides hospital expense or surgical expense insurance which includes pregnancy-related benefits and which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, while this provision is effective, or any policy of accident and sickness insurance as described in section one hundred and eight which provides hospital expense or surgical expense insurance which includes pregnancy-related benefits and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth while this provision is effective, or any employees’ health and welfare fund which provides hospital expense and surgical expense benefits which includes pregnancy-related benefits and which is promulgated or renewed to any person or group of persons in the commonwealth while this provision is effective shall provide, to the same extent that benefits are provided for other pregnancy-related procedures, coverage for medically necessary expenses of diagnosis and treatment of infertility to persons residing within the commonwealth. For purposes of this section, “infertility” shall mean the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. "
This is the Massachusetts law regarding infertility treatment.
Now, I 've been expecting to have to go through infertility treatment for some time. After all, my husband and I have been trying to conceive (TTC) for 22 months. Yes, it was inkling that this may pertain to me.
In November of 2005, approximately seven months ago, I went to my primary care for my yearly physical. I went armed with a chart of my then cycles. Please see below that chart with additional information.
No. Length Menses Ovulation
1 37 days 3 days Unknown
2 48 days 3 days Unknown
3 119 days 6 days Unknown
4 81 days 8 days Unknown
5 85 days 7 days Unknown
6 30 days 6 days Unknown
7 41 days 8 days Unknown
8 33 days 6 days Unknown
9 50 days 5 days O 14/15 – HF 16
10 30 days 4 days HF 10-25 – O N/A
11 43 days 8 days HF 12-27 – O N/A
12 5 days Clomid/PRO – 30-38
FM – N/A
She suggested that I talk to someone, maybe a gynecologist. She really didn't know what I had, that I had some symptoms of PCOS, as I clearly questioned on my own. But, that none of my symptoms were as drastic as PCOS usually requires them to be.
One week later, I went to the gynecologist. Let me preface this, I had gone to this gynecologist about eleven years before. At the time, I was suffering from irregular cycles, big surprise there, and she fixed it. She put me on the pill and my cycles were like clock work. They were beautiful. But, I was on the pill. Obviously counterproductive to what I want to get done now!
Back to November of 2005. I go to the gynecologist. Now, I admit my primary care didn't know what was going on with me, but I will give her credit. She put me through a heck of a lot blood work. She also gave me my yearly physical and PAP smear. Loads of fun, but she did what was medically necessary.
I go to the gynecologist and I am expecting more of the same. Do something! We talk. She comes to the same conclusion that I have come to, I may not be ovulating and that I have irregular periods. GENIUS! Heck, look at the chart. I think ANYONE can figure this out, I did.
She tells me to give it a few months. Looks like my cycles may be regulating and that I should just give it a few more months to see if this continues. Also, take the clomid to see if it helps and to make an appointment with a reproductive endocrinologist in several months.
OK. I left this appointment, confused, frustrated, helpless, and hopeless. Not good. Cried at my desk when I got to work. Definitely not a great day. What could make it better?
I called the insurance to find out about infertility treatments and what they covered?
The answer nothing to help you get pregnant! Only diagnostic testing.
WHAT?!?! WHAT DO I PAY YOU FOR?!?!?!
Luckily, I didn't say that out loud. I asked her to send me the information in writing.
So, I go about my business. In November and December I have two more regular cycles. Heck, I think, maybe the gynecologist is right and I am becoming regular.
In late December, I buy the expensive fertility monitor. At $187 for the machine and $49 for the sticks, it is not a cheap endeavor. But, after finding out my infertility coverage, why not?
In January, the little monitor says I ovulated. YIPPPEEE! My husband and I take full advantage. I go online to find out when to take the home pregnancy test. What find out is that I'm not pregnant and a FABULOUS group of women that know exactly where I'm coming from. It was a very productive month!
More confusion comes because a friend from the board posts this http://sharedjourney.com/articles/mand.html
It is an article about state mandates to cover infertility treatment. Mind boggling. It states:
Massachusetts:Massachusetts law requires those HMOs and insurance companies covering pregnancy benefits to cover those medically-necessary costs of fertility treatment. This covers IVF, IUI, GIFT, ZIFT, and sperm and egg retrieval. This mandate does not include experimental procedures or the cryopreservation of eggs.
This leads me to the MA state law, see above.
So, now the confusion has hit. But, I am not sure what to do yet. It sinks in, diagnostic testing. But, the law also states that the insurance must pay for the treatment of infertility. OK, to me that means getting me pregnant, but I see how that may mean everything but getting me pregnant.
Fast forward, it is now June, my husband and I go to our first appointment with the RE. She starts talking about IUIs. I say to her. Our insurance only covers diagnostic. She looks at me puzzled. She says, I thought it was required by law. I said, I looked at the law and it is ambiguous. She also suggests that I talk to the woman in her office who deals with insurance.
She calls me back, after five days of playing phone tag, she told me what I thought, just diagnostic testing. But, she goes on to say that I should talk to the benefits manager at my husband's company.
So, I send my husband to the benefits manager. Are you getting frustrated yet? Do you wonder why I am blogging?
He brings home the plan summary. I read it. After an hour of laughing out loud about the fact it doesn't pay for infertility, but it will pay for sex enhancing drugs. (I'm still chuckling over that one.)
I find a glimmer of hope.
There is a section about "Infertility Case Management and Education." Why would an insurance company that doesn't cover infertility treatments need this service?
I called today, and I'm waiting for a call back. Yes, I am fully expecting them to tell me "Sorry, but we don't cover infertility treatments. We are here to tell you that for the third time. We are sorry that the first two times didn't work. Have a good day!"