Sunday, March 11, 2007


I promised months back to share my research on insurance. And I am hesitant. Because in doing the research, I realized that it is very state specific. So, I will begin by saying the following - this is what I have found to be true in Massachusetts.

Also, I am hesitant to be certain what I found to be completely accurate - I'm still in shock and in complete apprehension mode. I am waiting for the other shoe to drop.

In Massachusetts the state law makers mandate infertility treatments - if you are in what they consider to be child bearing age, your FSH is at exceptable parameters, and there is no reason to believe you should not be able to get pregnant.

But, the law only mandates fully insurance careers, because these are the only plans governed by Massachusetts law. Yes, this is where it gets disappointing. If you work for a company with a self insurance plan, you don't qualify. And T and I work for two companies that use self insurance plans.

So, our work insurances did not cover infertility treatments at all. And the law did not require them to.

My RE advised me to search for a second insurance career. The local laws would apply because I would be buying a plan on my own. So it is secondary insurance in the sense, I will continue my current insurance and also the additional plan I purchased.

The one advantage of the law, is that the insurance company cannot deny me based on an infertility diagnosis. So, I do benefit from that - not to mention I will be able to take advantage of purchasing the insurance. It will save us several thousands of dollars each procedure, despite an additional $300 co-pay for each procedure and co-pays for the drugs. But, I'm not complaining.

So this is what I've learned, I hope that this helps in some way. And like I said previously, I did this reasearch on my own, and it could be wrong. But, I PRAY that it isn't.


Aurelia said...

I know this doesn't apply to you since you have PCOS, but reading the part about the FSH criteria, drives me nuts. It's just one number, and absolutely irrelevant as I have learned.

It can be manipulated, altered, changed and has no relevance to the patient's pregnancy outcome, but some idiot wrote it in stone years ago and everyone worships it.

And women like me get denied treatment, with a shred of EBM to back it up....gahhhh.

Kellie with an "ie" said...

Dianne, thanks for this information. Although I live in Alabama, and we're not known to be the most progressive state on issues like IF, I'm going to do some checking to see what the state laws are and if I can get some secondary insurance coverage. Thanks for lighting a fire under me!

Good for you in standing up to your nurse and TELLING her what kind of care you need. I love it!

Somewhat Ordinary said...

Thanks for sharing! I'm going to look into doing something like this in Virginia since they don't mandate it here.

Sara said...

I wish that every state had mandatory IF coverage. I'm glad that you were able to find a way to make Massachusetts law work for you.

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