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Sunday, November 11, 2007

12.5 Fighting Back

12.5% of the population is experiencing infertiliy and recurrent pregnancy loss. Yes, that statistic is correct. 7.3 million people in our country alone. Here is my story for Mel's Blogtavism.

Eric and I weren't even ttc a year when I told him I wanted to get checked out. The results were less than desirable. One blocked tube, bad morphology and not great FSH. According to our RE, we COULD get pregnant naturally, but it could take between 5-10 years. Yeah, not so great considering I was already 32. And really, who wants to wait that long?

We checked all of our insurance options. As both me and my husband work, we checked all of our plans. None of them covered fertility treatment. We decided to stay with my insurance, as all the testing and diagnosis was covered, and the RE we wanted to go to was in network.

Once we decide we were going with IVF/ICSI, we were also lucky enough to find out that all meds were covered. But it still left us with a approx $12,500 for a cycle. We opted for a shared risk plan. $22,00 upfront, and for that price you get 3 fresh/3 frozen cycles. If at the end we didn't have a take home baby, we would get 75% of our money back. Our story has a happy ending. A beautiful set of twins that has completed our family.

I live in NJ. New Jersey has an act called the Family Building Act. Here is what it says: The Family Building Act requires insurance policies that cover more than 50 people and provide pregnancy-related benefits to cover the cost of the diagnosis and treatment of infertility. The law defines infertility as the disease or condition that results in the inability to get pregnant after two years of unprotected sex (female partner under the age of 35) or one year of unprotected sex (female partner over the age of 35) or the inability to carry a pregnancy to term. This act covers IUI, IVF, ZIFT, GIFT, ICSI, surgeries and all diagnosis.

Sounds great, doesn't it? Ah, but there is always a catch. Companies DO NOT need to follow the state mandates if they are a self-insured company. A self-insured plan is one that is not backed by an insurance policy. The employer instead funds and administers its benefit plan (i. e. , pays claims covered by the benefit plan from its own money). It may outsource the administration of the plan to a third-party administer (like United Healthcare or Cigna), but this administrator does not provide the employer with any financial backing or assume any financial risk associated with the claims. Self-insured companies tend to be large, financially-sound companies. Small employers tend to not have the financial ability to self-insure, so they purchase insurance and rely on the insurance company to pay claims per the terms of the insurance policy. As a result, when state mandates are passed, they impact mostly small employers.

So, there is always a loophole. I work for a big financially sound company that decided not to offer fertility benefits. So just because I live in a state that has mandates, they still didn't help us.

I am lucky enough to have wonderful parents that paid for us to do the shared risk plan. It was money they took out of their retirement fund to help make our family possible. Without them, we would have taken out loans, probably would have sold our house, and put ourselves in financial debt to have our family.

Our family is most probably complete now. I can't imagine finding that money again to try and increase our family. It's sad to me that money is going to dictate the size of the family we will have, but I'm so thankful for the beautiful kids I do have. Honestly, I don't know if we would even try again, but it would be nice to have the option, and not have it dictated by how much money we have.

I hate that insurance pays for treatment for alcoholism and drug addiction. Because I didn't do anything to myself to create my medical problems. Yet people can CHOOSE to take drugs or drink, and they don't have to pay to fix a problem they caused themselves. I just hope that the more people that bring this issue to the forefront and talk about it, the more changes are made and people get all the help they need to create the family they want.


MoMo said...

Well put! As you said, so many people will sacrifice so much to have children b/c the insurance won't pay for it. As you said, it will get some attention the more people talk about it.

The Town Criers said...

You have great parents! Thank you so much for writing this.

Hez said...

The company DH & I work for is also big & financially sound & self-insured. A few years ago it covered two IVF cycles. It no longer does. Thanks for sharing the loophole information -- because those whose insurance is managed this way need to know!