Thanks for all your advice and comments. Becky and Poppy guessed it: Aetna. I spent half an hour on the phone with them this morning trying to clarify that though my primary partner is female, I have been "trying the old fashioned way" with a male friend for over a year. They wanted medical documentation, because I guess queer girls have to fill out paperwork every time they f*ck. I am not through fighting them and we are going ahead with Cycle #2 regardless, but I am vacillating between abject depression and spitting fury. I can get them a semen analysis. I can even get them an affidavit from my friend, but this is all red tape. In the end I think it doesn't matter: they will deny me.
Speedy and I decided we can do 2 add'l cycles of IUIs before going on to IVFs, which wouldn't be covered under my plan anyway. That means we'd be an additional $5K out of pocket, PLUS whatever IVF sets us back. We decided to go up to 2 IVFs. I guess because the first 3 IUIs are really your best shot, we're splitting our losses. We WOULD have been covered entirely for unlimited IUIs if I had a male partner.
I feel sucker-punched. I just assumed that because it would be Speedy's name all over my paperwork and because we ARE legally married, I would have to come clean. But now I feel like if I had just said I had a male partner I wouldn't be looking at this giant mountain of paperwork and looming debt.
Wow things are so different in our country, our health insurance doesn't cover anything fertility related, if you want to start IVF and can't afford it there are special companies that will give you loans specifically for IVF. I was so surprised when reading that you could have unlimited IUI's and they'd be covered (if you didn't have all the red tape), I wish they did that here.
ReplyDeleteThat sucks. I have United Healthcare now. They are awesome. Blue Cross also sucked.
ReplyDeleteDon't feel bad about saying you are gay. If you said you were straight and they decided to look into it, it wouldn't be that hard to figure out and they could revoke your insurance completely for trying to defraud them. That was why I didn't want to lie, not some grand moral imperative. After seeing "Sicko," I'm convinced insurance companies are almost as devilish as pharmaceutical companies. And from what I can tell, our watered-down new health care bill isn't going to change things much. I hate this country so much sometimes.
I remember hearing on the news last year that some European country legislated that sperm donations must be covered by infertility treatment and lesbians have a right to that sperm. Is it Sweden?
Aetna covered all 10 of my IUIs, with no question of male partner status. I was upfront from the beginning that I would be using donor sperm too. The difference, and maybe this is an option for you... I had a dx of PCOS and therefore female-factor infertility. The parts of treatment that they covered (the blood tests, HSG, SIS, ovulation induction, ultrasounds and IUIs) were all related to treating female factor IF. The only part I had to cover was everything related to sperm (vials, shipping, storage, and preparation... all told about $700/cycle). It might be a huge hassle for you to get a similar dx for two more IUI cycles (since they won't cover any part of IVF), but just throwing it out there for you...
ReplyDeleteHere's hoping that try numero dos is your lucky one and this becomes a moot point, right?
I know the paperwork sucks but I would totally fill it out and submit it. That's better than paying for the IUIs out of pocket. Also, talk to your doctor... maybe she/he can code things differently so that you are covered. We ran through this before and in the end... Aetna paid for everything. Granted... we didn't do IUIs because at the time we had only been trying for a few months. I know this sucks big time... maybe you should take a day away from it and then revisit the paperwork tomorrow? Hang in there....
ReplyDeleteSucky, sucky, sucky. At least it sounds like Aetna doesn't blow in ALL cases. I'm sorry you have to deal with all the bullshit red tape. Hopefully it will be worth it.
ReplyDeleteAs IF trying to get pregnant as a lesbian weren't stressful enough already. This all really sucks.
ReplyDeleteI'm still with saying you have a female and a male partner. Who is to say you are not polyamorous? Hmm? That was going to be my comeback if I ever had to defend myself, but it never came to that.
Go ahead and submit the papers...you never know.
But yeah, maybe step back a day and enjoy your new gifts from Babeland and chill.
So sorry this bit is so sucky.
So sorry. That sucks. I had to have 6 failed cycles before I got a penny of coverage from the assholes at BC/BS. They had to be medically supervised cycles too, so even though I could supply receipts for sperm, my 2 at-home attempts did not count. We fought the insurance company for MONTHS on this, and they pulled every trick in the book on us. Even though we pointed out that a heterosexual woman whose husband had a zero sperm count would be covered 100% on their plan, they would not budge. It's discrimination pure and simple.
ReplyDeleteIt absolutely IS discrimination, and I feel like an ass for trying to cover myself by admitting I had a female partner, thereby screwing myself completely. In any case, I am currently checking into whether NY ever passed that amendment to SONDA (Sexual Orientation Non Dicrimination Act) that included insurance. If so, I would TOTALLY SUE THEIR ASSES IN A HEARTBEAT. Trust me, just for spite if nothing else.
ReplyDeleteIn other news, a new known donor has raised his (alarmingly large) head. This may be a possibility. He has proven virility to boot.
Damn. I'm Aetna, too, and they gave me no trouble. I wonder why they seem to have different rules for different people? Hang in there and know we are all rooting for you!
ReplyDeleteUgh, that is some bullsh!t. I dealt with that a little bit when I was switching V to my insurance. First, the form I filled out said I had to check with the carriers since they might not cover same-sex partners (why the hell would they care?). Then a nurse was worried that they wouldn’t pay for IVF since she’s not w/ a man (again, why would they care). It’s so effed up.
ReplyDeleteHave you thought about doing the Clomid Challenge or anything? That might give you a sense of how fertile you are, and if it’s worth your time and money to do IUIs. Your fsh starts to rise around age 35 typically, and V’s was high at age 31. Had we known that, I’m not sure if we’d have wasted as much time w/ IUIs. But if you have a KD, it might not matter as much to you guys (we were spending an insane amount of money on sperm).
I’m sorry for the insurance bs.
I am sure it depends on what plan you are with. My plan requires this enrollment in their "infertility program" which I now see is designed to let them claim "100% coverage" for infertility while screening out anyone they might actually have to pay for.
ReplyDeleteBastards!
Oh crap! I know we are all taught that lying is no good,but you find out quick that some people don't like the truth.Like insurance companies.Another thing i have learned in life in general is don't volunteer information it just gets you screwed some way or another.
ReplyDelete*mercury is in retrograde until jan 15th so i've been almost afraid to talk.lol
Do you think if you hadn't added Speedy to your policy they would have known?
I really think it depends on what state you live in. Different states have different legislation about coverage requirements; most have none at all. New York has something, so at least there's that.
ReplyDeleteHere's what I found about NY at http://www.asrm.org/Patients/insur.html:
Insurers are required to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York providing coverage for hospital care or surgical and medical care are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded from this requirement, including IVF, GIFT, ZIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility. (New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).)
It sounds like there's no definition of infertility, though, which seems to be the problem. Also, that 12 month factor seems to be written into the law.
Maybe this is worth contacting someone from GLAAD?
Not GLAAD. I meant Lamda Legal.
ReplyDeletelol- understood! I have got my friend at NYCLU working on it. At this point I feel like I will sue them out of pure spite even though I would not gain anything from it by the time anything happened.
ReplyDeleteI say sue. And lie. I am aaaaalll for lying to bureaucracies that don't give a sh*t about me. To me that's just self-preservation and advocacy...
ReplyDeleteDid you talk to various people or just one? Maybe its a matter of who you talk to? Regardless, it certainly IS discrimination. How do they possible think you would provide proof of having sex with a guy for a year? Seriously. That really sucks. Sorry you have to deal with these a**holes.
ReplyDelete