insurance companies suck

nikinikinine · January 2012

We are 100% OOP for our current cycle. It's fine, we knew it was coming and what not and we know how lucky we are to have had even a limited amount of IF coverage.

That said, I have maxxed out my benefit. My husband has not.

His SA that he had to do for this cycle (his last one was about two years ago) was pretty bad. So much so that we now qualify as MFI. Our RE's billing coordinator called our insurance to see if we can process ICSI through his benefit and pay OOP for the cycle and they won't cover ICSI because even though he has MFI and he has coverage, "ICSI cannot be performed without an egg and therefore it would go through his spouse's benefit which is maxxed out".

Uh, WTF? So if it has to do with sperm it's not his benefit because sperm is injected into my egg? So basically all his benefit covered was his repeat bloodwork and SA. If they are going to treat IF benefits that way then we should have had a $20K lifetime max AS A COUPLE rather than two individual $10K plans. I'm so irritated by the loopholes that insurance companies get away with.

Sorry, but I just needed to vent. And I'm sorry if this is offensive to those who have never had coverage. I really do know how lucky we are.

swgal · January 2012

Wow! That is crazy. I'm Canadian so I don't really understand the ins and outs of insurance plans, but whenever I hear about them on here I can't believe the loopholes that they seem to put into everything! Sorry you have to deal with that craziness.

Mom2Reese · January 2012

That is no fun at all

no matter what - no coverage, some coverage or all covered - this stinks to go through. Hoping you don't have to deal with anything else and you have a successful cycle!

cookiemonster03 · January 2012

I'd file an appeal with the arguement you stated. Worst they can say is no.

We're currently having an insurance issue too. Its a long story, but in short we added the babies to DWs plan (and her) after they were born. Her insurance is primary since she's older, and they rejected all the hospital stuff etc because we weren't pre-qualified or whatever it is called. since, you know, the plan didn't exist until around 20 days after they were born. The hospital told us my plan (which WAS there) will reject it since the primary did and tried to get us on a payment plan. Um, no thanks. We're going to see what happens, then appeal until I die.

kme930 · January 2012

That is horrible! So IF is just a woman problem?? Ugh. I am so sorry!

KYRN · January 2012

I would keep calling and try to appeal. If you end up having to pay in the end you won't be any worse off. I would also discuss with your RE's office if you can hold off on paying them for at least a short amount of time (for the ICSI only) if you agree that you'll pay by a certain date if you can't get the insurance to change their decision. It is easier to get insurance to pay a bill than to get the money back that you already paid. Hopefully your RE will give you some time to fight it.

ALY1981 · January 2012

Sorry Niki

Mouseygail · January 2012

Ugh...that is really frustrating!! I like the ideas of appealing!

nikinikinine · January 2012

KYRN:
I would keep calling and try to appeal. If you end up having to pay in the end you won't be any worse off. I would also discuss with your RE's office if you can hold off on paying them for at least a short amount of time (for the ICSI only) if you agree that you'll pay by a certain date if you can't get the insurance to change their decision. It is easier to get insurance to pay a bill than to get the money back that you already paid. Hopefully your RE will give you some time to fight it.

for now this is what we're doing. I used my FSA card and our checking account to pay for the difference in the cycle this week. So aside from ICSI (a $500 charge) we're paid in full. I'm just so annoyed at the whole well the sperm has to go somewhere argument!

AvaLikeLava · January 2012

I wholeheartedly agree. The loopholes can suck it!

newsbaby · January 2012

Wow. That is unbelievable!!!

krissyh21 · January 2012

nikinikinine:
KYRN:
I would keep calling and try to appeal. If you end up having to pay in the end you won't be any worse off. I would also discuss with your RE's office if you can hold off on paying them for at least a short amount of time (for the ICSI only) if you agree that you'll pay by a certain date if you can't get the insurance to change their decision. It is easier to get insurance to pay a bill than to get the money back that you already paid. Hopefully your RE will give you some time to fight it.

for now this is what we're doing. I used my FSA card and our checking account to pay for the difference in the cycle this week. So aside from ICSI (a $500 charge) we're paid in full. I'm just so annoyed at the whole well the sperm has to go somewhere argument!

Erm. They cover viagra for men... the penis goes somewhere too!

This sucks. I would appeal!

Yellow_Daisy · January 2012

We ran into this too. Our dx was all MFI so we thought DH's insurance which had a tiny bit of coverage would help out, but no they said I was the patient so DH's insurance didn't even come into play.

JillRock96 · January 2012

That is just dumb. Sounds like they are just making stuff up to avoid having to pay. I'm sorry.

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