Really health insurance, REALLY? (long)

KezziRiv · July 2013

So, in fun news, my health insurance wrote me yesterday to say they were going to be dropping me because when I applied for the insurance I must have lied about being infertile. Their evidence is that I was seeing a RE previous to my application to them. Yup, I was...cause I'm GAY and need a doc to help me make a baby.

I am an enormous ball of rage over this. they pulled all my medical files and sent these little "incriminating" quotes in the letter. It's shocking and infuriating. They also failed to even get my name correct in the letter. Also, if the retroactively pull my insurance they will owe me a butt-ton because they haven't paid for anything since I've had them minus 1 doctors visit ( my annual and unrelated).

They will only accept a written response so here's what I've got:

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RE: Application questions

Dear Mr. Blah Blah,

I am writing to answer the two questions asked in your letter to me. Before I answer those questions, I would like to point out that you stated that the review was initiated by ?claims for services provided to you with a diagnosis of lumbago, venereal disease and thyroid?. After extensively checking with my health care providers I have confirmed that there is no diagnosis of either venereal disease or thyroid. I reviewed the information that you have on file with other members of the RMHCO staff, they like myself, are unclear on how you reached your conclusions regarding the venereal disease and thyroid diagnosis.The coding of the lab requests states exposure to or contact with; I was working in schools between August 2010 ? November 2012 and in hospitals from December 2012 to June 2013, thus creating constant exposure and contact.

The questions are a) why did I not disclose infertility issues I had experienced in the past two years and b) why did I not disclose my doctors visits to CCRM and lab work undergone?

A. I did not disclose any infertility issues because I had not been diagnosed with any infertility issues. I was given an exclusionarydiagnosis¹ of PID (which several doctors have since disagreed with) and after having the HSG test was told that that did not impact my potential fertility. At the time of my application I did not have any reason to believe I had fertility issues and had been assured by my physician that she had full expectations of successful pregnancy.

B. I did not disclose the doctors? visits to CCRM as I did not perceive their relevance to infertility. I was not seeking out CCRM?s assistance because of infertility but because as a married lesbian, I did not have the same avenue for becoming pregnant as a heterosexual woman. I did not see the value of discussing this in a drop down menu format, as there is not a ?GLBT? option in the available menu options on the RMHCO website. My wife and I sought top medical care because we felt that it was the best approach for creating our family. We, and our physicians, do not view homosexuality as infertility, however it appears that this definition and understanding differs at RMHCO. CCRM requires that all patients, regardless of sexuality undergo a series of tests prior to moving forward with any form of reproductive assistance (ICI, IUI, ART, etc), hence my lab work.

1 Diagnosis of Exclusion, from Segen?s Medical Dictionary 2012, A disease or clinical nosology that is rare or unexpected based on the patient?s details and often unresponsive to therapy, the diagnosis of which is seriously considered only when all other possible?potentially treatable conditions?e.g., 'growing pains' or idiopathic midline granuloma?have been completely excluded

The application questions were specific to treatment and diagnosis of infertility, at the time of my application I had not been diagnosed or treated for either. I was in the care of a reproductive endocrinologist (RE) because two women are unable to conceive, this does not mean that we are infertile only that we are unable to make sperm thus conception cannot occur without third party assistance. We chose a respected facility because we believe that this kind of thing should be done the right way by professionals.

Another discrepancy that I found in your letter was the reference to the HSG as a fertility treatment. It is not a treatment, but a diagnostic test, one that provided a favorable diagnosis. Both the tech and RE saw no need for concern after seeing the results and that my body should be able to become pregnant. The language used in the REI consult exists because as I have mentioned previously, some assistance is always necessary for homosexuals regardless of the diagnosis.

Additionally, it is unclear to me why you have included the information regarding my Hepatitis B test being taken three times. I work in both education (which requires an annual or biannual screening) and I was getting cleared at the time to begin work on the mom-baby ward of several hospitals. The drug screening and multiple infectious disease panels were related to this clearance.

I would also like to state that I believe that if you choose to deny my coverage on this basis you are choosing to pursue discriminatory actions towards the LGBT community. All of the medical files you so thoroughly reviewed reference that I have a female partner, this topic could have led you to the reasonable conclusion that two women will always require assistance. Traditional conception methods do not work for gays and lesbians therefore we are all required to seek professional assistance to build our families either through fertility clinics or adoption agencies. This should not mark us as infertile but rather, as responsible adults who have chosen to carefully approach the serious responsibility of adding a child to their lives.

Thank you for your attention to this,

Me

GoaliesWife123 · July 2013

INFURIATING. However, I know nothing about the insurance industry. This is the exact reason why I would rather pay cash than get insurance.

Wishing you the best of luck! If you continue to be discriminated against, I suggest calling the ACLU and see if they can help!

clairmeij · July 2013

Absolutely ridiculous!! Your letter is great though. Please keep us posted on the progress with this!

lbugher · July 2013

Ridiculous. I swear, insurance is the must inhuman industry out there. They'll do anything to save a buck regardless of the expense or harm it causes customers. Your letter is well-worded. Keep us posted on how it works out!

mwagner25 · July 2013

Ugh! How frustrating.... I would be livid if I were in your shoes. You did a great job on the letter. I hope it all works out in the long run. Keep us posted.

songbird31 · July 2013

Wow. I would be so pissed if I got a letter like the one you got. Are you and your partner or wife covers on the same plan by any chance? And to know that someone pulled your files to scour them for "evidence" is beyond disconcerting. I think the letter is good and althoughtbits necessary to explain to a stranger why you had these tests and procedures, I'm sorry that you have to do it. Definitely keep us updated because depending on the outcome you can definitely escalate this.

KezziRiv · July 2013

My wife and I are not on the same insurance because her company will not allow for same sex policies. It's extremely frustrating as we would not be in this position to begin with! She is asking her company again to reevaluate the policy in care I get denied. I had quit my position in November to prepare my body for pregnancy and had to get private insurance at that time.

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Really health insurance, REALLY? (long)

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