Do you think IF benefits will be a future step?

IBackBevo · November 2013

Insurance has been on my mind a lot lately...I guess with search and signing up for a new policy plus actually being able to obtain maternity insurance now. (My husband and I are private pray and in Texas you could not even purchase a policy with maternity prior to the ACA.) Plus, my facebook feed is a constant reminder of the changes. Do you think that infertility benefits will be a future step? Man, I am hoping so...and not because I will ever use them again (I plan on this being our last), but I sure would like future generations to not have one more thing to worry about...

JBDamonM · November 2013

I certainly hope so. Two things that chap my as*: 1. ) All of this talk on how Obamacare is modeled after what Mitt Romney did in MA - except in MA IF insurance is mandatory! 2.) All of the loopholes that allow company's to get out of providing coverage if they are in a state mandated state....

I am SO fortunate to work for a company based in Memphis, TN - where IF insurance is not mandated but they offer it anyways. Without it, we would probably have no LO. I give those ladies OOP HUGE Kudos for making it work

CarrieB. · November 2013

If you are interested in helping change legislation for IF coverage, you should check out the Resolve website. They sometimes have emails you can send to your representatives in congress.

BabyKsMommy · November 2013

I also hope so. We really want 4 kids but I don't know how many times I can go through months and months of treatment. We are 50% copay for infertility so injects/IUI cycles run about $600 a month. While I don't love paying that, I can. But we would be 100% OOP for IVF, which I think we would have success with because we are MFI.

I just can't afford IVF and really don't want to take out a loan for it. But in the future if it was covered that would be amazing, then I definitely think we would have 4 kids. It just is horrible that I may not have as many kids as I would like because of infertility.

mcgeeva · November 2013

I don't think it will be. With smaller companies and even some like mine which are huge they just chose not to cover it because from my experience people are close minded. A few years back I emailed the head of benefits to ask why and if it would be covered due to how much we were prying for treatments out of pocket. The head if benefits was a man and He told me that fertility treatments were not different they gastric bypass or plastic surgery. I was pissed off and taken back that someone could even compare the two. So I switched insurance to my husbands company who gets this.. Will cover treatments unless it's artificial insemination. How is that possible?!! They wouldn't cover a dime of any of my tests, drugs etc. So what infertility treatments are left if it doesn't cover that? So at this point I don't believe they will. Just like he whole insurance covers a breast punk based in women's care act. Well again I just called and my husbands company would not participate in this so no pump or coverage for a pump. Aye... Pita

mcgeeva · November 2013

Wow I would take your coverage over mine!!! We paid 2600 for one iui cycle not including meds and or all tests and copy at 100% us. Which is why we have to stop at two kids we can't afford any more. What kills me more... Because isnurance doesn't cover a dime they won't even allow us to put it towards our flex spending so I took out all this money for flex that I can not use. I hate the system

kzawisl · November 2013

We are totally OOP.

it sucks. I doubt it will ever change as a national thing though. My old company was based I a state that mandates coverage, but they were able to find a loophole and not cover it. DH's company offers $10k in reimbursement of adoption expenses, but no IF treatment.

IBackBevo · November 2013

@mcgeeva - To me, I would think artificial insemination would be different from an IUI or IVF. I think of that as being used in the instance of a woman having a baby on her own. Do they have this defined anywhere in the policy? If not, you might try fighting it. I fought my insurance company all the way up to the highest level over the definition of what "in connection with infertility treatment" meant and won. They paid my claim (finally- after 1.5 years of fighting over it), but then the *ssholes changed the definition in the policy!!! It made me so mad. Part of the reason I was fighting the good fight was because I thought I would do someone else some good down the line...because I put way more time into it than the money I ever saw back out of it.

mcgeeva · November 2013

We have tried for months now with his company benefits people and our insurance company. No one see my point even my doctor wrote notes but nothing has helped. I feel defeated at this point. Just trying to fins ways to use my money stuck with flex. I feel like I have been scammed

Ruthie04 · November 2013

Honestly, I think it's still a long way off. I think companies will offer and advertise IF benefits as a potential recruitment perk long before IF coverage becomes the norm. I worked for a large hospital system that was known for great benefits and their IF coverage was fabulous. Had we not had the coverage, it would have been $40k+ for treatment and meds. We ended up paying somewhere between $7-10k, which while difficult, was doable with our financial situation at the time. I don't know how we would have done it without that help and I hate that so many couples don't have the same opportunities we did.

mdiblasi10 · November 2013

I sure hope IF benefits will get better. We were 100% OOP for everything when I was on my insurance in 2011 and cycling to get pregnant with Grayson. We ended up spending a total of $6,754 for all of our testing, three IUI's with Clomid and one IUI with Follistim. I switched in 2012 to my husband's insurance (his company is much, much larger than mine) so we now have a $10,000 lifetime max benefit for infertility, with a max of 4 IVF cycles, $350 deductible and 80% coverage on treatments. My IUI & Follistim cycle (meds, ultrasounds, bloodwork) this time cost me $266 compared to $2,400 for the same thing with no coverage.

IBackBevo · November 2013

@mcgeeva - So sorry you are going through this! It absolutely sucks to not only have to deal with IF and all that entails, but also have to deal with the financial end of things.

I had a little bit different situation in that we never had to do IVF, but instead had my insurance company (and the IF clinic and the hospital) all tell me that a bunch of stuff was covered, then I get it done and then they a year later deny coverage and throw a huge bill back at me...right when I was in the midst of dealing with a high-risk pregnancy and then an IUGR newborn. Then the same company dropped my coverage altogether using my "infertility" diagnosis as the reason...for awhile, my entire family had trouble finding coverage at all...which is really scary. I went through this incredibly stressful time dealing with medical issues and my health and my LO's health and I swear the most stressful part of it all was dealing with the darn insurance company! I felt like I had been screwed up one way and down the other.

JBDamonM · November 2013

@mcgeeva - that is absolute horseshit that you can't use your flex spending for your IF expenses. Ia m pissed for you and it does not even involve me.

mcgeeva · November 2013

Thanks guys. Ibackbevo I totally feel for you too. I feel like we had similar birth stories with our last which you wonder where you catch a break?! Guess our little ones are it and same with this time around! Just paying out the ass for it so pre-e and bp better start put!

itsmevkb · November 2013

I work for the federal government and they cover no infertility treatments so no, I don't see that becoming some mandated coverage under the ACA. If they don't see fit to offer it to their own employees why would they see the need for the entire country to have it?

On another note, the ACA has actually done things to put those of us who do pay out of pocket in a worse position. Flex spending accounts are now capped at a mere $2,500 a year, which doesn't even come close to touching an IVF cycle, and probably won't cover an injectable IUI or a FET completely either. Also, the percentage of your income you need to spend out of pocket in order to take a deduction on your taxes also went up from I believe 7% to 10%.

@mcgeeva- are you certain you can't use your flex spending? Or is it not flex spending and some other kind of account? The IRS sets the rules for flex spending accounts and it 100% allows you to use it for infertility treatments. It makes no difference if your insurance covers it or not.

mcgeeva · November 2013

itsmevkb said:
I work for the federal government and they cover no infertility treatments so no, I don't see that becoming some mandated coverage under the ACA. If they don't see fit to offer it to their own employees why would they see the need for the entire country to have it?

On another note, the ACA has actually done things to put those of us who do pay out of pocket in a worse position. Flex spending accounts are now capped at a mere $2,500 a year, which doesn't even come close to touching an IVF cycle, and probably won't cover an injectable IUI or a FET completely either. Also, the percentage of your income you need to spend out of pocket in order to take a deduction on your taxes also went up from I believe 7% to 10%.

@mcgeeva- are you certain you can't use your flex spending? Or is it not flex spending and some other kind of account? The IRS sets the rules for flex spending accounts and it 100% allows you to use it for infertility treatments. It makes no difference if your insurance covers it or not.

I don't know how else to fight it?! They asked for more explanation I gave it to them to come back and say it's not a covered expense by insurance therefor it doesn't qualify. I wish I knew another way sicne we have a month left to get this money or it goes to waste. So unfair.

itsmevkb · November 2013

mcgeeva said:

I work for the federal government and they cover no infertility treatments so no, I don't see that becoming some mandated coverage under the ACA. If they don't see fit to offer it to their own employees why would they see the need for the entire country to have it?

On another note, the ACA has actually done things to put those of us who do pay out of pocket in a worse position. Flex spending accounts are now capped at a mere $2,500 a year, which doesn't even come close to touching an IVF cycle, and probably won't cover an injectable IUI or a FET completely either. Also, the percentage of your income you need to spend out of pocket in order to take a deduction on your taxes also went up from I believe 7% to 10%.

@mcgeeva- are you certain you can't use your flex spending? Or is it not flex spending and some other kind of account? The IRS sets the rules for flex spending accounts and it 100% allows you to use it for infertility treatments. It makes no difference if your insurance covers it or not.
I don't know how else to fight it?! They asked for more explanation I gave it to them to come back and say it's not a covered expense by insurance therefor it doesn't qualify. I wish I knew another way sicne we have a month left to get this money or it goes to waste. So unfair.

Do you have a HR person you can talk to about this?

Look at this:

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCsQFjAA&url=http%3A%2F%2Fwww.irs.gov%2Fpub%2Firs-pdf%2Fp502.pdf&ei=v8SDUv-HH_Pk4AP0oIDIAQ&usg=AFQjCNFSLrkNRVe15MSUjAqNnnj-FThSpg&bvm=bv.56343320,d.dmg

and

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCsQFjAA&url=http%3A%2F%2Fwww.irs.gov%2Fpub%2Firs-pdf%2Fp969.pdf&ei=WcaDUsybG_S54AOVuYCwDg&usg=AFQjCNFwJRyGDjoTOLmFA92C9Ktt4s9KJw&bvm=bv.56343320,d.dmg&cad=rja

mcgeeva · November 2013

I am going to check this out tonight and talk to my husband about it since it's the hr at his company. Something had to be done. Thank you for the info!!

danalawrence · November 2013

I hope that competitive economics eventually solves for this nationally. I see how that happened within my industry (financial services). Specifically: - I'm at a huge bank now that offers, standard within their main health care plan nationally, $30K lifetime max for IVF including PGD plus an additional $10K for meds. This plan is also open to part timers who work 20+ hours per week. A bank teller who works 3 days per week anywhere in the US could qualify and opt in. - why do they offer this? To compete for top talent in an industry where most competitors offer a variation of it. They know that the high-potential young prospective employees they want are attuned to benefits like this and look for them. They also offer 12 weeks paid maternity, another 12 weeks unpaid with guaranteed job protection if you want it, and on-site subsidized day care. - I got an offer earlier this year at a competitor. Bigger job, 20% raise. Turned it down. Why? Less generous health insurance plan. Lower caps for IVF and meds. Less paid maternity. No day care. Given all that, the comparison wasn't even close. At this point, given these benefits, my current job would have to become totally intolerable before I'd consider leaving (luckily it's not, it's actually pretty OK). So I stick around, and that's what they're going for in HR - low turnover, high duration. This kind of stuff is opening the gap between big and small companies. Benefits more and more are used to help compete for talent. I hope that continues and leads to more IVF coverage. I know that I'd be $100K in the hole right now if I were OOP. I am so, so grateful.

mcgeeva · November 2013

danalawrence I want to work at your company!!!!

pantsarella · November 2013

I honestly doubt they'll ever cover. Insurance is a numbers game. You pay your premium in case you "hit the odds" (essentially) and need treatment more expensive than the premium you pay. The company covers you betting that you won't hit those odds and they'll get more money from you in premiums than they have to pay out.

For example, in grad school I got an emergency-only health insurance plan for like $1,500 for the year. The company was betting that because I was a 22 year old healthy female, I likely wouldn't have an emergency. Well, my appendix ruptured and I needed emergency surgery...half way across the country (we were on vacation). They ended up paying $30K+. I also left grad school and never renewed my plan with that company. They lost their bet.

The last stat I heard was that 1 in 8 couples experience some level of infertility. Which means they have to decide the odds associated with that figure. And there's no way to tell really who might need infertility treatment, who might be trying to get pregnant, etc.

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