Tuesday, May 8, 2007

Fun Times with Blue Cross Blue Shield

After my miscarriage with Junior #2, my OB referred me to an RE. The city I live in does not have a recurrent miscarriage specialist clinic, so REs usually handle the habitual aborters by default. Lucky them.

The RE, Dr. Stretch, ordered 2 of the 4 tests given to recurrent miscarriage patients: (1) Clomid Challenge, which indicates how good my eggies are, which in turn can clue us in to whether the embryos are more likely to have abnormal chromosomes and (2) an HSG to rule out things like endometriosis, cysts, and the like. He also suggested we consider to other tests: (3) DNA / karotype analysis for me and Cowboy, which is done by analyzing a blood sample and gives us info on potential abnormal chromosome issues and (4) immune work-up for any clotting issues or antibody concerns for me, again, requiring a blood sample.

Since I’m risk averse by nature, I like to cover all my bases. Why not have all the tests? Let's put the issue(s?) right out on the table and see what we are dealing with. Plus, a looksy into what kinds of tricks Cowboy’s ponies are up to. Why waste any more time? Fo’ sure I am not getting any younger.

Sounds like a plan, right?


Only today I found out that because our insurance company excludes infertility treatment, including diagnostic treatment, exactly NONE of these tests, which cost about $3,000, will be covered by insurance.

So let me get this straight. Finding out why someone has massive bleeding and jaw-dropping cramps for days, not to mention the following hormonal imbalance and emotional trauma each time they get pregnant (by accident or not) is considered infertility treatment and is thus excluded from coverage?

Yep.

But – and just so I’m clear on this – drugs so a guy can get an erection are covered? (Sorry to anyone’s whose partners have ED. I am sure it is not cool at all, but I am just trying to make a point).

Yep.

If ONE man ever had to go through the physical trauma of a spontaneous abortion, missed abortion or a D&C, I can guaran-freakin'-tee you that the procedures required to solve this shit would be legally mandated to be covered by insurance companies.

I realize that three grand is chump change as far as infertility treatments go. The shit ain’t cheap. But we’re talking three K just to find out what is wrong. Treatment is, for sure, not included.

If you ask me, all 50 states should mandate ALL types infertility treatment be covered by insurance companies. Period. It’s not like you choose to have this happen to your body. And it is debilitating as all get out, both physically and mentally.

But, gosh, I mean, GOSH. Not covering the diagnostic tests just to find out why I keep having miscarriages?

This. (Sigh). Is just insulting.

10 comments:

Von said...

I completely agree with you. Why should it not be covered? Saying that my husbands work insurance for me covers 0% of anything that even has a wiff of IF about it.

Although I've had two miscarriages, my Doc. claims it makes me no different in my chance of a normal pregnancy than a woman who has had zero.
To be honest also, we have no desire to chase down that road. We are just taking things as they come.

tipsymarie said...

Hi, came here by way of anns.

Just wanted to say I know what you mean - I thought our insurance was bad, but you certainly have it on us. I cannot believe it does not cover even the diagnostics.

Anns said...

I want to throw up, I can't believe this. I haven't even gotten here yet but assume this is probably what I'll face when I go for testing.

Insurance policy is undoubtedly mandated by a man.

Such bullshit.

Anns xo

Sticky Bun said...

Word! It's so infuriating. So much of this IF stuff gets me super riled up. Because, the thing is, the only reason via*gra IS covered is because the drug companies shelled out the money to lobby congress and insurance companies to cover it. Which means that nobody has yet gone to bat in the same way for women struggling through multiple miscarriages, infertility, etc. It's f'ing INFURIATING. My very cynical guess is that, if there were more women in positions of power at the drug (or insurance) companies, we'd see better coverage.

But, again, that's my cynical view... (off my soapbox now. :-)

Bumble said...

Thats totally disgusting. It makes me sick. THEY SHOULD PAY DAMMIT! Not to mention some insurance companies view that IF treatment is "elective" and therefore not covered. Well excuse us if we Elect to have children, its only the God given right of every woman! Damn. I need to breathe.

Alice said...

Some insurance won't cover diagnostic tests for the habitual aborter because it's NOT considered an infertility problem - meaning that even though you miscarry, you are still fertile, so it's not covered. For example, IVF for me may or may not be covered because I don't have the requisite infertility issues for coverage--I can get pregnant I just can't stay pregnant. I hate insurance companies.

The Oneliner (Christina) said...

yes, TOTALLY unfair. at one point (after a 19 year old male told me that i should go to my PCP for menstrual issues who worked for BCBS) i told BCBS to f off. Man, it felt good.
maybe you should do the same?

Laura, the (reluctant) baroness said...

This is quite infuriating. My mom once worked for an insurance company, and gave me in inside peek to how things worked. The rules they have for what they cover frequently make no sense, and are made by people with NO medical background. Further, there were things that they would cover, but the policy was to refuse first and only pay if the pt or doc really threw a fit. I feel like these people are practicing medicine without a license. I mean, who are they to decide if something is medically needed or elective? And if they decline payment, for a lot of people, it means the patient can't get the treatment. Therefore, the insurance company is really denying them the care they need. I'm rambling, which I do when i get pissed.

Thalia said...

can your doctor code at least some of these tests as treatments for painful periods? My insurance covers endometriosis, for example, but doesn't cover infertility. So everytime I see my RE, he codes it as endo. doesn't cover teh cycles, but has covered hsgs, ultrasounds, lap and hysteroscopy.

momof3 said...

Did you read your policy before going to the doctor? Did you know that your employers make ALOT of the stipulations to the policies (EX: what is covered/what is not covered and the percent of the coverage?) Did you also know that they are 100% involved in the determination of coverage for their members choose what they would like to be offered. It's not just the insurance company pulling the strings. I myself have BCBS and had issues w/all 3 of my pregnancies without any issues with procedures not being covered.