Definition of Fertility/Patient Requirements
Infertility means the inability to conceive after one year of unprotected sexual intercourse or the inability to sustain a successful pregnancy.
Coverage
Group insurers and HMOs that provide pregnancy related coverage must provide infertility treatment including, but not limited to: diagnosis of infertility; IVF; uterine embryo lavage; embryo transfer; artificial insemination; GIFT; ZIFT; low tubal ovum transfer. Coverage for IVF, GIFT and ZIFT is provided if the patient has been unable to attain or sustain a successful pregnancy through reasonable, less costly, infertility treatments covered by insurance. Each patient is covered for up to 4 egg retrievals. However, if a live birth occurs, two additional egg retrievals will be covered, with a lifetime maximum of six retrievals covered. The procedures must be performed at facilities that conform with ACOG and ASRM guidelines.
Exceptions
Employers with fewer than 25 employees do not have to provide coverage.
Does not require religious employers to cover infertility treatment.
Employers who self-insure are exempt from the requirements of the law.
Employers with fewer than 25 employees do not have to provide coverage.
Does not require religious employers to cover infertility treatment.
Employers who self-insure are exempt from the requirements of the law.
Ok, so that's the law in my state. (You can find info on your state from RESOLVE.) The "sexual intercourse" part is worrisome. But this is just the law, not the actual B.CBS H.MO guidelines that we may change to in October. Will have to look more closely. I'm sure different insurance policies interpret the law differently. As Sarah said in the comments to my last post, it's more about individual policies and individual docs.
Clearly I've got more research to do. Whether I should stop consulting, get my own insurance. Go forward on my sweetie's, etc. Change from PPO to HMO and gamble that we can get coverage. Etc. Etc. But all of this is cart before the horse. We're going to do at least two more IUIs (for six total) before going that route .... I'm just so good about anxiety in the middle of the night about stuff like this.
4 comments:
hopefully the policies aren't too concerned w/ methodology. Keeping my fingers crossed that you won't need to figure this out anyways!
Wow-- your state is so much more progressive than ours is when it comes to this stuff, and we're not very far away. I'm jealous. Sounds to me like they're pretty stuck covering you. If they don't, I'd have the ACLU on their asses-- particularly if your partner's employer has a sexual orientation non-discrimination policy.
I am pretty sure that my doctor figured out a way to make me fit within the exceptions. Have you talked with yours yet? I think most doctors realize the rediculiousness of insurance and will do their best to work around it. I hope your doctor has that philosophy. Good luck. xo L.
Here in MA, the HMOs tended to see that rule for people in same-sex couples as "12 unsuccessful cycles paid out of pocket" before they will cover anything. Which SUUUUCKS.
I happened to get all of my stuff covered, but only because I made sure my doctor noted in my file that I was married to a man that I was with for nearly 6 years and we never got pregnant. Otherwise, I would have been denied and forced to pay a year out of pocket.
Good luck.
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