Legal Question: Can Anyone Help Me?

[Disneynut11676]

I was just wondering if anyone here personally knows a lawyer or works in a law office. I'll post this on the community board also, but you ladies are my friends & I just really need some advice. DH and I are having some infertility problems, as a matter of fact at our last doctor's appointment, she said that going through In-Vitro Fertilization is most likely the only way that we may be able to conceive. We are willing to try it, but the only problem is that it is a minimum of $6,000 per cycle and DH's health insurance doesn't cover any of it. The health company offers plans that will, but his employer won't "spring" for the package that does. However, enrollment time has come around again & they sent the paperwork home today -- so as I'm looking through it, sure enough they still won't help with any of our infertility costs, but they DO PAY 90% OF THE COSTS FOR VOLUNTARY STERILIZATION OR VOLUNTARY ABORTION . Is there anything that I can do legally to have them offer a plan to help bring life into this world? I have called all over his company, but they just keep passing me around to the next person. Before tonight, I thought that my world had come crashing down -- all I have ever wanted was to be a mommy, but then after reading the whole "we pay for abortion" health plan, I am devastated.
What would you ladies do? Thanks for any advice.

Michelle

 

[yummy72]

Disneynut11676-

I'm sorry to say I don't know anything legal, but I did work in a doctor's office once, and I know that health insurance is a nightmare...I just wanted to say that you and your husband will be in my thoughts and wish you pixie dust and good luck.

Take Care,
Candi

 

[Spinning]

I wish I could offer some words of wisdom or help but I can't. I think insurance companies can do what ever they please. I know I was made when they wouldn't cover birth control but found out they would cover Viagra!
I hope you can work something out. Maybe you can talk to your employer and see if you can pay more per month to get the coverage. Hang in there!

 

[AirForceRocks]

More than likely, it is purely a financial decision.

Sterilization and abortion are inexpensive, and they prevent future health care costs that have to be paid by the insurance company.

Fertility treatments are expensive, and if successful, they increase health care costs that have to be paid by the insurance company.

 

[jlp651]

I know what you mean with health ins being well-stupid...they dont think about "quality of life" but they think about what won't cost them more in the future and (in my eyes) that is pretty wrong...but anyway-enough of me on my soap box...
You might want to try ivillage.com I know that is sounds like I'm passing by the question and dumping you off to someone else...but if you look at there boards under health they have all sorts of boards and information on invitro and infertility...its at least worth a look-its nice to know that there are other people that are in the same boat-its pretty comforting when people have walked a mile in your moccassins.
I know this isnt much of a solution-but I hope it helps!

 

[rvoto]

I have now legal info for you. I want you to know that I am 38 and I was adopted. I love my parents. I can not even imagine what life would have been with out them. Remembeer you still have the choice of adoption. It really makes no difference if your blood runs through their viens. Love is love. I hope you can find the answers. My sister also is adopterd and she has had touble carrying she has since adopted 3 wonderful children. her first was a new born (A Gladney baby) it is a wonderful org. good luck I will put you on my prayer list. I know what a difficult time you are going through. All my love your way.
Lisa

 

[WDWMom]

I know this may not help much, but my best friend went thru infertility. Her DH had insurance that covered it but hers did not. Because she had to go thru her insurance first, then his covered the rest, she found out that her insurance did cover some things. I do not remember everything it did cover but blood work was one of them. I remember her saying how surprised she was at what her insurance did cover for the procedure.

If you can't get the insurance to cover it maybe you can get them to pay for some things and then out of pocket the rest. I know it is a long shot, but just some info to pass along that might help.

Good luck and you are in my prayers.

Sue

The ivillage website was a good idea. I'd go check it out.

 

[Disneynut11676]

Thanks to everyone who has responded. I've already been on the ivillage boards (you're right, they are a good support), but I have alot of ladies here that I feel more comfortable talking about. We have considered adoption, and unfortunately that is at least 3 times the cost of what a cycle of IVF would cost. If we had the money, it would be no problem, but....

Just wanted to say that I appreciate everyone's thoughts.

Michelle

 

[Pammy jo]

Michelle,
I sent you a PM.

 

[TonyS20]

I don't have any legal advice either. Just sending pixie dust your way. If the insurance company won't cover anything, could you set up the money in an expense account. I don't know much about them, but they withdraw a set amount of money from each paycheck on a pre-tax basis. My mom used it for her lasik surgery. It isn't the best solution, but would save you some taxes.

Wishing you and your DH the best!

 

[aurora19]

Tying into the last post if you don't have a medical expense account - any $ you spend on your fertility treatments may be tax deductible on the schedule A of the 1040 form (for medical expenses.)

I am sorry for your pain and I understand that you are frustrated but in-vitro has a low success rate and many insurance companies will not cover procedures that do not have a high success rate.

I realize that adoption is 3x the cost of IVF - but many of the people I know who have ultimately been successful with IVF have had to go through multiple cycles. (Massachusetts requires insurers to cover at least $20,000 of infertility treatments) Just something to consider.

I realize that you are angry at your insurance company but please also be aware that some people who have had to have abortions had them because of reasons other that "not wanting a baby." A friend of mine was pregnant with a baby with anencephaly (no brain) - she would have carried the baby to term and delivered (the baby would have died during birth or within minutes after birth). She developed eclampsia during her 6th month and was forced to have an "abortion" to save her own life. (medically that is how it was termed for insurance purposes - actually it was an induced labor & delivery)

Again, I will pray for you and your husband. I wish for you both the outcome that you want - to have a child in your family to love - whether it be your own biological child or adopted.

 

[Disneynut11676]

I just wanted to say that I didn't mean to judge abortions or those who have them. I absolutely don't believe in it -- but those people that do & do have them for whatever reason, are making a decision that they need to. I know you didn't say that I was, I just wanted to let everyone know that maybe my 1st post put wrong ideas out there about me. What makes me mad is that they would cover abortion, which most of the time has absolutely no relation to "disease", whereas infertility is a disease & they won't cover any part of it at all. Oh, and it's not the insurance that doesn't offer the plan, it's DH's employer who chooses not to offer that particular plan. But thank you to everyone who has taken the time to post & wish us like, or give us advice. I really appreaciate it.

Michelle

 

[AirForceRocks]

I think it probably goes back to the same thing - economics.

Good luck to you in whatever you decide to do.

 

[mcnuss]

HI,

I am afraid that legally, you are pretty much out of luck. First of all, the employer is not actually required to provide health insurance. If you sued, you might cause them to decide not to offer coverage to anyone anymore bc it's too expensive to fend off law suits. I think you'd agree that's not the outcome you want.

The states regulate to a certain extent what insurers must offer as part of all plans (vs. the optional stuff). If you wanted the insurance company to be forced to offer IVF as a treatment, then you have to lobby for a change in the law, the way they did in Massachusetts.

One other point, the plan has covered all your diagnostics and treatment up to IVF, correct? So if you challenged them, that's what they'll throw back at you. They will tell you that the statistically you have little chance to get pregnant with IVF and that they cannot offer these expensive treatments to everyone. (They are not going to look at your particular statistical chances, only that of the general population.) They will tell you that they treat IVF the way they treat a lot of cancer treatments, transplant surgeries, etc...

Last point, you said that most of the time abortions are not for disease, and that infertility is. The insurance company is going to say that most infertility is caused by age or past behavior. Not at all am I implying that either of these things caused yours (and I am very sorry for what is truly a loss for you), I am just trying to tell you what they'll say to your arguments.

I wish I could tell you that there's an easy answer. Your best bet is to continue to lobby your DH's employer to change plans. The problem is that it will cost more for everyone in the company, and I tend to doubt that they will do it. Just this past year, we had to change carriers after 5 years with BCBS bc the cost increase was going to be 100%. We are a company with 100 employees, and we hold their contributions to $100/mo. per family, up to 4 people. We carry over $250 per month of the cost for them, so as you can see, it's a big bite. Health insurance is a nightmare from everyone's perspective. People in the US do not realize how "rationed" our system really is until they need something costly that is not covered. I won't get on my political high horse, but suffice to say that everyone is getting hosed here except the insurers who have an awful lot of our lawmakers in their back pockets.

My best friend just went thru all of this and after several IVF attempts, gave up. It's hearbreaking, and I am so sorry you are going thru it.

Sorry this is so long!

 

[Favorite Auntie]

Not sure about the $20,000 limit. I have three sisters who all went throug infertility, from taking a pill, to having a pump in her stomach administering medication. I know that two of them had their bills WELL over $20,000, and they paid nothing. Their doctors told them that laws here in Massachusetts mandate that ins co's pay for infertility. BTW, It worked...as you can see from my tag!!!

 

[mcnuss]

I was just quoting a PP about the $20k in Mass. I have no idea what their laws are.