The Egg Drop Post

I have been writing this post in my head for almost two weeks. At the same time, I’ve been trying to remain calm and in my ‘pretty place’ so that I can be a welcoming host for my little one. But it’s time to let it out.

This is my tale of woe. It’s a story about the hidden cost of lesbian infertility.

In spite of my best efforts, my RE’s office did not start calling my insurance company for IVF authorization until 4 days into my cycle. I asked them in May when Nadia and I decided to move forward and I asked them again in July when I received my insurance card. I had the misfortune of speaking to the same receptionist both times and both times she said that they would get the procedure approved once I started. I was a bit leary of her, but at the same time I reminded myself that she did this kind of stuff all of the time, so she would know best. That was my first mistake.

One reason why I did not push it with her is because I myself had called my new insurance company several times to inquire about their fertility coverage. The first time was back in March and Nadia was on the call. In fact, it was Nadia who clearly inquired about health insurance coverage for her partner. We had them on speaker phone so, I chimed in several times to ask clarifying questions. It was on that call that we were told that they did pay for IVF, as long as I could prove medically that I had been trying to conceive for a year. Well, I knew that that would not be a problem for me. After all, I had had 7 IUI’s cycles (with 2 IUI’s per cycle), five of which were medicated, one fertility surgery, and one canceled medicated IUI cycle due to a poor response to medical stimulation. I got really excited about the prospect of subscribing to Nadia’s insurance when her open enrollment period would begin in July. I knew that we could do a few more rounds of IUIs and then if those didn’t work, it was comforting to know that I would not have to pay for the big IVF guns out of my pocket. Once I got my insurance card in July, I called them again to make sure that all of the paper work was in order and to reconfirm the benefits and requirements. I was told that everything was in order.

At the time, there was no way for me to know that with every phone exchange with my insurance company, I was operating under a false assumption that would prove to be very costly. I naively thought that they were operating in good faith. Please don’t ask me why I was stupid enough to think that because I really don’t know.

Imagine my surprise when I learned a couple days before my scheduled retrieval that they would not pay for my IVF treatment. “What?” I asked my doctor’s billing coordinator. “Well, it seems as if the fact that you don’t have a male factor, is a big factor,” she said. Needless to say, I was a bit confused.

It turns out that my health insurance company has different medical standards for women who have “access to sperm” and those who don’t. According to my health insurance, as a member of a same-sex couple, I am required to have 12 medically supervised IUI’s to prove my infertility and only after those 12 IUI cycles would I be eliglbe for IVF coverage.

What that means is that women who have male partners have different medical requirements than those of us who don’t; either because we are single (using donor sperm) or in a same-sex relationships (using donor sperm). Needless to say, finding this out at the 11th hour before my retrieval left me flabbergasted and dejected. I had come so far in my TTC journey only to discover that I had to foot an $8500 bill for IVF, if I was really going to see it through to the end.

There are many things about the situation that make me furious, but the fact of the matter is that each time we spoke with a rep for the company we identified ourselves as lesbian or in a same-sex relationship. We clearly explained that we were calling to confirm fertility benefits for the non-insurance holding female partner. I was never told that the medical standards for women in same-sex relationships were ‘different’, i.e. higher than those for other women. You would think that their employees would be trained to alert same sex callers about the differences, but no. If I had known about these differences, I still would have been outraged, but I could have planned things differently.

For example, maybe I would not have signed on to this health insurance; or maybe I woudn’t have waited three months…or maybe I would have continued with IUI’s until I reached their threshold, or maybe, hell, who knows? I never thought about different medical standards based on relationship status or sexual orientation

Another reason why I never thought to question my same-sex status and it’s effect on my medical coverage was because Nadia’s insurance is based in Massachusetts. Mass. is the first state to authorize same-sex marriage so I thought that made us all equal under the law. I never considered that they were would be ’separate but equal’ medical standards. Their company rules allow her to put me on her insurance–which in many states and for many employers is still a big hurdle same-sex couples must face– yet then they create different rules for us, even though we pay the same premiums.

Under the circumstances, my doctor was understanding. He said that he would help me with the appeal by personally calling my insurance’s medial reviewers, writing letters, and doing whatever he could to help but, obviously, he wanted to make sure that he would be covered, so I had to authorize his office to charge the full $8500 payment to my credit card. According to my doctor, if my ruling is overturned, I will be fully reimbursed.

OUCH!

I am not sure what hurt more, having 4 eggs sucked out of my bloated ovaries or signing that charge receipt.

As is stands now, my doctor has spoken to their medical ‘expert’ and he says it does not look good. They don’t seem inclined to budge on their requirements in spite of the fact that in his expert opinion whether or not I had a male partner, I would still have fertility problems and would qualify for infertility treatments. On my part, I have also written a letter to the company that is awaiting review, but they did answer my question about different medical standards for same-sex couples fairly quickly and this was their response:

“Our policies clearly indicates a member must complete 12 MD supervised IUI’s, which is equal to 12 months or one year of infertility. This has been in policy since 8/03. This is in accordance with the state mandate of one year. State mandate indicates a woman must have one year of infertility prior to coverage, in order to prove one year of infertility in a same sex couple or single female, they must show 12 IUI’s/12 months/ 1 year under the care of a md.”

One thing that they don’t mention in their response is that a woman in a same-sex couple would have to pay for the 12 IUIs. They won’t cover those either. So their fertility coverage for single woman and women in same-sex relationships is really non-coverage.

As of today, I remain embarrassed, angry, sad, humbled and little more broke than I had originally planned. In my case, the diagnosis of ‘lesbian infertile’ remains elusive and costly.

Now, back to my pretty place.