LOWER YOUR INFERTILITY COSTS (Part VII) Fighting with your Insurance Company; Clinical trials; Shared Risk- Attain Program

LOWER YOUR INFERTILITY COSTS (Part VII)

• Fighting With Your Insurance Company
• Creative Alternatives- Clinical Trials & Shared Risk Programs

Start Fighting With Your Insurance Company

When The Insurance Company Won’t Pay

$          Insurance companies often count on a large margin of denials.   Some couples may write an impassioned, emotional letter enclosing pictures of their houses and write about their other problems. None of this matters to the insurance company. It’s a business. This isn’t personal to them.

$          How can insurance companies get away with it?   They can because fewer than 1% of people making insurance claims even question their insurer when their claim is denied. 

$          Request an appeal. To file an appeal you must find out what the internal process is at your health plan. 

$          Get your doctor in the game. Ask your doctor to write a letter to your insurance company. They must use the language of your policy in the letter. Therefore make a copy of the appropriate page of your benefit booklet and give it to the office with the right terminology highlighted. 

$          Also you have the right to have your case evaluated by a Board Certified physician who specializes in reproductive endocrinology or gynecology, not a general doctor who is not familiar with infertility treatments.

Try to Be Civil

$          Whether your fight is with your doctor’s office, your employer’s HR Department or your insurance company, there’s one thing you must keep in mind: Don’t be a bitch, at least not when you are talking to the people who can help you.

$          Part of empowering ourselves to take charge is to enlist people who can help us along the way so don’t alienate them.

$          If you become too belligerent, they are not going to deal with you. 

When Less Is More

$          Because of the high cost of IVF therapy, it is often tempting to transfer too many embryos to ensure a better chance for success. As skills in the embryology lab improve and fertility rates with IVF in general improve based on more successful implantation, professionals are beginning to encourage more single embryo transfers or at best, two embryo transfer. Do not succumb to the temptation to be overly aggressive. Multiple birth pregnancies are complicated and extraordinarily expensive and potentially dangerous. 

Infertility Is A Treatable Medical Condition

$          The Americans with Disability Act and the U.S. Supreme Court have confirmed that the ability to reproduce is a “major life activity” akin to seeing, walking, working, and caring for one’s self.   Within that context a disability is defined as a physical condition that prevents someone from participating in a major life activity.   For the majority of infertile couples, infertility is therefore a treatable medical condition.

Infertility Treatment Is Medically Necessary

$          Infertility treatment is absolutely medically necessary. Medically necessary treatment generally has to be:

            1) Safe and effective.

            2) Not experimental.

            3) Appropriate.

Treatment of infertility with IVF clearly meets these three criteria as IVF is safe, more effective and less costly to a health care system compared to many other types of surgical procedures. IVF is not experimental, having been performed now for over 30 years.

Try Anything … Creative Alternatives: Clinical trials

Participate In Clinical Trials     

$          Clinical study and clinical trial are the same thing—a scientific study of how a new medication or treatment works on individuals. 

$          Participants in these types of studies won’t necessarily get a full free treatment cycle but a portion of treatment costs (occasionally 100%) will be paid for. Often the medications and one IVF cycle are covered in a clinical trial. Fertility Centers of Illinois (FCI) www.FCIonline.com is the largest infertility practice in the Midwest. We frequently participate in clinical trials and studies so check our website homepage for details of studies being offered.

Change Jobs To Get Better Insurance

$          Consider a job change. Research various companies that have great IVF insurance and if you have a fairly portable job such as nursing or teaching, consider making a switch.

$          Some companies offer health insurance for part-time employees, usually beginning at 20 hours a week. 

$          Conceive magazine and Working Mother magazine regularly publish lists of the best companies to work for in regards to infertility and adoption coverage.

Don’t End Up Broke and Not Pregnant; Try Shared Risk

Money Back Guarantees and Shared Risk Programs

$          Get back 70 – 100% of your costs … if you don’t have a  baby

$          Medication costs, which can run anywhere from $3000 to $5000 or more depending on a particular medication chosen, the dose and duration of stimulation, may not be included in some of these shared risk programs.  

$          Sometimes clinics will cut you a special deal on medications for participating in their shared risk programs. 

$          IntegraMed has a very successful program called “Attain”.   Go to www.AttainFertility.com   for details.

I hope this 7 part series of blog articles has been helpful … good luck.