Planes, trains, and….insurance companies.

I really do need to be more consistent with writing. Sorry in advance for this novel…

The last few weeks have flown due to my work schedule. I had been flying out to our corporate headquarters every other week for a big project I am involved in, and was bummed really excited to find out that the last trip was cancelled due to another big meeting taking place over the same time which would have pulled a lot of people away from the project I am working on, so I have had a glorious three weeks soaking up my wife’s company. Every weekend we have had formal plans: a college graduation, our niece’s first birthday party, a wedding, and this past weekend two days of birthday festivities for different family members with a family dinner at my parent’s house in between. Tomorrow we are headed to a baseball game to celebrate my brother-in-law’s birthday, and then Sunday I fly out again for the week. During the week, we are usually so tired between our weekend plans and work, that after dinner (which my wife – who has a background in culinary arts – prepares every night without hesitation or complaint) we just lay around like sloths until bedtime. I wish there was a way to put those lazy moments on slow motion: when the dog is curled up on our feet, we’re watching one of our favorite shows, and don’t have any plans, because as lazy and comfortable as they are, they seem to zip by more quickly than anything else we do.

Since we have been so busy, we both took off on Tuesday and extended Memorial Day weekend out to four days, and took the train into the city so we could have lunch and meet with the financial coordinator for our fertility clinic – who works out of one of their larger offices and just consults for the small facility we go to in the suburbs where we live.

We are still hashing out of this insurance nightmare, but at this point, I think the value in sharing our experience outweighs my fears that any of this could somehow be used against us because: A.) I know in my gut that they are wrong, and B.) if someone else has gone through this, I’d love their insights.

Basically, my wife’s employer is based in a state that has an infertility mandate which dictates that all employers that meet a certain size and a few other criteria, are required to offer infertility coverage as part of their overall insurance benefits (which her employer does).

Back in February, when we first started this whole process, I called the insurance company and was told by a representative (after filling her in on our relationship as a same-sex couple and what we were trying to do) that we had full fertility coverage with no apparent exclusions due to our sexual orientation. Good, check. We then met with the first fertility clinic (that we elected not to utilize) we were told by the clinic (who does a preliminary review of benefits with the insurance company to advise you of your coverage) that we had full fertility coverage for IUI and IVF with no apparent limits and no prior authorization required. They remarked how amazing our benefits appeared to be and how lucky we were for having them (which didn’t surprise us, as my wife has pretty great health insurance coverage across the board). They said they did not see any reason why we could not pursue co-IVF (a situation in which I would carry an embryo created with my wife’s eggs and donor sperm so we are both connected to the process). Good, second check.

These benefits were confirmed – in writing- by the second fertility clinic – who also remarked how amazing and extensive our benefits were. (Third check!) They had a special IVF representative reach out to us to start discussing the particulars, and she recommended just to be doubly sure that there won’t be any issues, that we touch base with the insurance company and inquire about whether or not there are any exclusions for same-sex couples. At that time, I placed a phone call to the insurance company for another unpaid claim that my wife had from a year ago for a completely unrelated issue (which we ended up having to pay for out of pocket, but that’s another story for another day), and the representative kept me on hold for about 45 minutes for that issue, and another 45 for the IVF exclusion question. When she returned back on the line the last time to confirm our coverage, she explained to me that we did not – in fact – have full coverage, and that our coverage complied with the state mandate ONLY (something that was never mentioned when either clinic inquired, and something that was NEVER said to us on the phone – even though we were aware of it due to our own research). The representative apologized and said that unless we could demonstrate that we had “tried” to conceive for one year by having unprotected intercourse. I said, “you do realize that isn’t possible, right?” to which she continued to apologize and genuinely seemed sad to share that news, but kept reassuring me that there was nothing she could do. We would not – she informed us – be getting coverage for IVF, IUI, or any diagnostic testing or treatment related to either because we had not been able to demonstrate a year’s worth of straight sex. (barf)

Now, that’s all good and fine – state has mandate. State is being discriminatory (more than likely because it hasn’t caught up with the times, but still). Insurance company is following state to pay out as little money as possible. I get it.

HOWEVER: my wife and I are friends with a lovely heterosexual couple (the wife works in the same office as my wife and use the same said insurance), who are currently experiencing infertility issues themselves. They had been “trying” for about 6 months after they got married (and heck – maybe longer before…that’s really none of my business) when they started seeing a fertility clinic. They told my wife and I that the clinic determined their issue to be a blocked fallopian tube and their recommended course of action was some type of surgery or IVF treatments, which they have been subsequently advised by the insurance company would be covered (at least, that’s what they told us and I really don’t see why they would lie about that). They haven’t yet started their treatments, so I don’t know how this will shake out, but they told us that they got confirmation of coverage for their IVF treatments (and I’m fairly certain that they submitted no videos or spreadsheets of their bedroom action…), but their diagnostic tests were covered – that I know for sure.

To be fair, my HSG test was apparently processed and paid out by the insurance co (we thought we’d test the waters), but we are still waiting on my wife’s internal ultrasound and blood work to be paid (which she had done before my HSG test), so it’s a little strange that it hasn’t been paid, yet. We haven’t yet tackled the reverse tests (the HSG for her and the ultrasound for me) because I’ve been traveling EVERY SINGLE TIME I’VE HAD MY PERIOD FOR THE LAST THREE MONTHS (can you tell that really irritates me?) and if I’m not home to make sure she does things – she…doesn’t do them. To be fair, she’s amazing with so many things (such as making dinner) so I can’t complain – but I’m definitely the “let’s get shit done” boss lady in our house. Doctor needs calling? I’m on it. We got overcharged at the grocery store? Give me the receipt, I’ll go complain. Car needs an oil change? I’ll do it. (haha, just kidding…but I’ll totally make the appointment to have someone else do it).

For what it is worth, the reason why we are each doing each test is because the clinic *thinks* the costs will be covered (again – see above. We’re cautiously optimistic), and suggested that if perhaps they find a genuine concern (such as the blocked tube) we can use that as leverage to pursue the same coverage for IVF, EVEN THOUGH the law is clear and says that the diagnostic testing is only paid after you demonstrate the 12 months of “trying” (which neither us, nor the other couple appear to have done). If they are going to balk and offer the coverage because of a different issue, I think that OUR different issue is just as important and should be considered coverable as well.

Soooo….all I can think, is that between the difference in messages once we pointed out our situation, and the stories we’ve heard from our friends, it feels like discrimination to me. In addition, the financial lady kind of scolded me when this all first went down, because she thought my final call to confirm the exclusions may have caused them to scrutinize our case and “realize” they have a legal loophole to exclude gay folk. My problem is: if you aren’t routinely scrutinizing ALL cases (such as our friends’) then don’t scrutinize ANY.

So we took the train into the city to meet with finance lady face-to-face (who I actually adore especially after she started out the meeting telling us how much she admires how much we are advocating for ourselves and encouraged us to “never stop fighting”) and she said that while she believes in our cause, she also doesn’t know if we will get any meaningful movement or payout from the insurance company in the time we would want to start pursuing treatments (basically now as we’d hoped to try to have our first – hopefully only – pregnancy attempt in August). Her recommendation was to pay out of pocket, which we can likely afford if we finance it (but it will make moving out of our condo and into a bigger home a bit tough in the foreseeable future). She provided us with all of the out-of-pocket estimates a little over a week ago when we spoke (I literally talk to this woman all the time – I feel like I should know her birthday so I can send her a gift), and we made peace with the fact that they have a package that is approximately $12K when all is said and done which includes one egg retrieval, two transfers, cryopreservation of any additional embryos, and ICSI (injection of the donor sperm into the eggs to form embryos).

After we rehashed all of the insurance company info during our face-to-face visit, we asked a few questions about that package so we could finalize our expectations as far as the cost (as there were a few small things we weren’t sure about) and she advised us, that the packages they offer are for transfer of your own embryos into your own uterus (so, not co-IVF/reciprocal-IVF). I’m thinking, “Um, lady: I really like you and all, but you KNEW we were lesbians when this all started, and I told you like 10x that we wanted to do IVF particularly as we wanted to go through the process TOGETHER. Why the $%@^ did you think I wanted to do a regular old round of IVF?”

So she said she didn’t realize that, and pulled us out their co-ivf package paperwork (a crappy sheet of paper with a list of all of the treatments instead of the beautiful brochure which highlighted the IVF packages in neat, detailed columns, with photos of cute babies and happy couples on the cover), which is basically 1.5 times the price (around $15k when all is said and done). Ok, so the clinic is doing extra paperwork because we are talking two people instead of one, but…IT’S THE SAME PROCEDURE!! HOW DID WE JUST SUDDENLY JUMP ANOTHER 3K? AND, now the sheet of paper loosely defined as a “package” covered a single round of “fresh” IVF, one retrieval, and no cryopreservation (we are waiting on a call back about the ICSI as she didn’t seem to think that was included in that “package” either as it wasn’t on the page). So in addition to the crappy price, it covered about 1/2 of the items.

Now, I started to tear up in front of this woman (who shouldn’t have been surprised as I called her and began ugly cry hiccuping the day I found out that the insurance company wouldn’t cover any of this), but held it together and didn’t full out sob…for now.

So we took their paperwork, and said our goodbyes, and agreed to touch base in a week or two after we had time to digest things, and she gave us a few other suggested options (asking the doctor if they can honor one of the packages for us as a kind gesture, etc.).

We then left and had dinner at a local market (Indian food for me, which is like…my favorite cuisine ever. And chicken and waffles for my wife…who hates anything remotely spicy and flavorful Indian food. And then we found donuts because…

  1. They are my favorite.
  2. We were near a really spectacular donut place
  3. We kinda had a rough day.
  4. Donuts. Do we really need another reason?

So that kind of made things better.

The next day, I called a lawyer recommended by a friend from college, as I am curious if there is ANYTHING we can do, so I am currently waiting on a call back. The receptionist listened patiently to my story and as I got to the part about being required to have heterosexual sex she gasped, and by the time I mentioned our friends’ situation, she interrupted me to shout, “OH FOR [HEAVEN’S] SAKE, THAT’S DISCRIMINATION!” Which made me feel so…not crazy and almost kind of vindicated for calling. Even if we have no legal recourse, I at least felt like a human being who was worthy of feeling enraged at the situation. Bless that lady’s heart. Fingers crossed for good news…

I am really trying to persuade my wife to pursue IUI instead of IVF but she feels really strongly that she wants to have a biologically related child (she was literally floating the first time we officially heard that IVF was a covered benefit), and she doesn’t feel particularly inclined to carry (and also had some past health problems that make her a little wary of it as well), and I am not quite as committed to the biology aspect but have wanted to experience pregnancy for as long as I can remember, so this just feels like a perfect fit. She said she would consider each of us independently carrying, but she would want to do it first as she is very concerned that by the time we have baby #2 (God, willing), her ovaries will be shriveled up like raisins, her uterus will turn to dust, and she’ll be incapable of getting pregnant (or something like that), so she is insistent that if we do that – she carry first (which is super selfish of me, but would be really disappointing as I have literally held my breath all year for the moment we can get started as I really want to experience pregnancy). I don’t know – IVF is just so ideal. It is the closet we will ever be to a baby that is OURS (raised in my body – feeling my heartbeat and warmth, and sharing my wife’s amazing DNA).

Anyway, I have so much more I could write, but this is probably already obnoxiously long, so until next time.

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