Monday, October 3, 2011

The deal with health insurance

A few weeks ago, I was lurking on a message board and found a thread of confessions. They're not uncommon as a Friday feature, and they sometimes get heated. One of the confessions on that board was something along the lines of thinking that health insurance shouldn't cover IF treatments when there are babies and children out there who already need homes. My jaw dropped - first at the insurance issue, and then at the implication that adoption should be favored over IVF or other ART. I couldn't let it slide and had to comment. I have already discussed our stance on adoption, but here's some insight on the health insurance part of it.

What many people don't seem to realize is that IF coverage isn't as common as they think. I am very fortunate in that my company gives a lifetime max of $5,000 for treatments, and most of my testing was covered as well. Most meds used in treatment are covered on my prescription plan. Buddy, on the other hand, has no IF coverage, and many meds used in treatment of MFI are also not covered. I'm lucky in that my company is headquartered in a state which requires at least some coverage. It's part of why, even though I ache for new challenges and am underpaid, I'll exhaust all opportunities within the company before looking outside and risking IF coverage. My point is, people who gripe that insurance is covering IVF and other treatments really don't know what they're talking about, because many couples lack coverage and are either completely out-of-pocket, or have coverage for only the testing but not any treatment. Sleep tight, critics, your insurance premiums are more than likely not being driven by infertiles taking advantage of IF coverage.

Another thing people don't consider is the very thing that health insurance is supposed to be for: health. Infertility isn't generally spontaneous. There's usually a reason, whether it be MFI, PCOS, endometriosis, blocked tubes, or anovulation. These are all issues that cause the reproductive system to perform sub-optimally. Even unexplained IF is an indication that something in one or both partners' systems isn't working right. Sub-optimal health is precisely how I would define illness. Therefore, infertility is an illness, and is often driven or caused by other illnesses. Just like cancer, high blood pressure, diabetes, osteoporosis, and any other illness that you might consider a health problem. So why should my health insurance not cover me for my health issue, but it should cover treatment for cancer or diabetes?

Additionally, many health problems that drive IF have other symptoms, such as very heavy or painful periods, weight gain or inability to lose weight, fatigue, hormonal imbalance, or depression. If someone with any other health problem was experiencing these things, they'd be advised to be treated. Whether or not a woman is trying to conceive, I feel we all have a right to be treated for health problems and feel our best. I fail to see how it is any different when the treatment of these problems also is for the purpose of fixing the cause of lack of procreation.

I don't really have a clever or clean way to wrap this up. It's an emotional subject for me, because I see women every day who have to choose their treatment based on what will be covered. I don't feel that anyone should have to choose financial stability over their health.


Farmer Lynda said...

LOVE this post.
I've read -- and gotten angry at -- many online threads and comments about whether or not health insurance companies should cover IF.
The detractors often say that we don't "need" to have a baby and that we should all just get over it. I agree wholeheartedly with your argument that fertility is an illness, and my second line of philosophical defense is: since when do we draw the line at "need"?
Does a person who loses a breast during cancer treatment "need" to have a replacement? (You don't "need" your breast, and a prosthetic or implant is not really functional for the breast's main purpose, breastfeeding.) Does a person who loses a leg "need" an engineered prosthetic when a wheelchair will suffice and get him from point A to point B?
I'm not saying that IF is like losing a leg or a breast. There are no equivalencies when it comes to health. (And I definitely don't mean to equate a prosthetic to a child, or anything like that.) I'm just saying that the line for what we "need" is way more blurry than many people think. Many things in health are not driven by "need," but by normalcy and quality of life -- and what it takes to be emotionally and mentally satisfied with our own state of health.
So yes, my insurance company should pay for IF for all of the reasons you listed, and the ones I listed above. Too bad it doesn't!

Jamie said...

You summed up exactly how I feel. I also can't stand when people tell me that we should just adopt. I had one person tell me to adopt. I shot back with why don't you adopt. She then told me well I can have kids, therefore I don't need to adopt. That was the last time I ever spoke to her.

Brooke said...

Excellent points, Lynda. I hope people read the comments when they read this post to get even more insight on this issue :)

Anonymous said...

I don't mean to pry but why isn't Buddy going to get a second SA? I have been following your story for a while and was hoping to see an update. I'm sorry things have been so rough for you guys.

Brooke said...

Anonymous, I think he will when he's ready. The first SA was a big hit to the ego, and knowing what the RE wanted to see for POST-wash numbers made him very discouraged. He went and had BW done Tuesday to get to the root of the libido issue, and I'm hoping that sorting that out will give him the confidence to try for another SA. Basically, I don't see the use in pushing my husband before he's ready. It doesn't do either of us any good. It will fall together in due time and I'm willing to be patient (for the most part) for the sake of our relationship, which will always come first.