Monday, June 10, 2013

Epic Fail

I have had the same health insurance for about the last 12 years. My plan gives me the choice of a PPO, HMO or Kaiser. I have always had the PPO so I wasn't limited by only going to network providers and I have been happy with it for the most part.When I  first made that choice it didn't seem like there were many differences between the PPO and HMO and I never looked at them again. When open enrollment comes around every year I just stay with what I have.

Turns out this was a terrible mistake. I should have been looking in more detail at what is covered by each. I just found out a few days ago that the HMO covers infertility. I am completely shocked by this. Every doctor I have been to says my insurance doesn't cover it so I assumed that meant the umbrella plan I have, no matter which specific option I chose, just doesn't offer it. Plus, who would have thought an HMO had more coverage? Granted, I don't know exactly what it covers. It may not have helped me with IVF. But even if the testing and drugs were partially covered it would have been a huge help.

I am so mad at myself for not researching and talking to my insurance plan myself. I researched the hell out of everything else during this process. Why did I drop the ball on this part? Why did I just believe the doctor's office? I am trying not to beat myself up over it. What's done is done and can't be changed. Stressing about it isn't going to fix it.

Anyway. Lesson learned. I'm not sure why I always have to learn these things the hard way.



15 comments:

  1. oh this is a bummer. but no use spending time being mad at yourself. live and learn, right?

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  2. That is such a bummer! The finances is one of the parts that hurts the most.

    I should've met up with you while we were in Denver. You are local,right?

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  3. I have similar options and was also shocked that the HMO offers more coverage. The downside is that it can be restrictive, you have to follow their rules. When I almost had my last IUI cancelled b/c the insurance payment hadn't come through, I kept thinking, but what if this was meant to be the one?

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  4. I'm so sorry! That must be enormously frustrating. I can understand the assumption. Although I did call my insurance providers, it was so hard to believe that I had to call back to talk to another person and make sure it wasn't a mistake!

    If it's any consolation, my HMO option (HealthNet, I think) had a maximum lifetime IF benefit of something like $2000. Now $2000 isn't chump change, but it wouldn't have come anywhere near covering IVF. I don't think it even would've covered my testing and IUI...The HealthNet PPO was even worse.

    For me, Kaiser offered the best infertility coverage (everything up to and including IUI), but not all Kaiser plans are the same. Some don't cover for infertility drugs at all. And obviously, Kaiser ONLY covers services provided by Kaiser doctors...

    I didn't mean to write a novel. I just wanted to say that you shouldn't beat yourself up. My guess is that the infertility coverage you missed out on wasn't worth a whole lot. And besides, your HMO might have had you go to a different doctor, who might have made different treatment decisions, and you might not be pregnant with your twins today!

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  5. Really?? I'm shocked! I just switched from an HMO to PPO and have thought the change was great. But how crazy to know that we don't always know all of the information. But, as others have said, there's no beating yourself about it...there's no going back. And who would have known??

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  6. Yeah, I found out that if we had coordinated our drug coverage earlier I would have gotten 100% drug coverage (IVF still out of pocket though). Because we delayed I was only covered 80%...but at least we've got the paperwork through for next time. Still...I'd rather be in your position. Out of pocket but pregnant. Silver lining.

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  7. That's so surprising, that the HMO would have had better coverage than the PPO plan!!

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  8. I don't understand the acronyms but it sounds like something that most people would have done in your situation. If it aint broke dont fix it, right? Of course there's nothing you can do about it now and like Aramis said, at least all the money you paid gave you your BFP!

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  9. Don't beat yourself up about this. ..understanding health insurance is about as easy as understanding quantum physics.

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  10. Awwww man that stinks! I am so sorry. I don't get health insurance either and it is so much easier to just go with it. I am surprised that an HMO would have better coverage of infertility!

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  11. I did the same thing. About 2 months before IVF#1 my husband was hired for a company based out of MA, which = Infertility coverage. I looked at the premiums, never even suspected that his insurance would cover anything IF related, and chose to continue with just my insurance. When we figured it out, we had to wait several months for his open enrollment, and then about a month before IVF#2 (covered by insurance), he got laid off so we had to pay for the Cobra which was $$$ (but not $$$$$ like IVF is normally). I still kick myself for wasting those six months between IVF#1 and IVF#2 and wonder if having less financial stress would have allowed us to do more IVF's and maybe even DE and maybe even have a baby at this point. Live and learn I guess, but I totally understand that feeling. (((HUGS)))

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  12. Health insurance is one of the most difficult things to understand. I would've made the same assumption that HMO would cover nothing and PPO would offer more coverage. At least that's what I have learned from doctors along the way. But I guess each plan is different. So glad that you don't need to depend on that coverage anymore.

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  13. We were told that our insurance (BCBS) did not cover anything but a few initial diagnostic tests. When I was ordering my meds, I was checking with 3 different places to comparison shop for price. They all asked about insurance and I told them (as we had been told) our insurance didn't cover meds. One pharmacy asked for my insurance info anyway, and said "let's just check anyway - you never know." Lo-and-behold, our meds for my (not surrogate) were COMPLETELY covered. 5 or 6K worth (I had a lot of meds). I was floored - but lesson here is you still may want to check.

    Also, more companies are starting to cover infertility. It constantly changes, so best to check every time. I think our insurance starting covering even more starting after (OF COURSE) our cycle was done. I was stomping around about it when I found out and my husband reminded me that at least most of our meds were covered.

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  14. I picked the HMO precisely because they say it covers infertility treatment, while the PPO doesn't. Well, guess what. If you do IVF they don't cover the drugs either because they're not covering the treatment (explicitly excluded), and it's either all or nothing.
    To be fair, they did cover some of my initial testing, but I think that may have been because of my complicated history and not under the infertility umbrella.
    But, on the whole, the insurance situation just sucks.

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  15. I hate insurance stuff, as well as all things money related. Ugh. As others have stated, at least you know it was money well spent and you have your little ones on the way!

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