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Insurance SNAFU - Karen's Musings
Random Rambling
estherchaya
estherchaya
Insurance SNAFU
The Cost of Doing Business
Most people know I changed jobs a month ago. The job itself is terrific. I love my client, my sort-of-but-not-really-boss is great, the work is interesting and challenging, the commute doesn’t suck, and the price is right. But on Monday, I was pretty sure I had made a dreadful (and costly) mistake.

You see, the firm I now work for is based in Virginia, while my former company was based in Maryland. You wouldn’t think this would be that big a deal, since I don’t work at headquarters anyway. And mostly, you’d be right: no big deal. Unless you’re me, or thousands of other women who are dealing with fertility treatment. Maryland law requires, under specific circumstances, that insurance plans based in Maryland must Provide coverage for fertility treatment. Virginia and DC have no such mandated coverage.*

When I accepted the position, I really had no way of knowing whether treatments would be covered for me. Just because it isn’t mandated doesn’t mean it’s not covered. When I was at BearingPoint (a VA-based company), for example, I had coverage for IUI, though not IVF. The insurance company would not discuss the specific benefits I had under the plan with my new company until I had a policy set up. Okay, fine. So once my policy was set up, they wouldn’t discuss specific coverage with me until the policy became effective (June 1). On June 1st, they finally would speak with me and said, “yes, you have coverage but we can’t tell you how much until you go through a n authorization process.” Great. At least I know there’s something, right? And hey, I’ve got the same insurance provider as with my last company, just a different policy, so really the authorization process should be a snap, right? Right?? Wrong.

Best Laid Plans of Mice and Men…
My financial coordinator at Shady Hell (as I like to call it) called Carefirst several times to find out the status of my authorization. On June 12th (a full MONTH after my initial inquiries), they finally responded. Yes, they cover all diagnostic tests at 100% (my former policy only covered at 90%, so that’s GREAT!), but they have no coverage for treatment of any kind. Let me just note that the medications alone for a single IUI cycle cost thousands of dollars. When billed to insurance, IUI itself is a mere $295, but the monitoring appointments throughout the cycle are $480 each (at my last cycle, I think I had 10 monitoring appointments). That’s IUI. IVF is much more expensive.

Plan B?
I immediately called Seth and asked when his open enrollment period ended. “Today,” he said. Great. So I could get on his insurance if I could make that decision and obtain and fill out the forms and turn them in to his HR dept. by 5pm. It was then around 10am. Plenty of time. The major drawback was that I’d have to switch clinics. That’s a major problem, particularly because I’m in the middle of a cycle right now. Bigger problem is the clinic I’d have to go to is in Baltimore and I know nothing about it or the doctors there or anything. That’s not cool.

I tried to call the CEO of my company (we don’t have an HR dept… the CEO deals with benefits information) to find out if it was too late to cancel my policy with my company since I was still within 30 days of my hire date, but I couldn’t reach her. I sent her an email and tried to brainstorm, but kept stressing more and more.

We Interrupt Your Regularly Scheduled Programming for a Short Nervous Breakdown
So, eyes brimming, I went outside equipped with my cell phone and called [Bad username: psu_jedi] asked, “Hey, you got a sec?” and then promptly burst into tears. Never, and I mean Never, tell an artificially hormonal woman that her best laid plans are falling through.
Good news for me: Jo wasn’t busy.
Better news for me: Jo’s used to me randomly bursting into tears without explanation. Because, you know, it took me a couple seconds (hours?) to calm down enough to explain what was stressing me out. I honestly wasn’t looking for answers, I just mostly needed to let out some stress.
Good news for me: Jo is smart.
Better news for me: Some of my questions turned out to be general HR questions and Jo was able to get some answers for me from her HR person.
Even better news for me: Jo still doesn’t run away screaming when I’m acting like a hormonal freak. Jo’s HR person said that cancelling an insurance policy within 30 days shouldn’t be a problem. Good news.

Brainstorming & Snakes
Information in hand, we continued brainstorming. Eventually I realized that most of what was stressing me out was the idea of having to make a decision about Seth’s insurance RIGHT THAT INSTANT. At the time, people said, “don’t be silly, you’d have a qualifying event to be on Seth’s insurance since you’re losing your insurance with your old company.” In retrospect, that’s true, except if I’d kept the insurance policy with the new company, I would have had to voluntarily leave that plan, which would NOT be a qualifying event to get onto Seth’s insurance. Brainstorm, brainstorm. COBRA! I’d originally decided against doing COBRA at all because it’s close to $400 per month. But $400/month isn’t bad when you consider the cost of NOT having this coverage and it still puts me ahead (salary-wise) of where I was at my old job.

I called my former company’s HR Director and said, “So, um, when I left the company I figured I wouldn’t need COBRA… uh…” I got in just under the wire on the deadline for securing COBRA Coverage. She emailed me the forms, I faxed them back, she sent them off to their broker, it’s all taken care of and I have COBRA coverage retroactive to June 1, though it will take a week or two to show in their system. Meanwhile, the CEO of my new company called me back and said she’d take care of cancelling my insurance retroactive to June 1.

Band-Aids
I called the financial coordinator at Shady Hell and told her my plan to stay on COBRA until we could figure out our long-term plan. However, since in the system it looks like I don’t have coverage (even though COBRA is retroactive), I have to pre-pay treatment until the coverage is updated in Carefirst’s system.
Good news: Shady Hell is pretty nice to their IUI patients who are paying out of pocket… they charge a global fee for all monitoring and IUI of $1950 per cycle. (“Unless, of course, you’d like to just postpone your next cycle…” Uh, NO.)
Bad news: This morning I had to write a check for $1950.
Good news: That money will be reimbursed.
Bad news: Not entirely sure WHEN it will be reimbursed.

Philosophy of Check-Writing
In some ways (understandably), it’s intimidating, depressing, and stressful to write a check that big. But in other ways, oddly, it’s a liberating feeling. Lemme esplain. No, there is to much. Lemme sum up. Buttercup marry Humperdink in little less than half an hour… Oh, wait. Right. Back to THIS planet. How on earth could writing a large check feel liberating? Well, the fact is that I COULD write that check. Let us not speak of the fact that the onl y reason I COULD write that check is that I recently got a reimbursement for a class I’d pay for with a credit card but never taken. They reimbursed me via check rather than reimbursing my credit card, so technically that money was already spoken for. But at least it was there and I did have that option rather than being forced to wait another month to continue treatment.


* It is, therefore, unsurprising that this Washington Post article indicates that the majority of Shady Grove Fertility Center’s Shared-Risk patients come from Virginia and DC. In fact, Robert Stillman, of SGFC is quoted in the article as saying (and has said the same thing to me) that he’d be happy to do away with the shared-risk program- if there were a better alternative, such as insurance companies fully covering IVF treatment.

Tags: , , , ,
Current Mood: frustrated frustrated

19 comments or Leave a comment
Comments
ouiserboudreaux From: ouiserboudreaux Date: June 14th, 2006 10:32 pm (UTC) (Link)
Hang in there.

We were in a state that wasn't mandated to have IF like MD and we spent a lot of money.
marag From: marag Date: June 14th, 2006 11:10 pm (UTC) (Link)
Oh yes, because *just* what you needed right now was insurance crap. Oy gotenu. You have my complete and utter sympathy as I had some problems (although not nearly so momentous as this) with our insurance plans. And I, too, broke down in tears.
estherchaya From: estherchaya Date: June 15th, 2006 03:23 am (UTC) (Link)
The good news is that it was all resolved within a few hours. It just was a REALLY LONG few hours. Sigh. Thank heavens for COBRA, because $400 a month is nothing compared to what this COULD cost me.
mysticchyna From: mysticchyna Date: June 14th, 2006 11:54 pm (UTC) (Link)
oh dear, what a hum dinger of a day. do hang in there, i'm sure it will work out.
mrn613 From: mrn613 Date: June 15th, 2006 12:48 am (UTC) (Link)
b''h for COBRA. I've known people to get a job for three months in a mandated state, and then quit and get Cobra.
From: have_inner_lady Date: June 15th, 2006 01:01 am (UTC) (Link)
What an awful day... but YOU GOT THROUGH IT, and it sounds like you made excellent decisions.

[applauds!]
estherchaya From: estherchaya Date: June 15th, 2006 03:27 am (UTC) (Link)
It was a real pain in the neck day, and I hate having to make such important decisions without all the information and with such a tight timetable. Thank heavens for COBRA, though... .if anything, what it did was buy me some time to figure it all out.
arosoff From: arosoff Date: June 15th, 2006 01:25 am (UTC) (Link)
Yikes. Almost makes me glad for the NHS.
oh wait, most trusts are super stingy about infertility treatment (some won't pay till you're over 35... when it has LESS chance of working!) but at least it's all straightforward!
estherchaya From: estherchaya Date: June 15th, 2006 03:29 am (UTC) (Link)
Yeah, why do you think my plan is to go to the UK in ten years, rather than now?? (Well, I have MANY reasons for that, but still).

Speaking of which, how far ahead is the UK? Six hours? I've got to call Scotland this week to get a copy of my birth certificate and I'm trying to figure out when to call.
hannahsarah From: hannahsarah Date: June 15th, 2006 05:40 am (UTC) (Link)
It's 8 hours.
arosoff From: arosoff Date: June 15th, 2006 06:07 am (UTC) (Link)
She's East Coast. It's 5 from there.
hannahsarah From: hannahsarah Date: June 15th, 2006 07:37 am (UTC) (Link)
Do'h! Forgot about that.

ichur72 From: ichur72 Date: June 15th, 2006 01:46 am (UTC) (Link)
Oy. Glad things are on their way to straightening out, but it does sound like it was a mega-stressful day.
allah_sulu From: allah_sulu Date: June 15th, 2006 01:48 am (UTC) (Link)
Ouch. I mean seriously, ouch.

Thanks for still having time to answer my question over the paperwork that was stressing me out.
magid From: magid Date: June 15th, 2006 03:05 am (UTC) (Link)
Just... hoping your evening has been calming and restoring, and keeping you in my thoughts.
estherchaya From: estherchaya Date: June 15th, 2006 03:30 am (UTC) (Link)
oh yes, much. I'm about to pick someone up from the train station and then I'll come home and SLEEEEEEEEEP.
:)
zis770 From: zis770 Date: June 15th, 2006 06:35 am (UTC) (Link)
GAH! What a not very fun ride. It's reminding me of one pretty intense IVF cycle I had with getting funding. I like "Shady Hell" btw. Hatzlacha Raba. And of course this is all supposed to make you extra relaxed so you won't be stressed out during your cycle, right?
singwa From: singwa Date: June 15th, 2006 11:49 am (UTC) (Link)
Whoa! you sound like u had some rough day! Glad it ended better than it started and u shld have lots of luck with this cycle.

Getting a reimbursant from insurance company is the song of my life. We also went through infertility and dh had a surgery that insurance was supposed to pay 3,250 for. Well, 8 months later they finally paid it.....yippee! Now I still owe 750. (that's after paying 1400 out of pocket and 2400 from Bonei Olam, and about 1100 from various Bikur Cholims....) these doctors rake it in big time-- it's insane!
(Deleted comment)
19 comments or Leave a comment