Massachusetts health insurance questions... HELP!

[osker]

For those of you in MA, what does your health insurance cover as far as infertility treatments? How do you choose a plan? I finally found a tiny bit of information for FCHP, but it has a disclaimer that stated that they don't cover infertility treatments for those whose lifestyle choices have made them infertile - does that mean us?
So far we've been doing everything out of pocket and at home, so we have only receipts for the sperm bank to show that we've done anything at all... but we've tried ten times, so would we be considered infertile? Or would we have to start at the very beginning? What should I be looking for in choosing a plan? DW just started a new job and is on her own to find self-coverage for both of us which then the job will help to pay for... does this make a difference?

Thanks everyone, I'm so lost.

[megincl]

Not sure about all of MA, though I know that in MA insurance is supposed to cover infertility. I wonder if it's legal for Fallon (that's what you meant, right) to discriminate like that. I assume they're meaning to discriminate against queer folks with that statement.

We have Harvard Pilgrim. They cover IVF, but you have to have done 12 (usually) medically-assisted IUIs in order to qualify. We are qualifying prior to that because of repeated, unexplained pregnancy loss. I don't wish that on you, though, of course.

In spite of the fact that we insemmed so many times, none of them counted for insurance purposes until we started doing IUIs. So, I'd say start doing IUIs ASAP as that will begin the "count" for insurance and help you get infertility coverage if, in fact, that's needed.

I think that you can probably get a visit to Boston IVF covered even without the infertility diagnosis. We did somehow and that's now where we go. We see Dr. Ryley at the Boston office. He's FABULOUS and will do everything humanly possible to get you pregnant asap. He helped us figure out that we could do IVF now, without waiting for the 12 IUIs. I highly recommend checking him out. They can also do your IUIs there, if you want (for $, of course). We went to Dr. Levine in Cambridge for the IUIs. Not too much $ and rather easy, generally.

So, that's a long response, but I definitely think Harvard Pilgrim is good. And I'd also check into what sounds very sketchy there about Fallon and who they will/won't cover.

Good luck! Let us know what you learn.

Take care,
Megin

PS -- When you call different insurance folks, be sure to ask about their infertility coverage. I think it will vary depending on which level of plan you choose, particularly since you'll be "buying" the plan as individuals, not through a company that funds most of it.

[Lyndzies]

I don't know if this helps at all, but the willingness of your doctor to find loopholes might make a big difference in whether you get covered or not.

I heard of a couple who were able to be covered for infertility treatments by their doctor indicating that the one woman's partner "does not have viable sperm."

Which is totally true in our situations, no? ;-)

Good luck!

[jjnoho]

fchp

i have fchp now and am pleased with their coverage. i chose them because they cover my midwife group and hopsital i wanted. the fertility issue as i understand it is this: for those who are understandably infertile - meaning women in menopause, women who have been sterilized and reversed. i do not understand it to mean women who are lesbian. i have not challenged this but would have difficulty believing that would be legal in MA to discriminate against lesbians just because we don't have ready access to sperm.

fchp provies for infertility treatment after 12 months of documented trying to conceive without success. i have had friends been able to convince their insurance companies that buying sperm was proof enough that they were ttc for those months - not sure why else anyone would be buying sperm!?

hope this info helps...jj

[osker]

Thanks everyone!
We're going to sit down and look at all of the choices and where they cover. Would love to see some of them cover birth centers instead of hospital, so that will probably be the first step.
Hopefully our at-home try in the next week will take and we won't need any of this, but it's good to be looking out for it, just in case!

[megincl]

Originally Posted by osker

Thanks everyone!
We're going to sit down and look at all of the choices and where they cover. Would love to see some of them cover birth centers instead of hospital, so that will probably be the first step.
Hopefully our at-home try in the next week will take and we won't need any of this, but it's good to be looking out for it, just in case!

Harvard Pilgrim covered our birth at the Cambridge Birth Center -- I think pretty much every insurance covers births there. And they charged our doula to insurance too and that was covered as well! I think that generally birth center births are covered in MA (not that there are so many birth centers to choose from, but that's another story...).

And yes, I hope this time works so you needn't worry about any of this!

Be well,
megin

[pigirl]

For us, it depended entirely upon the OB doing the insems. There are two locally; one would diagnose us (a same-sex couple) "infertile," one would not. It all boiled down to what the OB considered "infertile" to mean. We chose the one who gave us the "infertile" diagnosis, and my insurance covered everything. Office visits, insems, it even reimbursed us for the sperm (but not the shipping charges). If you know any other local couples TTC, ask them about who they used to insem. It can make all the difference.

Good luck starting your family!

[mumm]

Infertile is infertile regardless of sexual orientation. Typically it means 2 or 3 attempts with clomid and 2 or 3 attempts with injectibles before they will cover IVF. When I needed help with kid #3 (well, and #4) I purchased HPHC in MA to cover the costs. They wouldn't cover anything up to the IVF, but covered the IVF in full. Because I had insurance I didn't need to have a waiting period before I could recieve services. I called them and explained the situation and spoke with a nurse just to make sure it would all be covered. They were great and the monthly fee was about $500 or $600 and I only needed it for the two months that covered the IVF stuff.