is infertility a "pre-existing condition" for insurance

[rcr]

We want to switch insurance from mine (which we are on now) to DHs because they cover infertility (they are out of Illinois, which requires fertility treatments to be covered) - an amazing "up to 6 IVF cycles"!! I have to wait until open enrollment in November, and then the switch will be in effect Jan 1.

We visited an RE a while ago, before my miscarriage this month. We would like to start with an iui as soon as I am able to after my miscarriage is over. That would be before January, and we would just pay with our own $ for the iui, which is fine.

My question is (if we don't conceive again before the insurance switch), should we go to a different RE, and not tell them about the previous one, so as to not make infertility a pre-existing condition, or should we stick with the same RE that we have been going to?

[happysmileylady]

Originally Posted by rcr

We want to switch insurance from mine (which we are on now) to DHs because they cover infertility (they are out of Illinois, which requires fertility treatments to be covered) - an amazing "up to 6 IVF cycles"!! I have to wait until open enrollment in November, and then the switch will be in effect Jan 1.

We visited an RE a while ago, before my miscarriage this month. We would like to start with an iui as soon as I am able to after my miscarriage is over. That would be before January, and we would just pay with our own $ for the iui, which is fine.

My question is (if we don't conceive again before the insurance switch), should we go to a different RE, and not tell them about the previous one, so as to not make infertility a pre-existing condition, or should we stick with the same RE that we have been going to?

I don't think it would be considered a pre-existing condition. In fact, I think for the most part, IF is considered the symptom and not the condition...like PCOS is the condition, and one symptom of of PCOS is infertility. However, I am not sure.

BUT, if there is no gap in insurance covered, like if you have insurance A on December 31 and then insurance B on January 1, I don't think pre existing conditions matter.

And SIX IVF? OMG!!!!! How lucky!

[rcr]

Originally Posted by happysmileylady

I don't think it would be considered a pre-existing condition. In fact, I think for the most part, IF is considered the symptom and not the condition...like PCOS is the condition, and one symptom of of PCOS is infertility. However, I am not sure.

BUT, if there is no gap in insurance covered, like if you have insurance A on December 31 and then insurance B on January 1, I don't think pre existing conditions matter.

And SIX IVF? OMG!!!!! How lucky!

Oh, that is good news.

And yea, 6 cycles. I can't believe it.

[scarletjane]

I just wanted to respond to say that yes, infertility is considered a pre-existing condition by almost all insurance companies. You could call this insurance company you want to sign up for and just ask if it is, to be sure. They may or may not tell you the answer. They may ask you to just apply, in which case you're in a tricky situation.

If, when you apply, you have not been formally diagnosed, you would probably not run into problems (the diagnosis is usually made after 1 year of not conceiving).

I hesitated to respond, because I know how terrible it is to hear that. But I did just want to make sure you have the information. It may not be a problem, but it is so much better to be armed with information than to not know.

And hugs to you. This path we're all on here of wanting a baby is so hard, isn't it? And to have to deal with a bureaucratic difficulty like insurance is just adding insult to injury.

Best of luck to you.

[rcr]

So if I just lie and don't tell them that I have already been diagnosed with infertility (I have), and don't tell them about the previous RE visits, they wouldn't know... right?

[jeminijad]

This may be a dense question, but, is your DH's plan something he went ought and bought, or employer provided?

I was under the impression that employer provided insurance enrolled any new employees or spouses/dependents of employess, regardless of preexisting conditions. Certainly they have done so in my family.

[rcr]

Originally Posted by jeminijad

This may be a dense question, but, is your DH's plan something he went ought and bought, or employer provided?

I was under the impression that employer provided insurance enrolled any new employees or spouses/dependents of employess, regardless of preexisting conditions. Certainly they have done so in my family.

It is employer provided. We are on my insurance, but switching to his because of the fertility coverage.

Actually,I think I found the answer online. If there is no lapse in coverage, it does not matter what you have, they can't call it a pre-existing condition. Things only become a pre-existing condition when you get new insurance and have not had insurance in a while, which is not the case with us.

[Maurine]

Originally Posted by rcr

Actually,I think I found the answer online. If there is no lapse in coverage, it does not matter what you have, they can't call it a pre-existing condition. Things only become a pre-existing condition when you get new insurance and have not had insurance in a while, which is not the case with us.

I just wanted to pop in to say that this is my understanding as well. I think each state might be different, but where I live the major carriers can't refuse to cover a pre-existing condition, unless there has been a gap in coverage. As long as you had insurance up to the day you start the new insurance, no problem. Seems kind of loopy, but it makes sense to me that you can't punish people for moving or switching jobs and needing new coverage. (Doesn't make sense to punish those who can't afford insurance, but whatever...) Good luck, rcr!