So...what did it take in Illinois to get pregnant and use insurance?

[hallerm]

I'm brand new here, and at the suggestion of another member in the Queer Conceptions thread I am starting a new thread here to ask how anyone navigated getting insurance and/or FSA to pay for anything along the way. 

I'm looking for any getting started resources as far as navigating this stuff. I live in Illinois where infertility is covered after a year of trying and I am wondering, since we're interested in starting in the next year if I should start building some kind of "proof" of trying (even if we're not because we're two women!) like even asking my doctor about stuff? I did read in another post that Illinois qualifies trying as unrpotected sexual intercourse between a man and woman and I can run into snags there. But I really want to know how other people handled this. I am worried about setting off a red flag if I talk to my insurance (does that even happen?). I really want to figure out if I should just "say" I've been having unprotected sex with a man for the last year, when we are officially-officially ready, if I should be honest, if I should be honest with my health care provider and ask their advice? But I'm really worried about something coming up in my chart somewhere that would raise a flag later.

Also, as far as I know I don't have any "actual" infertility issues other than the fact that my partner can't produce sperm. I have some thyroid issues (ie., removed due to cancer) that require monitoring, and have uterine polyps removed but I don't think that would qualify for my infertility on its own.

Thanks so much for reading this! I really do appreciate it.  

[pokeyAC]

The FSA shouldn't be a problem.  That is a Federal thing.  I used mine to pay for my share of treatments.  Be sure to save all of your receipts because all the related health care expenses are tax deductible (Beyond the FSA of course which is pre-tax).  You can deduct sperm, treatments, testing, medicines, transportation and/or shipping to get the sperm. 

[hallerm]

Thank you, pokeyAC! That is very helpful information!

[prettyisa]

Hi! I had really good luck with insurance coverage in IL. Feel free to ask anything you want if I miss something!

The law in illinois says you have to have 12 months of unprotected intercourse with a man OR 12 months of doctor-supervised fertility treatments (including IUIs). There are some exceptions, mostly if you work for a smaller company, as far as I can tell, but if others in your company are covered, you should be, too. Here's the law:

http://insurance.illinois.gov/HealthInsurance/infertility.asp

It's totally worth checking with your insurance company first, though--mine said I only needed to do three months of IUIs with a doctor before they'd start covering things. I do have some friends who have run into some homophobia with other companies trying to tell them that they don't count because it's not straight sex, but I think that was rectified. There is a line in there about it 'violating religious beliefs' that I don't know quite how to interpret. If they give you trouble on that front you probably want to talk to a lawyer to get an idea of what you're up against.

I'm almost positive that at-home ICIs and IUIs won't be counted, unless your doctor is sympathetic and willing to say you are 'under their care' for those, but even then the company might require proof that it was medically supervised, blah blah blah. Again, worth asking.

So, basically, it's pretty likely that you can get coverage, but only if you actually do need fertility treatments. Hopefully you'll get pregnant without all the rigamarole! If you do need to do the whole year of treatments you could go the cheaper route and just do one unmonitored IUI per cycle. Since we were only looking at three months we did 2 per cycle, which got us a whole lot of nowhere, so once they started covering things I used clomid, lots of monitoring, and eventually IVF. There was no problem with the insurance and no one ever gave me any trouble.

If things do end up taking longer, keep good track of your expenses, including pregnancy and ovulation tests. If you get over 7.5% of your income in medical expenses you can start writing it off on your taxes.

Good luck!

[Sphinxy]

pokey - sperm is tax deductible? i had no idea!

[pokeyAC]

Originally Posted by Sphinxy 

pokey - sperm is tax deductible? i had no idea!

Yes indeed!  Shipping too.  It's considered a medical expense.  

[hallerm]

Oh my gosh, this is all so very helpful! Thanks so much everyone. I may have some questions for you in the future Prettyisa! It's really exciting to hear that this worked for you. I am not overly concerned about the religious-based exemptions since I work for a secular, social-justice (at least in principle) based university, but I think I will start figuring out who to go to for all of this. I actually see a midwife for my gyne stuff now and have for years, so I imagine they're the first place to start instead of going directly to a reproductive endocrinologist or anything. 

thanks so much!!

[prettyisa]

If you want dr recommendations ever, I've got a ton! And there's a little group of us who try to get together from time to time in the Chicago area. Not sure when the next outing will be with the holidays looming, but whenever we start posting about it, feel free to join us--all of us met online either here, through blogging, or both, so we've all had the fun of meeting internet strangers and then realizing that we're actually friends in real life, too.

[hallerm]

I would love to get together with all of you! I'm in Chicago, too -- on the northside but I'm happy to find you where ever. I have straight friends that know more lesbian/queer parents than I do (which is none) so I would love to meet some of you in person. Thanks again. 

-Martinique

[hallerm]

Ok, does anyone have any thoughts on this:

In order to check that everything is in working order I have to go to a reproductive endocrinologist (this is important because sperm is $$ but also because I don't have a thyroid and need to monitor the medication levels, and have had uterine polyps - I'm also a few months shy of 35 and won't be starting until after my birthday)

In order to see an RE I have to alert my insurance company I am "seeking fertility treatments" which results in a call from a nurse/case manager

So here's the question -- should I be evasive about my partner in that interview in the hopes that the Dr. can just diagnose me with infertility as a result of the uterine polyps or for some other reason?

The benefit of that is that I could get sperm and inseminations covered. I'm fine doing these at home and would prefer to actually, but it's so expensive that I'd rather have it covered if I could and we don't have a really great known donor option. Furthermore, on the off-chance they don't work at home and I truly-truly need higher-level infertility help I won't have had the necessary documentation for a year's worth of "medically supervised inseminations."

Thoughts? Thanks. I am totally lost here.

[hallerm]

Thanks for the pm, prettyisa. It looks like with a few more posts I should be able to write back-- i'm currently blocked since I'm new. I guess it's either ten days or ten posts, but here's one more 

[prettyisa]

Ha! I guess that's to keep you from dropping by to harass people? I never knew there was that rule!