no fertility coverage, boss says company not big enough for insurance coverage. can this be true?
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Anonymous
| 10:49 was the PPP (sorry late on hitting submit) |
Anonymous
| does anyone know the real cost of the difference in coverage with and without it? Like how much would it cost more per paying member vs total cost of the procedure? I have always found that coverage rarely takes care of all the IVF treatment. |
Anonymous
| I work for a Fortune 500 company and this stuff isn't covered. We have to pay thousands to cover ER visits for emergencies due to our awful coverage. The size of the company doesn't make a difference - lots don't cover anything they don't have to. |
Anonymous
I don't know the cost difference for the actual cost of insurance (it is through my husbands company- I am a fed) but the insurance (United Health Care) covered everything. Procedures, Meds etc. I had a $30 co-pay per visit (Specialist co-pay) and Drug Co-pays were between $10-$50. Total cost was around $500. I can assure you, it was much more cost effective than paying for it on my own. |
Anonymous
That's a ridiculous comparison. Knee replacements are a quality of life issue. They also ensure an employee can keep working. Tubal ligation save the insurance company money. I don't know what types of dermatological procedures are covered under most plans, but I would guess most strictly cosmetic procedures are not, nor should they be. Business certainly do NOT have an obligation to help employees create babies. That's absurd. |
Anonymous
| Hell, I own my own small business and I can't even get coverage that covers maternity expenses of any kind. Let alone infertility. |
Anonymous
As important as IVF feels to many of us, I don't think it is reasonable to make any of the analogies you have suggested. A knee replacement is elective in the sense that you won't die without it, but not in the sense that you will be able to walk or function normally without it. Most insurances do NOT cover cosmetic dermatological procedures. If you're talking about something like a horrible rash or skin cancer, again I don't think that falls into the purely elective category. Tubal ligation I would agree is purely elective, but I think there is a financial rationale in that it will cost the insurance company less over time in paying for accidental pregnancies and babies. None of these things apply to IVF and it is extremely expensive. |
Anonymous
Yes, but in other expensive elective procedures, patients typically get what they paid for. You go in for knee replacement, you get a new knee. You get lasik done, generally your vision improves. Not so with fertility treatments. So many women try it, multiple times, with no success. For the insurance companies, it is like throwing money to the wind for something that is elective. That is probably why it costs too much for many employers to offer it in their coverage. If it were a procedure where the patient received exactly what they paid for (a successful pregnancy) every time the procedure was done it would probably be an entirely different story. |
jindc
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The underlying issue is that health insurance companies are there to make money, and they don't really care about the kind of care you do or don't receive.
It's great that your employer was willing to hear you on this, but I think the best way forward might be a clinic with a guarantee program. I have insurance coverage, and while it's a blessing...it's definitely a mixed blessing because the stress of having to deal with the insurance company is its own cycle. It's probably easier (yet painful) to pay for your own and consider the tax write off for your medical expenses. |
Anonymous
| You've basically described my situation and it comes down to money. They cannot afford to pay for it and I don't expect them to just for me. They can't pay per employee; they have to offer those services to the whole group and honestly, very few of us would need it. It sucks, but there's nothing you can do. What I find ironic is that my CareFirst plan will cover as many abortions as I want absolutely free but I can't even use the prescription plan to pay for Clomid or the like. I'm 100% pro choice but I find this ridiculous. It's not my employer's fault that insurance companies are run by heartless assholes. |
Anonymous
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Insurance is a major expense for cost small companies. My husband's firm just raised the annual deductible to $2500 per family and the premiums are still outrageously high. We're lucky that I'm a fed and our plan is affordable so we don't have to rely on the insurance through his work.
BTW- even the federal government BCBS plan, which is considered one of the best health insurance policies you can have, doesn't cover infertility treatment. We had to pay out of pocket. My guess is that if your boss wanted to provide infertility coverage, he could find a way to do it. However, it would cost the company (and possibly your fellow employees) a lot of money. The HR person is probably being polite in saying your company isn't big enough because she doesn't way to tell you it costs too much. I think you need to let it drop and look into alternative way to pay for treatment. |
Anonymous
Please don't compare making phone calls to an insurance company with paying tens of thousands of dollars out of pocket. Thanks. |
Anonymous
| From the insurance company's point of view its an elective procedure. If your plan includes it everyone of your peers are paying for it regardless if they plan to use it or not. |
Anonymous
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"It's not my employer's fault that insurance companies are run by heartless assholes. "
I agree lol but, employers have a choice of adding the coverage or not adding it. It's usually available though the insurance co but the employer won't add it because of the expense, or because few people would use it. |
Anonymous
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Insurance companies don't want to pay for infertility treatments mainly because of the exceedingly high risk of multiple births. Paying $15K for IVF is nothing to them. Paying 1 million+ for a 2 month NICU stay for premature twins is a huge loss.
Something like 40% of IVF pregnancies are multiple pregnancies and 50% of these are premature, many quite premature. It's a huge liability for an insurance company. |