Calling the Insurers OUT

As I've said before, I'm angry. And now I have an outlet for that anger - an outlet that absolutely, really and truly deserves it. The insurance industry.

I met with my doctor on Thursday, and he told me that he wanted us to start IVF right away - that at my age (37, 38 in May) and with our test results, we'd likely have a 40% or higher chance of getting pregnant on the first IVF try.

But we can't do IVF right away. Instead, because my insurance mandates it, we've wasted three months on Clomid and IUIs, and are now going to have to waste two more months on FSH and IUI. So I get the worst of IVF - injecting myself in the stomach every night - without the benefit - the high success rate.

Why?

Because my insurance company, like many in Massachusetts, blatantly violates the law and puts all sorts of limitations on infertility coverage. Apparently the insurers sat down with fertility experts (including my doctor) fifteen years ago, and asked them what their different treatments were. And, fifteen years later - a thousand years in fertility treatment improvement - the insurers are still requiring the same protocols.

In 2008, this is like iTunes suddenly refusing to allow downloads: "Welcome to iTunes! From now on, you can only buy 8-track tapes here!"

I live in a state with some of the best doctors and hospitals in the world. But because of the insurance industry's stupidity, I might as well be getting treatment at a small clinic in a developing country.

And the most infuriating thing is, IT DOESN'T SAVE THEM MONEY!! If they had let me go ahead with IVF right away, they wouldn't have had to pay for all the doctors' visits, ultrasounds, blood tests, medications, IUIs and other expenses over the past four months.

I am going to do something about it.

The law in Massachusetts is crystal clear: health insurers who cover pregnancy-related expenses must cover all medically necessary costs of infertility diagnosis and treatment. ALL.

My insurer - Harvard Pilgrim (I have a PPO plan) - is violating this law. My doctor says that IVF is medically necessary - and my insurer says, "too bad."

They also put caps on coverage - 6 IVFs. And age (when the woman turns 40) will trigger all sorts of requirements - for example, they can cancel a cycle if my test results aren't equal to their mandated levels.

What I want to know is this: if a pregnant woman is having her seventh child, do they refuse to cover her hospital costs?

"Sorry! You've had six kids - that's our limit!"

Do they kick 20 year olds out of the hospital five hours after giving birth?

"Well, you're young and strong, so we only cover you for five hours of recovery!"

Do they refuse a pacemaker in a 70 year old because even though the technology exists to make his heart beat like a 30 year old's, it's his age's fault that his heart is old?

If my eggs are old, but technology can make them act young, isn't that just like a pacemaker (or Viagra, or eyeglasses, or hearing aids or knee or hip replacement)?

I'm sick of the double standard, and I'm not too embarrassed to fight it. The insurers seem to be banking on a few things:

* infertile couples are just too ashamed to take their plight public
* the insurer can take up to 90 days to review a claim - so if my doctor told them that he wanted me to go directly to IVF, we'd waste three months - so I might as well do the FSH and IUIs
* once a couple does become pregnant, they want so badly to put this all behind them that they won't take up a battle against the insurance companies
* people won't learn their rights and will just assume a denial is a denial and there is nothing that can be done about it

Well, as my friend Lyle would say in a southern accent that can make any swear sound like sugar, "I call bullshit on that."

I am calling bullshit. I have already written to two state senators (one of whom called me back and was furious and is going to look into all of this, and is going to work on the currently existing bill in Massachusetts - Senate Bill 599 - which would change the law's definition of infertility from inability to conceive for 12 months to inability to carry a child to term - because the definition currently allows insurers to refuse infertility coverage for 12 months after the cruelest fate of all - a miscarriage for a couple who has fought so hard to get pregnant).

I am going to find a class of plaintiffs, and I am going to fight the insurance companies.

I may have spent my most fertile years getting a law degree, but now I am going to use that law degree to get the fertility coverage that is legally mine.

- L.