Monday, August 10, 2009

Maxed Out

I apologize in advance for this post. If you don’t have insurance coverage for fertility treatments this post is going to read like a beauty queen complaining that it’s hard to be so pretty. If you don’t have insurance coverage please feel free to quit reading, my complaints will only annoy you (and rightfully so).

With my insurance I have a maximum amount to spend for treatments and a different maximum amount to spend for prescriptions. Because I have now had two cancelled IVF cycles, and because I now require a dump truck full of drugs to coax my ovaries into producing sub par eggs, I have now…(wait for it)… maxed out on my insurance prescription coverage!!! Let’s have a moment of silence please…







I have been in a pharmacy death spiral the past week; shopping my prescription needs around from pharmacy to pharmacy. This one has the best out of pocket prices, but that one takes my insurance so that I can eek out every last cent of coverage. And on and on and on.

Finally I have determined that my drugs will cost me about $3000 this cycle.

The good news…I foresaw this and budgeted $3500.

The bad news…My drugs are going to cost me $3000.

And that brings us to the insurance word problem of the day. Hubby’s work is going through open enrollment right now. His insurance would cover half of my meds (no coverage for procedures), but would cost us an additional $100 a month. However, his insurance would not go into effect in time for this cycle. I could only use his insurance for future cycles. So my choices are:

A.Sign up for his insurance which would be tantamount to admitting that this cycle will fail and I will have a need AND a desire for more IVF cycling this year.

B.Don’t sign up for his insurance and pay OOP for all future IVF cycle meds; assuming I would need them of course (wink wink nudge nudge).

I’m choosing B. I'm choosing optimism. But I think it totally sucks that I have to make this decision right now.

Insurance and money and paying out of pocket and dealing with insurance companies and saving money and blowing through savings and the economy just makes this stressful and emotional time MORE stressful and emotional.

And it’s just not fair.

I know. I know. I’m preaching to the choir.

26 comments:

Melis.sa said...

gahhhhhhhh to everything!! I know i'm keeping a close eye on my IF lifetime max...

Melissa G said...

Ugh both options suck a little, but having to make the choice RIGHT NOW is lame too.

Although my not having any IF insurance coverage trumps all that. *sticking out tongue*

=)

Either way, you're right. It's just not fair.

Amber said...

I hate the whole financial part of this IF deal. My insurance covers 50% of office visits, ultrasounds and labs. But nothing else. Which is incredibly ridiculous and outright rude... Like it's our fault...

EWebey said...

BOO TO INSURANCE MAXIMUMS!!!!
I'd choose optimism as well!!!

Valerie said...

Bummer that you have to make this decision! I'd go for optimism too...and I only say that b/c I did make that decision.

My husband carried me on his insurance (fire fighter) and the city does not provide for IF coverage.

We paid OOP for it all. We like to joke that Mary Catherine's middle name is really VISA. And while we literally are still paying her off today (LOL) we'd do it again in a heartbeat!

Keeping fingers and toes crossed that this is YOUR cycle!!!

Blessings,
Valerie

Logical Libby said...

You odn't know me from Adam, but I have Follistim, unopened, in my fridge... Just let me know.

jenicini said...

It's painful! My insurance covered this round of my IVF drugs (I paid $65 in co-pays...what a joke!). However, after this I am SOL and doing it myself.

I feel your pain. I feel your Visa Card's pain.

I try to make myself feel better by putting it on the Discover so I get "cash back" of like $100. Yep, $100 bucks to my next treatment if this one doesn't work.

Meg. said...

Insurance companies are the DEBIL! (say like Adam Sandler's mom in "The Waterboy")

I know that either decision you make is gonna sting somewhat. I wish we had the ability to put life on pause for a while, to give our brains and hearts time to process.

Kristen's Raw said...

Good luck with everything.

Tara said...

Good luck! I've been there - maxing out the insurance. It blows...

Lorza said...

Money woes are money woes. It sucks no matter WHAT your situation is. Good luck- hopefully you canfind some programs to help!

Sprudeln said...

I just picked up my down-regulation drugs this morning - oh how I feel your pain. (My insurance covered 50% of this round, but still OUCH.)

One consideration about your insurance dilemma - which offers better maternity and pediatric coverage? Might also be worth it to spend the extra $100...

Best of luck to you!!!

womb for improvement said...

Much as I complain about it reading post like this make me so thankful that, in my particular part of the UK, I get three free goes at IUI and one at IVF. Then, well, I'll cross that when I come to it.

B. said...

Hallelujah!

And amen to having insurance to cover at least the next procedure. It does feel like a slap in the face when thecoverage we seem to have to fight for doesn't cover all that it should.

Good luck!!

Shinejil said...

I don't resent anyone whose insurance maxes out, even if I have no IF coverage. Because that means we're in the same shitty boat of gobbling up family wealth to get tortured by hormones, procedures, and the like. And usually you don't max out your insurance because good things are happening.

I'm sorry you're having to juggle all this bs. I hope you never have to think much about it again after this cycle...

Erica said...

I want to comment on your No Resolution post. I understand how you feel. It's okay. All of your pregnant IF sisters will be waiting for you to get on the train. We're here cheering you on, okay. You don't have to read our blogs because we know how painful it can be. But I'm still reading yours and I know others are too because you haven't gotten on yet, Megan, and until you do - I'm not going anywhere.

Sorry about the insurance shit. That blows.

areyoukiddingme said...

Go with hope - I've done some rudimentary math, and hope is the far better option. Personally, though, I'm skipping hope and going with DETERMINATION THAT THIS CYCLE WILL WORK!

the misfit said...

Good grief, what a decision! I think in general it does make sense to bet on yourself. But I don't like betting at all :( And the whole "lifetime IF limit" - it has such a symbolically fraught, needlessly dramatic quality to it! (Not in that boat myself - my plan covers everything but IVF/IUI [though not in full], and those are the ones I don't want, so I have the twin comforts of getting my care paid for and getting *what* I pay for. But I understand how rare that is!)

Silya said...

That totally sucks. And, ignore this if it's totally wrong because I'm speaking out of ignorance, but couldn't option A also be optimistic if hubby's insurance would make a labor/delivery cheaper? We have also made insurance/enrollment/flex-spend decisions in the past few years with the optimistic idea that since giving birth is expensive, we would want the maximum amount of coverage. Then we've found ourselves trying to spend the extra flex-spend money at the end of the year (which, I know, sounds a lot like the beauty queen analogy). Just a thought. But still, totally sucks that you are in this situation. Infertility has made me despise insurance companies more than I already did!

Kara's Mom said...

I've paid out of pocket for the last 4 of my 7 IVF cycles. I found a website where people sell their unopened, unused fertility drugs for cheap. I have saved a TON of money. www.freegaragesale.com go to the medical section and check it out.
Good luck this cycle.

Celia said...

Hey,

We are broke this month too. I have had three office visits a week every week and spent triple our normal budget for the doctor.

The silver lining, is that you can write this off on your taxes. We wrote off a grand last year. If you go to the Lost and Found and read Mels most recent post there is a link to all the things you can write off with medical costs. I never realized we could write off mileage, and I am thrilled cause I drive six hours a week for my treatments. Plus tolls. Which you can also write off.

I hope this helps in some small way.

Celia

TeeJay said...

I hate that our reproductiveness (not even a word) depends a lot on our money situation. Seems so unfair.

On another note, I nominated you for an award on my blog!

strongblonde said...

to the best of my knowledge, boys don't have to deal with a lifetime max for their viagra rx. i totally don't get it!!!

arg. i hope you find someone who is not that expensive :(

Samantha02 said...

I just came across your blog. I am one of those people who has no insurance coverage for IF treatments, but I continued to read anyway! HA. A very special friend told me about freegaragesale.com you can buy leftover meds from people who have either switched meds or gotten preggo. I have used it twice now and saved over 4000.00. Hope this helps you!

KuKd Chick said...

Well, I've not dealt with this IF-insurance thing, because my cervical mucus seems to suck up sperm and cling to it without much problem (it's the subsequent parts of the process where baby-making doesn't work for me). I can say though that I've dealt with lots of medical insurance crapola in my lifetime regarding baby/fetus losses, and can attest to the general suckage that's out there. So yeah, your complaints seem fair enough to me.

MelissaP05 said...

I'm sorry about the IF insurance woes, I think we've all had them at one point. I'm one of the unlucky one's w/o any IF insurance, but I completely get being pissed about having to spend money on meds. It sucks that we all have to pay to get PG, why couldn't we just get PG the cheap way?

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