Taking my business elsewhere: The reality of the disabled Infertile!

Well the last month has been a bit of a whirlwind.  I don't even know where to start.  You know that Kevin and I decided at the end of July that we were going to do an IVF cycle in October. So in the past few weeks I have talked to insurance reps, pharmacy reps, and the nurses at my doctor's office more than I have my family. No joke. It feels like I talk to someone from one of these three places everyday. When I call my doctor's office, all I have to say is "hey, it's Katy." Their response is "Hey, what's up?" I don't know if that's a good thing or a bad one.

Anyone who has done or planned to do an IVF cycle knows how expensive it is. We got a preliminary report about how much the procedure would cost. Then we got a list of medications. My nurse told me to call my insurance company and find out what, if any, coverage I had for those medicines.  She told me how important it was to tell them that I was taking the medications in conjunction with an IVF cycle. Because of my low AMH, I have to have the highest medication protocol they have. So of course that means that the meds are going to cost more because I need more of them.

So I called the pharmaceutical side of my insurance company. (Side Note:  There are two separate parts of my insurance company: the Medical part and the Pharmaceutical part. You will see that they apparently don't talk to each other)  When I talked to the first representative, I told her that I was doing an IVF cycle and I needed to know how much my medicines were going to cost.  I repeated to her that I was needing these medications so that I could become pregnant with the assistance of doctors.  For a third time, I told her that my husband and I could not have children on our own and needed the assistance of some really smart people. We went through the list together and she gave me a co-pay amount for each medication. The total? Drum roll please (imagine it)! Less than $500. That was for 8 IVF medications.  I couldn't believe it!  I was sitting in my office and my jaw dropped to my desk.  I was speechless.  I asked her if she was positive that she was right.  I reminded her that I was doing IVF and she said I know but that's what it says your co-pay is. We hung up and I called my nurse.  She was just as excited as me.  But being the pessimistic and cautious person that I am, I had to call the insurance company back.  I called the medical side this time.  I knew that I only had coverage up to diagnosis, but nothing for IVF or medications.  So I wanted some clarification. The representative told me that I didn't have coverage for meds.  I told her what the lady on the pharm. side said.  She said "Well if that's what she told you then that's what it will be."  My heart fell onto my desk, instead of my jaw.  But that still wasn't enough for me. I called the pharm side back.  Knowing I would get a different representative, I decided that I would trust the total if she told me the same thing. Well she didn't tell me the same thing.  IT WAS CHEAPER!!! Ok this time, I fell onto my desk!

Well you know how they say "if it's too good to be true, it probably isn't right?" Well, it was too good to be true.  My doctor sent the script to the pharmacy, they ran it through my insurance, and called me and said my bill was $6,300.  I fell out onto my desk again. Totally skipped the jaw and the heart drop. The whole body, just collapsed. I asked them why they didn't run it through my insurance. She told me that they did but that insurance denied the claim. She followed that up with "will you be paying with credit or debit?" I wanted to say "Monopoly money," but I didn't. I told her that I wouldn't be paying for anything right now.  Throughout the next week, after many phone calls to and from the pharmacy and insurance company (every call, by the way, the representative gave me wrong information or they said that my concerns weren't their department and transferred me.  One lady pretended that she couldn't use her computer and hung up on me) we determined that I had no coverage for 4 of the 8 medications.  4 of the meds were covered because they were meds that are not associated with infertility. The other 4 were still going to cost close to $6,000. Still going to have to use Monopoly money for that!

So I was super excited that we had support group that week. I needed some advice from my sista infertiles and needed to just let off some frustration. Well it just so happened that we had a newcomer. She told me about a pharmacy in the UK that she was buying her meds from. They ship them here and they are ridiculously cheaper. So I rushed home and looked them up. OMG after checking out the site, I determined that my meds would cost less than $2500.  The most expensive medicine that I need costs $72 a vial here in the US. I need 66 vials. In the UK, it costs $29 a vial.  Of course I didn't trust it.  So I checked the pharmacy and their meds out the best I could.  The pharmacy is totally legit.  The medicines? It is the exact same medicine that I would have gotten from the pharmacy here. I went to the pharmaceutical manufacturers website and discovered that the medicine that I would have received from the USA pharmacy, comes from overseas to begin with. So ladies and gentlemen, that's what we call the American mark-up!  Sorry, it really chaps my tiny hiny that the EXACT  same medicine is $43 more here. And to make me feel better, my insurance company told me that if Kevin and I were using the medications to try to get pregnant on our own at home (not with IVF), they would cover them and it would have cost the original $500.

So my America, that I truly feel privileged to be a citizen of, just told me that it's my problem, not theirs, that I was sick as a child and as a result can't have babies, the almighty dollar is more important than the hard working people, and we would prefer you to do your business elsewhere.  But what is our problem, and therefore your problem as a working person who pays taxes, is paying the rent and grocery bill of people who decide they don't feel like working anymore and doctor shop until they find someone to say they are bi-polar because they lose their temper when they get too drunk everyday. After all, they have a disability.

Well that is interesting, because under the Americans with Disabilities Act (ADA) infertility is a disability.  So why is my disability different? Because it costs too much money! After the Supreme Court made up some crap about excluding an entire group of people from insurance benefits doesn't qualify as discrimination, the American insurance companies can legally discriminate against infertiles who need IVF.  So because it is too risky and not a guarantee that IVF will result in a pregnancy, insurance companies don't pay.

Now please don't misunderstand me.  I don't think that the American government should pay for my procedure and medication, or send me a monthly check for my disability. I don't want that because I am completely capable of working and making my living. And I am not saying that everyone who receives a disability check is not completely deserving of it. But let's be completely honest, most people receiving a disability check are abusing the system. People who really CAN'T (this is different from WON'T) make their living because of their disability are unable to get assistance because we are paying too many people whose "disability" is laziness or stupidity.  I am saying that I don't think that insurance companies should be able to pick and choose whose disability is worth giving coverage to and whose isn't. We pay the same premiums as everyone else.  I thought the point of insurance was to help with medical costs when you need it. I guess I was wrong. It's for helping with medical costs when someone else thinks it is worth it and as long as it isn't too serious, too risky or costs too much money!!!!  Silly me!!! 

So instead of putting my money into this dreadful economy and trying to help turn it around, because let's be honest I don't see it being successful anytime soon and it seems too risky to me,  I am choosing that America's disability is not my cause today.  Because contrary to the belief of the people in charge of this country (which is supposed to be the people, but isn't), I am not made out of money and after contributing to the disability of everyone else with the taxes that they take out of my paycheck, I can't afford my own, here!

Sincerely,
Taking my business elsewhere!