I am an incredibly healthy individual that has been covered by them for the last five years. I (and my co) pay an exorbant rate to have high coverage insurance on me. People might think I’m crazy about carrying so much coverage but hey, I wasn’t planning on breaking my neck in ’04 either but it happened. Luckily I had good insurance. I’m one of those people that would rather have a higher payment and lower risk then a lower payment and higher risk. That is my choice.
In the last five years I have only used my insurance, maybe once a year. Usually just for my well woman exam. Recently, as in the last six months have I actually had to use it. So let’s just see how that breaks down.
Aetna receives a total of $536 for my coverage monthly. I pay $123 and the company pays $145 (nice benefit huh?) per check. As I mentioned before I’ve been with my company for almost five years now, with the same benefit plan, with Aetna, the entire time. That means, between the company and myself, we’ve paid into my insurance plan a total of $32,160 freaking dollars. I will say that over the past six months, after reviewing my EOBs that I get for the treatments I’ve been doing with Dr. Le (surgery, IUI, sonograms, Rx’s, etc) I would say the insurance has probably paid out MAYBE $6,000. The Hubs and I have probably paid around $2500 so far. So that, if life was fair, would leave the insurance company with $26K of “my money”.
All of this leads up to me saying that the insurance company denied the IVF claim because they decided that it wasn’t medically necessary. Ummmm how about my doctor, who is a leading specialist in infertility care, who is actually treating me and seeing me, decided that it IS MEDICALLY NECESSARY?! How about that?!?!? Do they not have all the facts or something?
Whew. I needed to get that off my chest. I called Aetna fuming, and will say after being transfered a few times (and starting to get worked up), I finally spoke to the nicest lady named Kathy. I’m so grateful she was nice because I was going to either, A. LOSE IT or B. cry my eyes out (which is still losing it).
Right now I’m wishing I lived in Maine where IVF is required to be covered. I wonder if I can call my state representative. What do we think? Would Texas go for it?
After the anger adreneline wears off I’m just left with feeling sad and defeated. I’ve filed an apeal to see if they will reconsider. I keep hoping there are real human beings behind the line and recognize the turmoil and heartbreak this process involves.
theallennuggets 