A Meditation on Health Insurance: “Money, Money Everywhere But Not a Bit For Me”

In which I discover why medical insurance companies are well known for their (sarcasm alert) excellent customer service skills and warm service.

I was unloading the groceries in the kitchen when I heard my cell phone ringing.  “Hello?”

“This is G, calling from the hospital.  We have you pre-registered for your ultrasound on Thursday morning.”

“Good, that sounds great!”

“There’s one thing we need to tell you.  Your insurance doesn’t cover this ultrasound and they told us that we had to call you about that.”

“Oh.  How much?”

“It’s going to be about $950.  The insurance doesn’t cover anything related to an infertility diagnosis.  Is there any other reason you would need this ultrasound?  Something your doctor could specify and change the diagnosis reason?”

“Are you fu—“ I reminded myself I was talking to someone who had the unenviable job of giving me some really crappy news, and that swearing at the messenger wasn’t going to help my cause.  “Are you serious?  $950?  For real?”

“Yes, we’d have to have a different diagnosis for insurance to pay it.”

“What kind of diagnosis do I need?”

“I’m not really sure.  I’d suggest you call your insurance company and talk to them.”

_______*_______

I called the insurance company.  First call got transferred to voicemail and then to a bored–sounding woman who identified herself as Katie.  “Hi,” I said, trying not to burst into tears.  “I have a problem.  I have an ultrasound scheduled for a follicle count and the hospital is telling me it’s going to cost $950.”

Katie didn’t ask me for any further information on my plan or my situation.  “How did you get me?  Did someone transfer you here?”

“Yes, something like that.”

“Well, I don’t do any of that stuff.  We don’t cover infertility treatments, though.”

“Oh.  Can you transfer me to someone who does know about this?”

“No.”

_______*_______

I hung up, took a deep breath and called the company back at the number listed on my card again.  This time I talked to someone who identified herself as Lisa.  I gave her my name, birth date and plan number and repeated my story.  “Your company has chosen not to cover infertility in their plan,” she told me. 

“So let me get this straight” I said.  “You will not pay any portion for me to have a follicle ultrasound.  You will not pay any portion for my drugs.  You will not pay if I have to see a reproductive endocrinologist.”

“Correct.”

No expressions of “I’m sorry, but we don’t do that”.  No “I’m sorry to hear about this.”  No expression of sympathy, no expression of any sort of humanity, even though it’s clear that I’m distressed and on the verge of bursting into tears.  Just a very cold, “no, we don’t cover that.”  The tone she used made me feel stupid for even calling to ask such a question. 

_______*_______

I get that insurance companies are in it to make money.  Based on a few calculations made because I was royally pissed by adding up receipts, bills, and premium payments by both ourselves and our employers over a few years, I can safely say that the various health insurance companies that have covered Arthur and I have made a huge amount of money on us.  We’re generally healthy, see a doctor once or twice a year, and other than my birth control for those years, had no major prescription costs. 

Insurance works by using low-risk people (like myself or Arthur) to balance higher-risk people’s costs.  I understand that too.  But I can’t shake my rising fury and sense of injustice that now that I need something, all that money has not done me a bit of good.  I’m SOL, and that’s just that.  I suppose at some level, I shouldn’t be surprised.  After all, it’s not that unusual to read about people who had to fight with insurance companies to get treatments for conditions like heart problems or cancer covered.  If people can’t get even potentially life-saving treatments covered at times, I’m not sure why I naively thought something like infertility treatments, viewed (wrongly) as an entirely optional expense by much of fertile society would be covered.

I’m a little “lucky”.  My insurance does cover “diagnosis” of infertility, even if it doesn’t cover treatment, so things like an HSG might be at least partially covered.  It just baffles me though that even the most basic treatments such as Clomid or ultrasounds or blood work are not.  I have a giant lump in my throat as I think about things coming up, like injectables, or the 800-pound gorilla in the room, the possibility of IVF.  It infuriates me.  Even though I have a legitimate disease, my insurance does not pay for me to treat it.  To add insult to injury, the staff at the insurance company aren’t even polite about it.   

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2 thoughts on “A Meditation on Health Insurance: “Money, Money Everywhere But Not a Bit For Me”

  1. Clearly you needed something else to stress about in your life so the higher powers decided that it should be money. Well fuck them. Does your doctor have a sense of humour? Because you should convince them to order all the tests and treatments and write that the diagnosis is a hangnail. Or testicular cancer. Or anxiety, an anxiety diagnosis would work because no one, not even health insurance companies, wants to fuck with a mental health diagnosis.

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