Let's talk Insurance

Admittedly, I’m not good at this whole insurance thing. Most of my adult life I have either had insurance through employment or I haven’t. I never paid attention to what my coverage was because I didn’t have a choice. It was a set plan, they gave me a card, I handed it to the doctor and paid a co-pay. Then I lost insurance when I became an independent contractor and had a few medical mishaps that nearly killed me financially until I got married and DH was eligible for insurance through his company. Then I got insurance again and all of a sudden I was learning what was covered, what wasn’t, deductibles etc because honestly, the plan wasn’t great but it’s a small company and it was better than nothing. Now we have a choice, because both my company and my husbands company have insurance plans. His insurance plan still sucks (what we are already on) and they are raising the prices by 20% so his company is currently dropping them and searching for another provider. Panic attack ensues until I realize, wait, I’m eligible for insurance through my company NEXT WEEK. Problem solved, but I wanted to see what I’m getting into. Make sure it’s not WORSE then what we have now. It seems to be a pretty good plan. I have analyzed what parts of are real interest to me at the moment as outlined below. Also, it will only cost us $41.00 out of each paycheck (I’m paid every two weeks) compared to the almost 200.00 from each of my husbands paychecks that we are paying now. That’s a savings every two weeks of $159.00 which is $344.50 PER MONTH and $4134.00 per year. So it’s like we are getting a $4000.00 raise. HECK YEA. 401K here we come (which I’m also eligible for which DH doesn’t have at his company!). Plus the deductibles and co pays are A LOT Lower then our current plan so that should save us even more out of pocket.

Infertility

Care, supplies and services for the diagnosis of infertility and treatment of the Sickness or Injury which caused the Infertility.

Treatment must be rendered on an outpatient basis.

The Plan does not cover any service that provides assistance in achieving a Pregnancy, I.E., artificial insemination, in-vitro fertilization, in-vivo fertilization, gamete Inter-fallopian Transfer (GIFT), Zygote Inter-Fallopian Transfer (ZIFT) or similar procedures to achieve Pregnancy.

So that is both good news and bad news. The insurance will not assist us in getting pregnant but will cover the RE and the medications to treat the hormonal issue of PCOS which can also aid in getting pregnant. Since I’ve achieved pregnancy before addressing the hormonal aspects, fingers crossed that I can do so again.

All maternity related expenses are covered under the Plan.

Allergy Care

The Plan covers allergy treatment including, but not limited to, office visits, serum, scratch testing and laboratory testing.

Chiropractic Care

Covered except for maintenance or to PREVENT worsening. It is only covered if chiropractic therapy is administered directed at functional improvement (active treatment).

Mental Disorders and Outpatient Mental Health is covered according to the benefit payment Maximums.

In-Network Benefits
Deductible $500.00 per family
Max Out-of-Pocket Limit: $1500 per family

Out-of Network Benefits
Deductible: $1000 per family
Max Out-Of-Pocket Limit: $3000.00 per family

General Inpatient Hospital Services and Birthing Centers In Network: 90% Out of Network 70%.

ER: If patient is admitted no co pay. If patient is NOT admitted $50.00 co pay.

These are the basic items that apply to us in our current situation. There is a lot more in depth of course. We are required to get pre-certification (as in call first and approve our birthing facility etc so they are prepared for what their costs are going to be) but that’s not a big deal. It looks like perhaps my deposit won’t be as great this time around (like last pregnancy I had to fork out 1400 by the 7th month or my Dr. would not deliver me) since this insurance plan pays more than my current one.

So, I’m getting a little excited about it now that I’ve been investigating it. What do you think? What are your feelings about insurance? I think it sucks that very few plans cover getting pregnant if you are infertile and consider those procedures elective. One part of me sees why it would be considered elective because you don’t have to have children and many people ELECT not to, however, as an infertile it discriminates against me because I don’t have the CHOICE naturally and therefore if I CHOOSE to have children I HAVE To seek medical intervention, so I think there should at least be available riders for those programs. Since my company is self-insured though, riders do not exist so I’m at least pretty happy with what I’m going to get (that low price also covers dental and vision btw but my brain is focused solely on fertility and anything my body is psycho enough to pull currently that might effect that, like the allergies).

In other news, my Dr. has decided to keep me on the Clomid Metformin cocktail. I’ve only been on it one month this time around and it worked on the Fourth month (which is average results) last year. Interestingly enough, I realized I started it last year at the same time as this year. I honestly hope it doesn’t take four months. I really can’t handle getting pregnant the exact same time of year as I did last year, having the same due dates and everything. That would be excruciatingly hard I think, but I guess I need to take what I can get huh? Let’s just say I hope it works A LOT quicker than that for more than one reason.