My Medical Insurance Sucks

My medical benefits coverage sucks for my needs.  Now if I were a drug addict or wanted to have an abortion, that would be just dandy.  But alas, I “only” keep losing babies.  The insurance solution for that is – stop procreating cuz that’d be best for us.  We certainly don’t need to help you with your fertility issues just because you want to have more children.

I’m not infertile.  I’m just a habitual loser in the whole pregnancy maintenance arena.  Who can help me there?  My path has taken many turns, most leading to dead ends with providers who can’t acknowledge their limits.  Most recently, I was diagnosed via an uterine xray with a double uterus and told to “keep trying.”  I would need a referral to see an endocrinologist, even though I doubt that a general endocrinologist in this town would have a whole lot of experience in reproductive endocrinology.  In fact, the endo that my insurance service agent recommended seems to do more with diabetes.  But I’m expected to exhaust in state possibilities before I pursue specialists out of state.  I have yet to find an obstetrics group in town that believes that imbalanced hormones contribute to pregnancy loss.

I’ll be in Denver this summer, and even though there are reproductive endocrinologists (RE) there that are considered “in network,” I’m not allowed to see them?  I can waltz into any urgent care clinic in Denver with a common cold and get treatment, no questions asked, but I’m not allowed to see a RE?

My employer has no maternity policy and no infertility benefits.  Great place for a woman in the childbearing years, eh?

13 responses to “My Medical Insurance Sucks

  1. I’m so sorry you’re going through this. I just read your post on MDC. I wish I had some advice for you – I’m sure you’ll get some answers/advice soon.

  2. All health insurance sucks. No one has “good” insurance, unless they’re a naturally compliant person and OK with what their insurance is OK with. You’re not alone… and that is no help at all, is it?

    Hugs.

  3. Perhaps make a case to your insurance company of this? Maybe you can lay it out this way — you will follow their stupid little rules and waste their money if they want you to, and then after you have exhausted everything in-state you will go out of state; but it would be better for them in the long run if they make an exception in your case. If you can find information to present to them that supports your case (that this *is* an endocrinology issue, and that you need to see an endocrinologist that works with reproduction, in order to get this issue resolved), then that may help.

    In the meantime, pursue natural alternatives as you can. Remember the old saying, “You are what you eat”? Well, perhaps you can support your body naturally into getting back into proper health as far as the endocrine system goes. You can research what other people have done on this issue, and what they ate, and how that affected them. I may not have a medical degree, but I do know that whatever substances are in your body have to be made from the food you eat. Some people have done well with a detox program — eliminating certain foods, or going on a juice fast, etc.

  4. I have had a whole smash when it comes to health care. Universal in Great Britain and for those who rave universal is the way to go you might want to think twice. HMO’s and PPO’s while living in Fresno, CA and both sucked and rocked in equal proportions. I currently have Kaiser and it works for me although there are plenty of people who will say it’s the devil. It’s probably not that helpful but I wish you and your family well.

  5. A uterine anomaly is actually not coded as infertility. You should check with your Dr. to see how they are coding it when they turn it into the insurance. I would also be very, very leery of the “double uterus” diagnosis – especially when accompanied by a “keep trying.” If you have a septum, not a double, it carries a very high miscarriage rate. It is also remedied with a simple out-patient surgery.

    I hope you find some resolution with the insurance. I was fortunate that my DH got a new job with insurance at the very moment I started having losses.

  6. Ok, I’ve just been reading some more about double-uterus, bicornuate-uterus, and septate uterus, and from your other blog posts, it doesn’t sound as if you had any problems with miscarriages prior to the birth of your first child. Does your doctor have an explanation for that? Is it possible that you carried your first daughter in one uterus, but your second uterus is, well, malfunctioning? That’s the question that is setting off my “question it!” center in my brain. Why now? Why not before? What’s different?

    Are you going to have another test (perhaps a 3-D ultrasound) to verify the X-ray diagnosis — just in case the X-ray was wrong? From the little that I’ve read, it’s important to understand exactly what the anomaly is, because these different variations of uterine malformations require different treatments and respond to different things.

    Oh, and I second what “admin” said about insurance codes — a friend of mine had no end of problems with her husband’s insurance due to incorrect coding — some of it was because the doctor’s office coded it inaccurately, but sometimes it was due to a clerical error on the insurance side of things. You should probably be able to get a manual or something from your insurance company that details exactly what they will and will not cover, and what codes need to be used. It might require you to spend some time on the phone, though, talking to an insurance company employee in a cubicle in order to get some straight answers — take names, numbers, times/dates you called, etc. And KEEP TRYING — it’s possible that the insurance company has a policy of denying just about everything straight off, hoping that most people will just accept it and stop; but you may be able to wear them down.

  7. Thank you all for the comments and your support!

    “Admin,” I’m enjoying getting to know your blog and appreciate your feedback regarding coding and diagnosis. I am glad to know WHAT to fight for when I talk to my insurance.

    Kathy et al, what I think MAY be the difference, is that perhaps I was fortunate that my DD’s placenta implanted low near my cervix. I was being monitored for previa. I didn’t have miscarriages before my DD because we weren’t trying to have a baby. So, perhaps I did get extremely lucky first time out. Or perhaps the shape of my uterus isn’t the issue. I will pursue a more thorough diagnosis with a RE in Denver this summer.

    Hugs to you all,
    Kimberly

  8. Please check the ingredients list on the food you are eating. I have had some health issues and my opinion food manufacturers and big pharma do not care. However I do care and will pray for you to concieve. I noticed that some
    companies are adding ingredients that are considered toxic for human consumtion for example proplyene glycol (anti-freeze) to our foods

  9. Continued proplyne glycol is is known to cause problems with fertility. I have found this ingredent in Zataran”s Cajon Mustard and some varieties of A-1 steak sauce. I want to share any information with you because I have been diagnosed with a mass on my pancreas and do not want this to happen to other people.I am not saying that I got sick from this but ingesting anti-freeze can’t help!

  10. If your intrested in our right to natural herbs then be aware that our U.S. government is trying to take away our freedoms. Just google this Neoplianic law called the Codex which will try to take our rights away for natural supplements. This is the way the big pharma has no compitition.

  11. I know it’s been some time since you posted this, and I have no idea where your life has taken you since. I work for a physician in Indiana who specializes in recurrent pregnancy loss. I am actually the one who fights with insurance companies, and stumbled across your blog because I am researching how to fight an insurance right now who is denying a patient’s surgery to repair her septate uterus as “infertility”. Fact of the matter is, insurance companies define “infertility” as the “inability to get pregnant”. You obviously have no problem getting pregnant, therefore, you just haven’t found the right person to help you; both treatment-wise AND fighting for insurance coverage. I do hope that if you are still searching for answers, you email directly. If you have stopped searching, make sure it’s not because you have given up.

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