Winning at the Insurance Game
By: Melanie
(eventual IP via GS)
I agreed to write this article in hopes of helping other infertile couples achieve the amount of insurance coverage I have. I also look forward to the day that *all* insurance companies are forced to cover all infertility related costs.I have known about my infertility since I was 17 years old. My husband and I got married when we were 20 and wanted to begin investigating surrogacy and other options available to infertile couples. Since we got married young, money was very tight and surrogacy was very expensive. We decided on gestational surrogacy regardless of the costs. We met with doctors and psychologists and got all the preliminary screenings out of the way. The only thing left to obtain was the money to move forward.
When I started a new job, I had Pilgrim Healthcare and my husband had Blue Cross/Blue Shield of Mass. I contacted Pilgrim and was told that very few (if any) procedures for GS were covered. I was very discouraged, but contacted Blue Cross since I was also covered by them through my dh. When I called BCBS, I spoke with a young girl in member services. I asked for nothing specific, but instead asked her to fax me all the covered infertility benefits package that she had. To this day, I don't think she was supposed to do that, but she did and I was ever so grateful. The procedures that I was to undergo were covered, right there in black and white. The only difference, however, was that the embryos transferred would not be transferred to me, but to our surrogate.
I contacted the billing office at the infertility center, and she sent a treatment plan to BCBS. They sent a letter back denying our claim, stating that the gestational surrogacy program was not covered. The billing woman then suggested we send in a letter of appeal. I thought, why not? So, I got to work.
I gathered letters in support of us from both my and my husband's primary care physicians. I also typed a letter myself and so did my reproductive endocrinologist. Finally, I copied and highlighted *every* procedure outlined in the benefits package that had been faxed to me from the insurance company proving that these procedures were covered. Every letter I sent stated that gestational surrogacy was my *only* chance at having a biological child due to an abnormality in the growth of my reproductive organs. This was in no way my fault and I should not have to pay for every expense out of my own pocket just because I wasn't the one who would carry the child(ren).
The letter was sent off, and a few weeks later I got a call from the infertility center's billing clerk saying that my insurance company has agreed to pay all expenses related to gestational surrogacy *except* for any costs directly related to the surrogate mother. I was thrilled and waited anxiously for proof of coverage in the mail. It arrived soon after our conversation, and right there in black and white it said I was covered for everything...INCLUDING EMBRYO TRANSFER!!! The only thing we had to do was pay 20% of everything because that is how BCBS works, they pay 80% and the insured pays the rest.
Then the unbelievable happened, my company dropped Pilgrim Health and subscribed to HMO Blue which is owned by Blue Cross/Blue Shield. I had the billing office contact the insurance company and ask that my benefits be transferred to my own insurance plan. They agreed and not only was I covered completely, but I wasn't even required to make my co-payments for office visits. We have done 2 cycles, (failed) and the insurance company paid for all services with not one problem. I have spoken to them since, and they said they usually allow *six* cycles before I would have to request an extension. We hope it works before it gets to that point.
I know that I may be an exception to the rule and that all cases are viewed individually, but I hope that *some* people can get at least partial coverage for surrogacy procedures. We are very thankful because otherwise, we could never afford to do this amazing program.
December 1997
Copyright 1997. The American Surrogacy Center, Inc.(TASC), Marietta, GAThe information contained in the website may not be published, broadcast, rewritten or otherwise distributed without the prior written authority of The American Surrogacy Center, Inc. If you would like to include this information on your website, you may link to the page directly on our site.
Email: surrogacydotcom@gmail.com Disclaimer