William: You folks from AIA, find this through the e-mail we sent out, or just find it from the main chat directory?
Alex: jan, I have never heard of IAAC. I live in Ontario.
Bye Deb
jan: William I found it thru the chat rooms directory I got the email but i couldnt link up my puter was giving me problems
Alex: William, I was given the fertilethoughts.com address by a woman I met at a workshop.
jan: Alex Im in Ontario too outside Toronto a city called Mississauga I run a local support group here for IF
William: did the e-mail message look ok? Dave sent it out and he told me that it didn't "word-wrap" on his e-mail system, but it looked fine on my system
William: kewl..*smile*...glad to hear word-of-mouth gets us new visitors, how long have you been visiting, Alex, and are you from the New York City area?
Alex: jan, Cool. I don't have any support group. I am in London. I have good friends in Mississauga. Chat lines are my support for now! LOL
Alex: William, sorry only Canadians here!
Alex: Hello klre!
Alex: Hello jodee.
jan: Alex there is a group in london go to
www.iaac.com to find it under the heading chapters
also you can go to
www.onelist.com and search INFERTILITYTO and find our EMAIL group of people in the ontario area we have a lot of connections for infertility
Alex: William, I had a m/c about2 months ago and was told about the web address then. It has been addictive to visit once I got the hang of it.
jan: Alex I got to go know im suffering fro flu and feeling quisy but please email me Ill help you anyway I can to support and get information to you my email is

jan: William I have been telling people about fertilethoughts any chance I get I have to admit its one of the best Infertility sites on line I have met so many wonderful people here not only on line but in real life this site has truly been a life saver
Alex: jan, Thanks. I will check that out.
jan: Ok Alex please email me, there are others too from FT who live in London
I plan on coming to london in Spring
Alex: jan, Thanks. I am at
jan: Great Alex Ill be in touch you can probbaly find me on line tomorrow am as Ill be home from work working on some IF stuff take care nice to have met you
William: *smile*...we like to think highly of ourselves here, Dave and I have been running the site for oh about 2 years now, and before that we started back in July 1996 with the original WWW infertility chatrooms...
Alex: jan, I don't know any other IF people in London personally, but they are out there hiding somewhere. My dr. didn't know about any support group for me...so I appreciate your news.
jodee: Hi... is this the same site that was just starting out about 3 years ago? I found it extreemly helpful when we were going thru the infertility before we had got pregnant with our daughter three years ago. Now we are starting the process again(FSH), so I thought I would check it out.
mich: I have never been in this room, whats the topic of conversation?
jan: well before I go I just want to say Thanks to both you and Dave for your dedication, contributions and unconditional support you truly have made thousands of people more comfortable dealing with if issues and so many friendships have been bonded along the way
take care and good nite
Alex: William, Three cheers for you and Dave!!!
Hi Katie!
Alex: mich, Whatever you feel like!
mich: Is this the people who run the site? I would send you both cyber hugs abd kisses!!! This is much cheaper than therapy, and I laugh a lot more!! You guys are awesome!!!!!!!!!!
William: g'nite, jan, welcome back jodee!
jan: Alex the support group in London is just getting its foot off the ground check on the www.iaac.com site if you have problems let me know and ill email you a contact person who runs the group in your area
Jodee sorry i cant stay but wanted to say welcome and maybe ill catch you on line again
( See WIlliam how addicting these rooms are it takes me 1/2 hour just to say goodbye)
Alex: mich, I second the thought and the cyber hugs and kisses!
William: Dave is the main dude, he's always doing the programming and organizing the BB moderators, I just handle the insurance questions and give Dave some ideas here and there...I've been really busy with my new job and relocating to Virginia
Alex: jan, Thanks so much. You take care and +++ thoughts to you.
Addiction....yes I have been on until 5 in the morning while on my holidays!!
mich: hip, hip, hooray to dave too then! Please forward my message to him.
mich: What made yoy guys come up with this site?
Alex: William, How did you get started with this in the first place?
Alex: mich, What is up with you?
Alex: klre, jodee and jannie....You're being awfully quiet.
jodee: I would like to give my big thanks to this site, too!!! I remember the sorrow between clomed and metrodine. I had been so depressed. I think this site was was the only thing that kept me from going completly going over the edge. I send my cyber hugs and kisses to you, too!!!!
mich: Alex, im pooped! I need to go to bed. I test next Monday, and frankly, my nerves are shot!!
William, you didnt answer us!
William: I was answering insurance questions on the newsgroups, and I set upa chatroom and BB to archive those discussions, and it sorta took off from there
William: sorry for the lag, working here and want to be home by 11...
mich: what time is it for you? Where are you, William?
Alex: William, However it came about...we are grateful.
mich, Test for what Monday??
mich: What about you Alex, how goes it?
mich: Alex, pg!
Alex: I am getting over m/c in Nov. My AL hasn't resumed since. ttc 4years :(
mich: Alex. whats AL?
Alex: mich, OH! The awful am I am I not wait for you then?!
Alex: mich, Sorry, meant AF (Aunt Flo) period.
William: William is in Richmond Virginia, where he is a statistician manager for Capital One Finance, a really cool company to work for, so if you have one of our credit cards, by all means use it, and if you don't visit our website and get one!
http://www.capitalone.com
mich: my computer is running toooo sloww tonight!! I am falling asleep at the keyboard! It was nice talking to you all, and thanks again William & Dave, you guys rule in my book!1!(((hugs))
Alex: mich, Goodnight and goodluck with that pg test Monday. ++++ thoughts to you!
jodee: Hi Jannie. Are you new to the site, too??
mich: William, you salesman, you! (I happen to have the one that gives miles, the platinum card I think!)
mich: Good Night to all Then!
Alex: jodee, What is up with you tonight?
Alex: William, Well, I think you got your positives tonight!
William: hehehe...our cards sell themselves :o)
I have the platinum miles card also
Alex: jodee, You there...want to talk??
Alex: Hello Pam
jodee: We started the FSH last week. I will be getting my first ultra sound tomarrow. Just wondered who else was going thru the same stuff.
Alex: jodee, I've done 6 cycles on clomid. ttc 4 years. is u/s to see if your follicles?
jodee: hello pam
Alex: Goodnight! Thanks for fertile thoughts William....it's great! :)
jodee: I'm not real current on the abriviations. What is ttc? Yes, the ultra sound is to see follicles? I did the clomid 3 years ago. Ended up going to metrodin. I got pregnant the second cycle. This time we opted to go staight to the FSH. I have endometreosis.
SUSAN: CAN ANYONE TELL ME WHERE TO FIND GRANTS ASSOCIATED WITH INFERTILITY COSTS.
camille: Hi Susan...have you tried the infertility foundation?
camille: is anyone there?
sassysheila: I need as much advise as possible
jan: hi sassy your here all alone thught i would pop in and say hi
jan: r u here
jan: sassy advise???
sassysheila: hi
jan: how can i help
sassysheila: I need to know where do you go if your insurance does not cover feritility and what are the cost
jan: there is a web site on here for usa called the fertility foundation that can help its best you check out that site and see if you qualify
AmyF: hi everyone
jan: Hi Amy
sassysheila: can anyone recommend clincs in the Cleve, OH area
sassysheila: Hi Amy
jan: Hi Kathy
sassysheila: Hi Kathy
jan: sassy is cleveland near canton I have a friend in Canton who is very happy with her clinic
Kathy2: hi, new to this chat format, yikes help
sassysheila: This is my first time chatting too
Kathy2: should I do something to be able to see the messages? or just scroll to death?
jan: kathy have you been to FT before
and sassy is this your first time at this site
sassysheila: Canton is near the Akron which is about 45-50 min. away from me.
AmyF: i have pco....i am also ttc.....when i called the insurance company they said that they would not pay for anything to help me to get pregnant or anything to keep me from getting pregnant......my question is...for treatment of my pco and to try to help make sure that i ovulate i am going to take clomid....should my insurance pay for this....and can my doctor code things so that they wont be directly linked to treatment of infertility?????
jan: Kathy you have to keep clicking on the send key each time to see msgs
Kathy2: i may have been here before, but never in chat
Kathy2: yes, I have to push send, but the real problem is that I have to scroll down to see any messages
admin: Hi all.
Just checking the room out to make sure it is okay.
sassysheila: I tried the clomid before but I did not get pregnant. We have been trying and but no luck yet
AmyF: i will try to be back later if anyone has any answers please email me at
jan: sassy do you have a good doctor in your area that you can confide in and ask about a good RE, what is your dx???
Amy clomid is an infertility drug and relatively inexpensive to other drugs clomid i beleive is about 5 dollars a pill for 50mg and you need 5 pills a cycle some drug stores can charge more best to shop around for the best price
Kathy2: admin, am I doing this right? Should I need to scroll down to read messages? Is there a way to have them appear like an IRC chat window?
sassysheila: Yes this is my first time to the site
AmyF: how long were u on the clomid sassy???
Kathy2: do you guys have to keep hitting "refresh"?
jan: Kathy yes you have to scroll in these rooms to get your msgs on in java chats you dont have to but in these rooms you do ( youll get used to it)
sassy what is your diagnosis?
admin so far this room is great but just so you know us canadians come in here for information too LOL
admin: Kathy2-Hi. We are using an older type chatroom so everyone can chat. We would hate to exclude anyone because of an older browser. :)
We provide the java chatrooms for java enabled browsers.
Kathy2: I guess I am just used to irc, sorry if I am whining, I will shut up now, LOL
jan: Kathy admin is right you can click on JAVA chat on the left hand side of the screen
under Infertility you will see Chatroom - Java and chat in there
Kathy2: thanks for the advice folks!
admin: Kathy2- I like irc too. :)
jan: Kathy your not whining!!!!
hi Monty
Kathy2: Jan: will it be this same room?
sassysheila: I am trying to find another doctor. I changed jobs almost 2 years ago and had to change insurance companies. I did not like the new doctor I was picked and I'm looking for another one. I do not have regular periods. I have had numerous test, I am 37 years old, never been pregnant and it is frustrating. I was told by the last doctor that I may be going through earlier menopaulse. But my previous doctor did not find this
jan: Kathy its not the same room but its an infertility chat room
hi Mrs. Beanie
jan: sassy like me ill be 37 this year too and never been pr and have seen quite a few doctors remember you are the consumer you must find a doc tat you are comfortable with
admin: Well. I need to run. The insurance chat should begin in about 30 minutes.
Take care.
Dave.
mrsbeanie: hi Jan!
Hello all...just checkin out the new room.
Kathy2: thanks Dave
Monty: We live in Arkansas and this state has a mandate to cover fertility treatmentbut I am a state employee and the state covers some of their employee's and not other. I have a BC&BS PPO and was told at first it would be covered then I received a phone call saying it would not be covered because it is a state policy has anyone elese ran into this problem??
sassysheila: I only used it once. My insurance does not cover
jan: mrsbeanie me too just checking the rooms tonite im going to go now and check out the friendship room
sassysheila: I work for a hospital, which sucks because my insurance does not cover alot of things.
Kathy2: has anyone here taken action against an employer for not covering IF?
mrsbeanie: my insurance is privately funded by the employer and they don't cover anything...take up to 6 months to reimburse you ...it is awful
mrsbeanie: Hi melpa! How are you?
Melissainpa: good tonight to see people here, we need as much help as possible
HI ALL
Melissainpa: bean, good thanks and you dear, did you guys see that NJ may be close to getting mandated coverage, whitman just has to sign bill
sassysheila: Hi Melissa
Kathy2: i hear gov whitman does not want to sign tho? any word today?
Melissainpa: hi sassy and mary
Mary13: What's this chat room for??? confused*
mrsbeanie: Hi mary13!
Melissainpa: kathy, REALLY, wow, i did not hear that, that sucks dh works in nj we could get coverage from there, oh my mot good
sassysheila: Hi Mary
Mary13: Hi Melpa..what's the deal with this room? Is it for "special" speakers or something?
Melissainpa: not good, typo sorry
Mary13: Hi Mrs. Beanie!
Can I ask a really dumb question?
Kathy2: yes, it is VERY frustrating, I thought a female governor would be good for the cause
Melissainpa: mary there will be some poeple here tonight discussing advocacy and things
Kathy2: go ahead mary
mrsbeanie: Mary13?
Melissainpa: kathy, I hear oyu on that one, that is so bad, she is a idiot if she does not sign....what a shame
Mary13: Ohhh...cool! I like that idea Mel.
My dumb question: I read on a post on the bb that someone heard that if you have a whitish discharge during the 2ww it means that's the corpus luteum,and you are not pg. Is this true?????
Melissainpa: hi to everyone who has entered
Kathy2: she used the usual, UNPROVEN excuse, that it would raise rates too much
Melissainpa: mary, i think not, never heard of that one:)
mrsbeanie: Mary13 - i don't know sorry.
Mary13: I love the background in this chatroom...much easier on the eyes.
Melissainpa: kathy , that is crap, same thing happened here inpa
Melissainpa: mary, so true, i agree
Kathy2: why does this chatroom show our IP addresses?
Pamela: Hi everyone! Don't be confused. You are just a little early. At 8:00 EST we will have Mark Sokoloff Esq. myself (Pamela Madsen) and William Panak, Ph.D to help answer questions and facilitate a talk on discrimination, mandates and insurance.
Mary13: MelPa...I hadn't either, but of course I've noticed that I've got a whitish discharge and I test on Tuesday, so of COURSE I'm freaking out! =) #($& 2ww! I can't cope!!!
Kathy2: it all sucks, my employer is self funded so it will take a Federal mandate tohelp me
mrsbeanie: Kathy2 they all do here at ft just a security feature i think
Mary13: Hi Pamela! Can't wait!
mrsbeanie: Kathy- our insurance too!!
Kathy2: i would think that was less secure, now the whole world has our addresses...LOL
Melissainpa: kathy, most of them do, no big deal......
mary , relax:))
Hi Pamela
sassysheila: HI can't wait
Mary13: Melpa...all right, I'll ask another nagging 2ww question. Do you think it's weird that my boobs hurt from last Wed thru this past Monday really bad, and now they aren't as bad....I was so hopeful last week, and now that it's the second week, I'm losing faith...
mrsbeanie: Kathy2 - they did it more to track troublemakers and such.
Melissainpa: kathy, noone but ft people come here, i would not worry about it, it is used so that we dont have any trouble makers and if there are those who causes problems that they can be banned
Mary13: Melpa....AAAUUUGGHHH! I'm trying I'm trying!! *lol*...I do this to myself EVERYtime...maybe I should just put myself into a coma or something during the 2ww!
Pamela: The reason we show the IP address is so people cannot annonymously come in and disrupt the board.
mrsbeanie: are there supplemental infertility insurance companies???
Mary13: Kathy2, most chatrooms do monitor with an ISP addy...
Melissainpa: mary, now you stop it, you are making yourself nuts, LOL, mine did nto hurt at all, and i was pg, so go figure, hard to tell
Kathy2: i see, thanks for the info
Mary13: *lol* I was already nuts before all this started Mel!!! *sigh*...
Kathy2: I know that others keep a sort of log, but these are published for everyone to see, not just the webmeister
Kathy2: no biggie, I was just curious
Melissainpa: mar, ME TOO, you arent alone, alot of us out there, LOL
Mary13: Oh...here's a little vent for you (well, me actually!...you just get to read, or ignore it!!)....My referral ran out (AGAIN) for my RE and my primary care paperwork-person is hesitant to give me another one. She told the lady at BCBS that I've been in contact with that "these women just don't know when quit, and it's just costing the rest of us more money"....Needless to say, I was seething!
Kathy2: can you get a new primary???
Kathy2: Mary that is horrible
sassysheila: That sucks, what gives them the right to play God.
William: Greetings folks, everyone here looking for the insurance/advocacy chat sponsored by American Infertility Association?
Kathy2: I think a letter to the primary dr is in order
Mary13: AND....the top news story in MN this evening, besides the first snowstorm of the season (pathetic I know): a 15 year old girl had a baby and dumped it in her neighbor's garbage can. Her 10 year old brother saw her do it and saved the baby. I just don't get it!!!
Kathy2: Yes, William
Teresa: hi room
Melissainpa: hi william , how are you:)))
sassysheila: Hi Theresa
Pamela: Mary 13, You should tell ask her when should people "quit" treatment for asthma?
Kathy2: Hi Teresa
Mary13: Kathy2, nope, not without even more paperwork. My OB is fine with it, it's just this woman who apparantly thinks that she sits at the right hand of God that irks me!!
Kathy2: Pamela- BEAUTIFUL!!!!
William: Doing ok, a bit tired but such is the life of the Titan of Industry :o)
How y'all doing?
Kathy2: or mention that we pay her same rates for her children!!!!
Teresa: does any one no about tubel preg.
Melissainpa: william, glad to hear that..
Kathy2: no Teresa, not much really, sorry
Mary13: Pamela...I've said more than my share to her. When I had my miscarriage in June and needed to get my referral updated (She's so dumb, she just give it for a year), she said "You don't need to keep going there cuz they already got you pregnant." I lost it; went off on her, and then told her to transfer me to her supervisor! GRRR...
Kimberly: Hello,
Anyone doing ivf?
Kathy2: So how many letters have you folks written to your senators to ask for their support for HR2706??
William: Kathy is the the federal legislation or legislation in a particular state?
Mary13: Hello to everyone who's come in during my tirade!! *lol* Who'd think I teach little kids?!??! *lol*
Kathy2: that is the FEDERAL legislation
Melissainpa: i have written three , emailed and called
Teresa: the dr. told me today that i mscarried
Mary13: Kathy, what's HR2706?
sassysheila: That's what I need to do next.
Pamela: Bill, Mark is with me (we are sharing the computer) so I will be typing his answers to questions...
Melissainpa: mary, SCARY THOUGHT, LOL
Kathy2: Teresa, I am so sorry
Teresa: then called me back and said i might be preg n the tubes
Mary13: Teresa...{{{hug}}} I am so sorry...how far along were you?
Melissainpa: Teresa, I aM SORRY TO HEAR THAT, HOW R U HOLDING UP???????(((((big hug)))))
Kimberly: Has anyone heard of getting pregnant betweeen ivf cycles is it possible?
Kathy2: HR 2706 is the proposed federal bill AKA: Family Building Act which would mandate that infertility treatments be covered for the whole US of A
William: heya, Pam, wasn't sure if that was you, Mark, try to keep her in line ok? :o)

Folks, we'll get started in a few minutes but if any of you need to leave soon but would like to ask questions we can start early..
Pamela: Is this our Rochelle???
Mary13: Melpa...laugh all you want, when I make teacher of the year in MN...I'll gloat all over this site!!! *lmao* Just kidding!!! =)
Melissainpa: does anyone know what is happening in pa, i get resolves info but looking for update here
William: (William looks suspiciously at Rochelle...hmmm...haven't I seen her someplace??)
Monty: I was told today that there is a way to get your self insured insurance to pay if it is not in the excluded benefits on your health insurance policy??Has anyone elese heard this it came from an attorney.
Mary13: Kathy2 where can I find out more about it???? I'm so for that!!! We've got four more paid IUI's and then it's all out of pocket.
Melissainpa: ROFL, you are toooo much, teacher of the yr, i would not be suprised, :))))
sassysheila: Are there grants or programs for FC's
Kathy2: Monty- good luck
wish I knew!
William: Pam, it might be possible for you to open a second browser window and log into the chatroom with a second handle (Mark)...then you can switch back and forth and the chat might be a bit more readable when we archive it.
Rochelle: Hi, William, I believe we've met. How are you??
Kathy2: Mary do a search for the house of reps, and then for the bill # 2706
Melissainpa: kathy what state r u in
Kathy2: or I could email you info, ???
Rochelle: Hey, Pam and Mark. Hope you're doing well.
Kathy2: I am in CT
Mary13: Mel...I don 't think that'll be happening anytime soon. Although I had a teacher from a different district in my room today observing me cuz she's heard so much about some of the stuff I do that's very successful, and their district might try some of it. i could get paid to teach them stuff!! I'm loving that!!!
Mark: Okay Bill, I think we have two windows!
Melissainpa: good to see so many here
William: Monty, in general, if a health insurance policy does not specifically exclude infertility treatment, it is implicitly covered. For example, if the policy specifically excludes IVF but doesn't mention other forms of treatment such as IUI, then those other forms should be covered. Policies that make no mention of infertility treatment are typically interpreted as covering infertility. This is based on a court decision in Iowa that has been interpreted in a consistent way in other states, and Mark may know of similar cases that are not specific to infertility but that support this general notion: If it ain't excluded, it's covered.
Mary13: Kathy2, my email is
(a thirteen after mpahl)...of course I'd like info!!!
Kathy2: does anyone know about "apthorp" which is advertised up toP?
William: heya Mark (sharp suit btw)...
Yup, I thought I recognized you, Rochelle, is your DH there also??
Mark: Yes, they are a pharmacy that specializes in fertility medications and they are very supportive of this community.
Kathy2: Mary, I will do that lateer
William: Kathy, Pam could tell you more about Apthorp pharmacy, they've been very supportive of her organization.
Kathy2: great, thanks Mark!
Mary13: I have a related question: If I use up all my covered cycles of IUI's on my insurance, and then get coverage under my husband's (he's also on BLue Cross/Blue Shield of MN, but a different group, different school), can they exclude my fertility treatments because it's an "existing condition"??? Or do they have to pay for them?
Rochelle: William,no, dh is @ a board meeting for our condo.
Mary13: Are meds from apthorp cheaper???
William: Good for you, Rochelle, send him to do the grunt work so we can talk shop :o)
Mary13: Melpa...are you on aol????
sassysheila: I am in OH and my insurance is with Qualchoice
Melissainpa: mary , no
Mark: Mary 13 - do you have the coverage at the same time? And do you both have a family plan?
Melissainpa: I have US healthcare in pa, LUCKY MEEEEEE
Mary13: Can anyone answer my insurance question?
Chatlogger: Chatlogger is also William, I'm logging in a second time to archive this chat for later rebroadcast :o)
raz: IS INFERTILITY NOT COVERED UNDER THE MEDICAL FAMILY LEAVE ACT?
I WAS TOLD THAT IF I MISS 2O DAYS BECAUSE OF DOCTOR OR IVF PROCEDURES
I WOULD BE FIRED BECAUSE IT IS ELECTIVE. SOMEONE THOUGHT IF IT WAS DOCTOR ORDERED
THEY COULD NOT DO THAT. I WAS ALSO TOLD THAT IT WOULD NOT BE PROBABLY WOULD NOT BE COVERED
UNDER DISABILITY BECAUSE IT WAS ELECTIVE.
William: Mary, I'll let Mark take first shot at that question, then I'll tell him where he's all wrong haha..
Mary13: Mark, we both have single coverage under our school's plans, but work for different school districts. Our plans differ slightly, but both cover 6 IUI's, and then if a ++ pg is achieved, up to 6 more.
Melissainpa: raz, unlock your caps
Melissainpa: hi julnick
Mary13: *lol* all right William!! That sounds like a good plan. Keep in mind I'm an elementary teacher, so by the end of the day, my patience is shot!! =)
whoah, raz...off with the caps...you're hurting my ears!!!
Monty: I work for the state and this state mandates this coverage.When I went to find out about my coverage I was told that it would be covered BC&BS PPO but then was told that this was a state policy and it would not be covered but the teachers and water company are covered. They say that they are covered because their are less of them then people thatwork at the health dept.They can afford to give them this coverage. We both have the same PAID drug plan. I went to the appeal board and was told I could not appeal their decision because I had not started treatment before I asked them about coverage.This seems stupid because I followed directions I lose appeal rights.
Mary13: chatlogger.....wow, wish I had a cool name like that!! =)
Mark: Mary 13 - I don't think that they can deny you coverage under the grounds of pre exsisting conditions.
William: Raz, infertility should be treated like any other illness, you should be able to use your normally accrued sick leave, vacation time, comp time, etc. to cover any time off from work. And certainly if you live in Illinois or any other state in that same federal circuit, you have a lot of protection under Pacourek v. Inland Steel
julnick: hi mel
Mary13: Monty, do you live in MN?
Monty: I live in Arkansas
julnick: hi leslie, hi misao
Melissainpa: brb.......
lisanvenice: i live in la area. my dh just started working for cal tech and there is 0 coverage even for dx how can i get them to reconsider?
Mark: Monty- the state has the right to elect which of there employees are to receive special benefits. Sorry.
Mary13: Mark, so even though we are both covered by BCBS (husband's is goldnet, mine is triplegold)as long as I got on his insurance they'd cover my IUI's and meds? I hope I don't need to go onto his, but it's not looking like I'll be pg under the 6 limit.
Mary13: Welcome to everyone just coming in!
Katie: My insurance is provided by my employer, a state government, and it excludes everything related to infertility. I am appealing this because I believe it violates the ADA. Does yesterday's Supreme Court ruling that states are not bound by the federal age discrimination law make it less likely I'll eventually prevail? BTW, the state does have a management directive in place stating it will abide by the ADA. Does this make a difference?
Leslie: hi there!
Mary13: Monty...oh, I thought with BCBS maybe you were in MN...
Kathy2: My insurance company was unable to show me where in my contract IUi was excluded (thoughIVF and GIFT were) I had to exlplain to them that they are DIFFERENT. I asked my self insured employers admin person for help. Between BCBS and the admin person I wasted 6 months and NOW they have rewritten, though according to them the coverage did not change just the wording. So now that it is a new year/new contract I am SOL. I did not know where to turn at the time and now that the contract is written to show what they originally inteded, I will probbly pay out of pocket. Any ideas for next time? I still have to get a copy of the new contract.
Mary13: Daje {{{BIG OLE HUG}}} how are ya girl?????
TinaM: hello everyone!
William: Monty, it all depends on what the contract states...if there's no mention of infertility exclusions in your contract, then it's covered, even if they say later that "oh, that's a mistake, we accidentally forgot to tell you it is not covered." I've seen lots of cases where employers try to retroactively change contracts and exclude coverage...they can do this if they are self-insured, but not if your group is unionized and bargains collectively for benefits, and they can't deny the coverage without first changing the contract, either unilaterally if there is no union, or through good-faith collective bargaining if there is a union.
Mary, they can't enforce any pre-existing conditions clauses if your prior plan covered infertility AND if there was no lapse of coverage between the past and current plans. If you have continuity of coverage, you're ok
julnick: lisainvenice, i also work for a university that doesn't cover fertility treatments (but does cover sterilization procedures). i am appearing before the employee relations committee to discuss changing the policy.
Mary13: Wow, kathy2, it seems like bcbs is in the business of screwing people...
Daje: Hello, everyone! I don't know if anyone can help me with this or not...but I live in Little Rock, Arkansas and my insurance is denying labwork for IVF...I have state mandated IVF coverage, but yet they think they can pick and choose what they want to cover..not what is necessary. Is there anything I can do...I'm in the process of appealing for a second time and filing a complaint w/ the insurance commissioner...any advice?
gypsysv: Hi. Does anyone out there know of any insurance company(ies) that cover the IVF procedure?
Monty: But how can they elect which group to give special benefits to if we are paying an increase in our drug program because the public school employees have created a deficit. In one breath they are telling me that they are seperate and in another they are saying no you are all state employees.I guess they can have it both ways.
ellen: We are having difficulty finding out New York State's law regarding insurance provision of infertility treatments. Any help?
Kathy2: BINGO MAry- I thnk they did it at the request of my self insured employer tho
Daje: (((mary13)))) It's great to see ya, hun!! *smile*
Mary13: So WIlliam, if I do need to do this, I should maybe be double-covered for a month so they can't hassle me?
*lol* How ironic...BCBS is sponsoring tonight's broadcast of the Gopher Men's Basketball game tonight!! I might have to kick my tv...
louise: our plan was just changed to bcbs (ny)- does anyone here have any experience with them?
Mary13: Daje, how are you? I'm on the last leg of the 2ww....not nearly as positive as I was last week...
William: Lisa, you have two options, the carrot and the stick, the carrot is to petition the Cal Tech officials for better coverage, the stick is to sue them in federal court under the ADA, and that's one thing we're here to talk about tonight.
LADIES AND GENTLEMEN! Tonight we have two special guests from the New York area. Pamela Madsen is Executive Director of the American Infertility Association; her group has been very active in legislative and advocacy in New York and are now expanding their scope to nationwide familybuilding and women's health issues. Mark Sokoloff, Esq., is an attorney who specializes in the very type of court cases that are of interest to infertile couples, namely using federal laws to improve coverage for those needing treatment. I'll let Mark talk about more of those specifics if Pam will let him haha...
Kathy2: Louise- my advice about BCBS in general (I am not in NY)- is to take good notes, dates, names, times and what is said!!!!!!
lisanvenice: gypsy,
we used to have ncas as our insurer and they covered everything accept donor expenses up $25,000 life timme limit
emme: hi all
Mary13: louise, I have BCBS of MN, and they cover 6 IUI cycles 100% with a referral, and then if you achieve a ++ pg, they give you 6 more tries. They cover nothing of IVF. But each policy is different, just read the fine lines...
Daje: Mary13, ((hugs))) hang in there girl!!! I wasn't positive at all after 7dpt...it's hard..but keep your chin up!! I'm cheering you on!!!
Pamela: Ellen, Do you want the mandate explained or do you want to know where to find it?
Leslie: Ellen..in NY, they have to cover you to diagnose what is causing IF and they have to give you tx to fix a problem, like surgery, but they don't have to cover anything to make you pregnant like IUI or IVF
Toni6619: Hi. I have UnitedHealthCare POS coverage in NY. Under my plan, UnitedHealthcare will pay for 3 cycles of IVF. 100% if I go to a clinic that's in the plan. Only 70% if I go outside the plan. I have already started my first IVF cycle with Dr. Chung at Cornell. Now, Dr. Chung is an in-network doctor, so all his charges are covered. However, since Cornell is not in-network, only 70% of "what's reasonable and customary" will be paid. I'm concerned about the "reasonable and customary" part because I feel the full amount that Cornell will charge will not be considered "reasonable and customary". It seems to me that this is very subjective. How can I evectively appeal this if the "reasonable and customary" falls short of the Cornell charge?
Melissainpa: Pamela, can you tell me how i can volunteer for your org too......I run support groups for resolve an do helpline there
Mary13: Well, I hate to run, but I've got company coming for the game...take care everyone, and thank for the advice William and Mark! =)
Kathy2: Has anything else happened with the case against Franklin Covey in NY?
Mary13: +++ thoughts to all...
Melissainpa: bye mary
Kathy2: bye Mary
Daje: Mark,
Did you happen to see my post? I am thinking of getting an attorney for this becuase I've been told that this goes on because no one inforces the IVF coverage law and the ins carriers find all kinds of loopholes...fortunately labwork was the only one they've tried w/ me
ellen: Pamela, yes I would love to have the mandate explained. Thanks. Ellen
Melissainpa: hi mm
Daje: hello, mm!!!
Pamela: The case aganist Franklyn Covey is in suit in the southern district court in white plains. We are currently in discovery. This means we have asked Franklyn Covey to provide us with documents which would support their position in refusing to cover Rochelle Saks infertility treatment.
William: Double coverage make it more bulletproof, but shouldn't be necessary so long as one policy starts when the second lapses.
Monte, I would find out if your group is represented by a union, if they bargain seperately from the other state employee groups, and also the specific language of your contract. Even if you're not in a union, you still have some leverage if your contract did not specifically exclude infertility, particularly if they now try to impose a restrictions...it's sorta like "oh, now we know you have the disability, so we're going to deny coverage for the disability", and I'm sure Mark would agree that would expose the employer to litigation under the ADA.
Daje, I believe the mandate in Arkansas requires $15,000 coverage, and that it cannot exclude IVF, thus you should get your lab charges covered up until the point that all of your infertility bills max out the $15,000 limit. If they try to exclude anything, tell them they can't exclude it unless it maxxes out the $15,000 cap, and then listen for them to stutter because they don't know their own law.
Pamela: That was Mark!!
Chaya: Louise - I'm also in BC/BS in NY. They are quite good with infertility medication, such as follistim and gonal-f. Another benefit is that after you reach their maximum (I think it's around $4000), all additional medication, sonograms, etc. are exempt from co-payment. However, as mentioned by Leslie, they don't cover IUI, and they don't want to see IUI on any of the bills that you submit.
Kathy2: thanks Pam
Rochelle: GO Mark! You have my vote.
Daje: William, I've tried that...they say that the law does not specifically say that they have to cover labwork...of course it doesn't say that they don't have to either! I don't know how they are getting that interpetation.
raz: IS INFERTILITY COVERED UNDER THE MEDICAL LEAVE ACT?
I WAS TOLD IF I MISS 20 DAYS GOING TO THE DOCTOR OR
IVF PROCEDURES I WOULD BE FIRED. SOMEONE TOLD ME THAT
IF IT WAS DOCTOR ORDERED THEY COULD NOT DO THAT. I WAS
ALSO TOLD THE IT WOULD NOT BE COVERED UNDER DISABILITY BECAUSE
IT IS A ELECTIVE PROCEDURE. IS THIS TRUE.
Melissainpa: if nj gets mandation, and my dh works in nj, can i get coverage even if i live in pa????????
Kathy2: this whole mess is a travesty? Is it this ridiculous for persons with any other disease? I can't believe what we go thru
Melissainpa: or do i need to establish resid.???
Mark: If Monte is a state worker what the supreme court is telling us this week is that the states may not be restricted by the a.d.a.
William: Toni, Pam might be able to tell you more about Cornell than I can, all I can say is that from what I understand, many Cornell doctors are in network but the clinic itself is not, so your physician fees should be covered by the lab work, OR charges, etc, will be covered at the lower rate.
emme: Is there any mandate in NJ as to ivf in NJ?
Melissainpa: pamela, did you see my ?? about helping your org.??
julnick: kathy2--it is a mess, and i wonder if all the stress of dealing with these details actually lowers the chances of the treatments working!
louise: chaya: After 2 failed clomid iui's, re is suggesting one more iui with gonal-f b4 going ivf. So you expect that bcbs will cover meds but not proceedure? Will trying iui one more time lead to problems with ivf coverage?
Katie: I can't believe it either, Kathy2. Sickening, isn't it?
Melissainpa: emme, it is with governor to be signed or not right now......
Kathy2: Emme- Gov Whitman shall decide that for you soon!
sassysheila: Can anyone tell me where I can turn in OH
Monty: I am an R.N. with the health dept and if we tried to form a union it would be a mess.I was told today because I told someone about my problems that I would not get a increase in postion if I kept on with this. I am scheduled to talk with a reporter with the Arkansas Democrat. When they tried to break the mandate here in Arkansas it failed partly because of his reporting and alot of work by alot of people.
Daje: Monty, you are in Arkansas also??? So am I!! What are you having trouble with??
Leslie: Has anyone heard Gov. Whitman's position. Someone told me that she wasn't going to sign. Does anyone know anything?
sassysheila: It's not fair we pay som much money in taxes and get no help for our problem!
emme: melissa or kathy i've been out of the loop for a few months would you mind updating me as to what the gov. is going to be deciding thanks
Kathy2: Leslie I heard the same, she thinks it will make rates too high
Leslie: or at one point, it was reported that she wouldn't or something
Mark: NJ just passed a bill and it is waiting to be signed or vetoed by the Governor. The mandate will cover up to four cycles of IVF life time and will apply to companies with 50 or more employees. If the company is self insured however, they are excluded from the mandate.
William: Ouch!...that's right, Mark, I heard about that case this morning from Nina on NPR...sounds like a big bad idea but the Supreme Court is hard to over-rule, eh?
Raz, I think I got your question down below, you can scroll back to read it but in general, your sick leave and vacation time can be used, Family Medical Leave can be used for you to care for others, not for your own illness, but you should be able to use your own sick leave.
Daje, this sounds like an example of stonewalling, and in my experience the best way to deal with that is to be the squeeky wheel and keep appealing
Kathy2: the NJ Family Building act passed house and senate, now sits on Gov's desk, she doesn t sound likely to make it a law
raz: CAN ANYONE ANSWER MY QUESTIONS?
Daje: William, you can guarantee that I'm a squeaky wheel!! LOL Thanks for your advise...
ellen: We are at the beginning stages of all this. We had one bad experience with an Endocrinologist who wouldn't explain anything. Can anyone recommend a good endrocrinoligist(sp?) in NYC? Thanks a lot, Ellen
emme: mark is there anything we as taxpayers can do?
Monty: The insurance board which is called the Arkansas State employee and Public School employee board is saying that my BC&BS PPO is self insured where as the teachers and guys at the water dept. are not.
Kathy2: Raz- willim did see below
julnick: does anyone know if the same sort of mandate is under discussion/passed in indiana?
William: Monty, best thing I can recommend is to get ahold of your contract and hold them to the contract language.
Kathy2: Jul- the resolve site has lots of info...not sure about IN
raz: IS INFERTILITY COVERED UNDER MEDICAL LEAVE ACT?
Daje: Monty, so they are saying that you don't have any IF coverage?
Mark: Toni i missed your question about cornell???
Kathy2: William HOW do you hold them to the language though??/With a laywer? If I had that money I would pay for IVF
julnick: kathy2--thanks. i'll check it out!
Rochelle: Unfortunately, even if your state has a mandate, if your employer is self-insured, you need to fight them directly.
Toni6619: Here it is again:
Hi. I have UnitedHealthCare POS coverage in NY. Under my plan, UnitedHealthcare will pay for 3 cycles of IVF. 100% if I go to a clinic that's in the plan. Only 70% if I go outside the plan. I have already started my first IVF cycle with Dr. Chung at Cornell. Now, Dr. Chung is an in-network doctor, so all his charges are covered. However, since Cornell is not in-network, only 70% of "what's reasonable and customary" will be paid. I'm concerned about the "reasonable and customary" part because I feel the full amount that Cornell will charge will not be considered "reasonable and customary". It seems to me that this is very subjective. How can I evectively appeal this if the "reasonable and customary" falls short of the Cornell charge?
julnick: thanks for information everybody!
William: The folks in Indiana have been pushing for a mandate for a few years, and each time they get a little closer to passing it to the governor. But so far they don't have a mandate there.
Pam, I'll pass you Melissa's contact info a little later, I've worked with her on mandate stuff in PA.
Monty: Right but when I phoned the insurance company and asked about coverage on my policy I was told I did then when they found out I worked for the state I didnt.
Daje: I've caught a rumor at my clinic that if your employer doesn't have IVF coverage that you can sue for discrimination possibly as a disability....I don't know a lot about this, but thought I'd bring it up...
emme: what exactly do you mean by self insured?
Mark: Raz, I have to get back to you. I have to check it out and find out if there is any case law on the subject. Look on the AIA message board next week.
Mark: Raz, how long have you worked for your employer?
Vangie: Hi! Does anyone know if there are any insurance companies out there that cover the IVF procedure?
William: Kathy2, you can use an attorney, or act like one..*smile*...I've found that being persistent works, but it is very easy to be discouraged when they tell you, "you've exhausted your appeals" etc.
Daje: Monty, I don't know much about the self-funded part of it all, but it was my understanding that if you have maternity coverage, you must have IVF coverage becuase of the mandate..??
Kathy2: So, what can we do to help the federal Family Building Act at this point?
William: Daje, Mark here is an expert on that disability law. Depending on the circumstances and also what state you live in, you could have a very strong court case.
Monty, they didn't show you your contract, right? Unless you read it yourself, you won't know what you have. Does your benefits booklet, the one you receive each year, have a clause excluding infertility?
Monty: The fact of the manner is that it was not sold to me as a self funded policy and no where on any paperwork does it say this.I have the booklet and the certification booklet and in this is listed the exclusions and no where does it mention fertility but to say it does not pay for voluntary sterilization.
raz: CAN ANYONE ANSWER MY QUESTIONS? IF YOU CAN PLEASE EMAIL ME AT
IS FERTILITY COVERED UNDER THE MEDICAL FAMILY LEAVE ACT? I WAS TOLD THAT IF
MISS 20 DAYS FOR GOING TO THE DOCTOR ANS IVF PROCEDURES I WOULD BE FIRED.
SOMEONE TOLD ME THAT IF THE DOCTOR ORDERS THAT THEY COULD NOT DO THAT. IS THAT TRUE.
I WAS ALSO TOLD THAT DISABILITY WOULD NOT COVER BEING OFF FOR IVF PROCEDURE BECAUSE IT
IS ELECTIVE. IS THIS TRUE.
julnick: thanks william
Toni6619: Mark, did you miss my question again?
Monty: No not at all
Mark: Daje- this is an over simplification of the present state of the law, which is presently quite uncertain. There are many questions that have to be answered before considering a ADA suit aganist an employer for discriminating aganist certain infertile employees. How many employees are there in the group? Is the employer self insured? Does the employer have a reasonable finanical study which would indicate that covering the fertillity treatments would cause a financial hardship to the employer. Does the employer have a written plan which delineates what coverage it will pay for regarding pregnancy benefits.
William: Daje, I believe that requirement that policies with maternity coverage also cover infertility only applies to Massachusetts. In MA, the mandated infertility benefits are specifically tied to maternity coverage, thus ensuring very broad coverage for non self-insured plans
sassysheila: If anyone has info on FC funding email me at
sassysheila: i have to run, but will be writing my reps in the area
Vangie: Hello, does anyone know if Pamela will be joining us this evening?
Monty: They told me that my certification booklet was my contract there is no more paper work they can give me because there is no more.The lady at the insurance board told me to quit asking cause I had all there was.
Emjay: Hi all, just checking out the new room :0)
Pamela: Pamela is here, I am just busy typing for Mark!! And yes Toni, I keep missing your question!! Please try again!
Toni6619: Mark/Pam - Here it is again....
Hi. I have UnitedHealthCare POS coverage in NY. Under my plan, UnitedHealthcare will pay for 3 cycles of IVF. 100% if I go to a clinic that's in the plan. Only 70% if I go outside the plan. I have already started my first IVF cycle with Dr. Chung at Cornell. Now, Dr. Chung is an in-network doctor, so all his charges are covered. However, since Cornell is not in-network, only 70% of "what's reasonable and customary" will be paid. I'm concerned about the "reasonable and customary" part because I feel the full amount that Cornell will charge will not be considered "reasonable and customary". It seems to me that this is very subjective. How can I evectively appeal this if the "reasonable and customary" falls short of the Cornell charge?
Daje: Monty, this may be a stupid question, but have you dealt w/ BCBS directly or are you dealing with some in-between person?
Kathy2: Monty- did you make request in writing? I thnk that is key
William: Ok, Monty, we're halfway there. The benefits booklet is not binding in court, but the contract is. In my experience, most of the time the benefits booklet is consistent with the contract, and in many cases the state will argue that the benefits booklet IS the contract, that there is not a separate contract that list coverage and exclusions. You have the right to review your specific health insurance contract, they have to let you review it. So ask to review your contract in detail; your benefits coordinator at work should have a copy.
Raz, i've e-mailed my reply, sorry if you're having trouble reading it, we've had as many as 30 people in this chatroom at once tonight, sorta crowded :o)
Anyone want some whisky?
emme: gotta run thanks for the info
Monty: I have written everyone including the governors wife I work for the Vaccine for Children Program and she's a big supporter of this. I did send a certified letter to the insurance and the board.
Laura: Hi
Pamela: First, I would call my plan and find out what they consider reasonable and customary. You have wonderful coverage and you may be very pleasantly surprised. But as far as appealing, you can't. It is your choice whether to stay in network or go outside of network.
Laura: Is this the scheduled chat for insurance issues?
Kathy2: Laura- yep!
William: Monty, good work, you now have been told that the benefit booklet stands for the contract. Did you get the name of the person who told you this? Now you can argue that since there is no exclusion in the "contract" then infertility treatment is covered, and you toss the ball back into their court because they'll have to try to argue that it should not be covered. In the end it will come down to arbitration, or litigation, but your position is stronger than you might think. After all, doesn't it make sense that they'd tell you that you don't have coverage if in fact you do? It saves them money to deny you coverage, and 95% of women in your situation take their suggestion and stop asking for what they really have a right to. However, Mark is also right, you don't have much standing under the ADA given this week's supreme court decisions that affects state public employees, but you may still have standing based on simple contract law. Brian Allen at U. of Iowa is an expert in this area and I've learned a llot from him on this.
Pamela: Yes Laura. Welcome.
Kathy2: so, no ideas on how to help the federal bill along? And by the way I was using the wrong# for it before, it is 2706
Laura: Okay good, I am wondering about donor sperm. Is there a way to state that for insurance?
Toni6619: RE: "Reasonable and customary- I did call my insurance company and they told me they wouldn't be able to determine that until they got the actual medical bills. I was just wondering how to handle the "reasonable and customary" since it seems to be subjective. I guess I'll find out shortly. Thanks and best of luck to all.
Laura: Hi William this is Laura from Iowa
Pamela: The Federal Bill did not move out of committee in 1999. You should continue to write your Senators and Representatives in Congress about the need for federal legislation.
William: Yup, this is the insurance chat, hosted by FertileThoughts, and our special guests are:
Pamela Madsen, Executive Director of American Infertility Association
Mark Sokoloff, attorney of record in the Saks v. Franklin Covey case
Rochelle Saks is also here, she's the plaintiff in that case
And of course, William the Magnificent is here, drinking again :o)
Kathy2: Pam- do they pick up where they left off, or start over?
raz: INSURANCE COVERAGE: KEY BENEFIT ADMINISTRATORS
P.O. BOX 55210
INDIANAPOLIS,IN 24205
THIS INSURANCE IS UNDER PROHEALTH THE PHONE
NUMBER IS:
Pamela: Toni, you should try asking Cornell what percentage your insurance company usually pays. I bet they know since they submit all the time.
William: Laura, as in Luka, or another Laura...sorry, I'm drinking hehehe...
William: or Laura D?
Toni6619: Good idea. Thanks!
Laura: Laura D
Pamela: Kathy, I am really not sure but I don't believe that they have to start all over.
Kathy2: Pam- lets hope not!!!!
raz: THE ZIP CODE IS WRONG FOR THE INSURANCE IN INDIANAPOLIS THE ZIPCODE IS 46205
Monty: It just seems unreal that a state that pays for Viagra would put up all this hassel
Kathy2: Rochelle- I did not realize that was you, if you can talk about it, how is it working for Franklin now with the case going on?
William: Heya, Laura!...long time no see!
Pamela: Rochelle is no longer working for Covey but that is not because of the law suit.
William: Well Viagra is vitally important to the national security of our country! We must have Viagra, our little widdlers are so fragile.
Rochelle: Kathy2-Actually, I left Franklin. It was very difficult working there with this going on, as I'm sure you can imagine.
Kathy2: i see, just wanted to say that I think what you did in taking them on is quite admirable Rochelle- you are my hero!!! lol
Pamela: Bill--Mark and I just fell off our chairs!
Laura: Yeah, we are going to Iowa City Feb. 7to see dr's. Infertility and urologist
Laura: Can I ask what the law suit is about?
Pamela: Rochelle is a hero to many people. She has help raise awareness of this issue on a nation wide scale. I beleive that she has helped us tremendously in our effort to pass federal and state mandates.
Kathy2: Thankyou Rochelle!
Monty: I am not trying to take this away from theneedy. I'm just saying that this is a short term treatment and Vigra could go on for years.I told this to the lady in the insurance board Ann Nulty and She got very angry that's when she yelled at me not to call anymore I had all the paperwork. Viagra must be vital to her security.
Kathy2: Your situtaion sounds all too familiar to me.
William: hmmm...according to my stock report, Franklin Covey's stock has lost about 80 percent of it's value in the past 5 years. Good for you, Rochelle, you bailed out on a dog. Now come to work for us, Capital One, greatest company that William has ever worked for!
Rochelle: Not that I'm an expert on all this stuff, but I would like to say that if you feel you are being wronged (and we are) you need to fight. It is very difficult and you may find out who your friends really are, but the deal is that you can't sit back and passively accept the no's and bureaucracy of the insurance companies. I am not usually the type to fight either (except with my dh)haha.
William: Quick, Pam, check his widdler, is it damaged??
William: Laura, which docs you gonna see? We used Syrop and Van Voorhis, Van Voorhis did both of the successful ZIFT transfers
Mark: Saks vs. Covey is a federal action seeking money damages as a victim of employment benefit policies that disciminated aganist her on the basis of gender, pregancy and disability by denying her coverage for infertility. The suit was commenced under the ADA and the Civil Rights Act of 1964.
William: Yes, and if you've ever seen Rochelle, you'd know she's a fighter. :o)
Laura: I'm not sure I just made a appointment, should I ask for 1 over the other?
William: Laura, Shelton just corrected me, Syrop did our successful frozen embryo transfer
Rochelle: One other word of advice and then I'll shut up; I do recommend that you DOCUMENT every conversation that you have and keep every piece of paper AND get the names of who you spoke to; you never know when you'll need them.
Mark: At AIA we are forming a advocacy network and if you are interested in being a part of our email network, please send me your email address at
Kathy2: Rochelle- dont shut up, I have alot to learn from you, keep talkin girl!!!
William: Both are great, and Shelton says you don't get a choice, they're sorta adamant about no favoritizm. Syrop is a bit more outgoing, Van Voorhis is more soft-spoken and serious, but they are among the best REs in the country if you ask us.
Kathy2: Rochelle- I have a HUGE RED binder (which I like to think looks imtimidating when I take it to HR with me) that holds all of the "transcpits" from my conversations with the brain trust at BCBS and my HR dept
Mark: We are also interested in speaking toinfertile men and women who have been denied benefits under medicare. We are also interested in speaking to DES daughters and sons who are currently experiencing infertility due to in utero exposure. You can communicate with me later as well through email at
William: Mark, one thing we can do is set up a special bulletin board to get more people dialoging about the DES and ADA cases. Pam and I can discuss that.
Rochelle: Kathy2: I've devoted 1/4 of a room to all my paper; its truly overwhelming esp. when I've had to sort thru stuff; seems like its all I've done the last few yrs.
Monty: Medicare or medicaid?
Pamela: that sounds great Bill
Laura: I agree with documenting everything, we had done that when we fought our insurance company and since we had names, the listened to us and I won.
Pamela: Medicare covers the disabled individuals as well as individuals over 65.
Kathy2: Yes it has benefitted me here and there, I won a few skirmishes, but so far they are winning the battle
ginca: hi
Rochelle: Kathy2; don't give up. Believe me, its easy to do, especially when everyone seems to be against you. My family wasn't thrilled when it went public. It was very hard.
William: Laura, can you tell us a bit about your victory? This sorta reminds me of a few other resources we should develop here at FT:
1. Victory over Insurance stories
2. List of best employers who cover infertility (I work for one!)
Pamela: Hi Ginca! Welcome!
Kathy2: I had such nasty treatment by my HR admin person (also a VP) that I went to a senior VP to complain. Turns out the senior VP has been thru IF too. So far he hasn't been much help.
William: Did anyone see that Martha (that's Sheltons' first name) and I were in REDBOOK magazine last month in a story on embryo storage and donation issues?
ginca: what is the topic
Kathy2: William- I missed it! but I will look!
Pamela: No I missed it, but I will look for it now. The December issue?
Monty: Since I've been with the health dept. the huge battle has been getting womens medicare to cover certain treatments associated with breast cancer.This has been a nightmare for them I really couldn't imagine anyone trying to get them to cover infertility.
texasbb: Can we ask questions?
William: January issue, one with Meg Ryan on the front (ya I know, could have been Shelton but hey..)
Sure, Tex, ask away :o)
Kathy2: Rochelle- was your family aware of your difficulties conceving before the news hit? Mine are not aware
ginca: What is the topic about? insurance issues?
Laura: We were quoted 2 attempts if no preg. than 2 more attempts. We had done 3 IUI's and the day of our IVF consulation they called and said no only 2 attempts lifetime. So I was denied coverage for 3rd IUI but the upseting thing was no IVF coverage. Since I had documented and clinic had also documented and after a long letter written to them. They agreed with paying for the 3rd IUI and 1 IVF. They had quoted BCBC's policy not my companies.
texasbb: My company's insurance just started w/ a new policy which covers IF testing only, no treatment or IVF. However, they also cover b/c pills, pregnancy related stuff, and viagra. I'm not sure, but I also think they cover sterilization procedures. Can I make a case for descrimination here?
Mark: Monty, believe it or not, the medicare manual has a specific section which indicates that national policy is to cover certain infertility treatments. Moreover, infertility treatments are not specifically excluded.
Rochelle: Kathy2-Yes, they were aware, but it wasn't something we really talked about, you know, "private stuff". Even after all we've been through, its not something that they really ask about. I've gotten used to it.
Kathy2: Rochelle- I can't even imagine.
Vangie: Pamela, my husband and I were channel surfing and saw you on "Best Talk" this Sunday. You were great and very well informed. We've been wanting to have a baby for over 5 years but never really "actively" tried. Tuning in to Best Talk was fate because time is running out for us. I'm 38.
William: aaahh...yes this seems to happen so often, insurance companies don't tell you the right stuff about your specific policy. Their phone reps are not really able to pull up the right info when you speak with them on the phone. happens all the time, glad you're able to hold them to at least some IVF coveage.
Mark: Texasbb - is your company self insured? How many employees are in the company?
Kathy2: What is Best Talk- I missed it
Lori: Hi Kathy and all.
Rochelle: Kathy2-now add in a very pg.sister and sister-in-law=totally difficult situation.
Lori: I have 2 pg sisters in law.
Kathy2: Wow, that must be hard. Are you otherwise very close to you family?
Laura: Yes, but now when I call I get a "special" rep. to talk to. They don't let just anyone talk to me!!!
GINCA: HI
Monty: I believe that all persons should receive this treatment if they need it but it sure gets old working every day and seeing others be handed things and your made to feel like a begger if you ask for something everyone should be intitled to.
texasbb: Yes, self-insured. Fortunately I have a lot of experience in HR and currently head up payroll... so I am aware of how that works. Problem is convincing the HR staff and head of HR that this is not fair. They stated "there currently is no law or case law requiring us to cover this" We have 500+ emps worldwide but only about 250 currently in the U.S. I know our leverage in the insurance industry isn't great, but can't we say what we will or won't cover b/c of being self-insured?
William: TexasBB, here's what I would look for, and Mark will have comments on this as well..
1. Was the infertility coverage reduced? If so, this improves legal standing, in my mind, because reducing coverage is an act of commission, whereas having no coverage in the first place could be more like benign neglect and an act of omission.
2. If the coverage for infertility was reduced, was anything else in the plan reduced. If not, then you may have a stronger case because infertility was specifically excluded.
3. If you talk with your HR people, what do they say is the reason that they exclude infertility coverage; if the exclusion is based on misinformation (costs too much, for example) then you have a stronger case under the ADA.
Mark?
Rochelle: Not really; this whole thing has kindof built a wall around us and even sometimes betwn.me and dh,ya know...
Kathy2: Rochelle- a related concern that I have is that not only do I work for this lousy employer but (get this) Dh , father, BIL, brothers sister!!! If I fight them I make life miserable at work for ALOT of my famliy Guess that s what they mean about allthe eggs in one basket
Pamela: Vangie- I am glad that you caught it! I am glad that someone was up at 6:30 am on a Saturday morning. That insurance guy really got be going when he said how could infertile people raise a child if we couldnt' afford to pay for IVF. I am glad that you found us.
William: Laura, Shelton wants to know who you work for?
Vangie: Hey Kathy, re: Best Talk. It's the 1st time I actually saw the show, but from what I gather, they have debates on controversial issues.
Laura: I recently received a rider to my policy with more coverage, I called insurance comp. to find out specific questions. (The papers they gave us we in a different language, or at least I couldn't understand exactly what they were saying.) I probably need to get something in writing again.
Vangie: Pamela, you really let him have it and exposed him for the ignoramous he is! There was no hint of human compassion in him. Thanks.
Pamela: Texasbb- You can file a complaint with the EEOC aganist your employer to get the ball rolling. The EEOC will investigate your charges of discrimination and issue a report. In order to start a law suit such a complaint must be filed, and possibly the threat of negative publicity could push your employer into providing coverage.
Laura: Bunn-O-Matic (the famous coffee machines) We have BCBC of Ill.
Kathy2: Ohhhhhh I am soooo sad I did not see this!
texasbb: William-
I actually submitted a LONG letter explaining my position as well as trends, survey data, etc. I got off the internet. Actually, the IF testing was added this year... however, I think it was the ignorance of the person developing the plan w/ the insurance company which caused the "testing only" to be there. It is only up to $1500 per year too. I'm fine w/ limits, but hey, that's nothing. $1500 wouldn't cover 1/4 of the tests for IVF. Test is relative too. It says tests, but what it actually includes is monitoring and b/w. Does this make sense at all to acknowledge IF by covering this, but then exclude real treatment?
Laura: sorry BCBS of ILL
Kathy2: I've always wondered if anyone from BCBS ever dealt with IF :)
Vangie: Ciao all. Must get up at 4:30 AM. Very interesting & informative topics. Good luck to all!
texasbb: Pamela- Thanks, I have actually thought of doing just that. My only concern is the fact that I work closely with HR and report to the EVP of HR currently and boy, that would really put a damper on the work life. But, in the long run, it would be worth it.
Laura: When we talked to HR(this guy has no compassion) at my job(husband and I both work there)he told us that our company would never deny anyone of trying to have a family. But when the benefits run out what is that?
William: TexasBB, I've never seen the sense in covering diagnostics but not treatment. I've also never seen the sense in covering the surgeries but not IUI, or the IUI but not IVF; each procedure's incremental cost to insurance is quite small, the cumulative cost to insure is reasonable, and if you don't cover all the treatments, the things you do cover end up being used in an inefficient manner that means, in the end, everything costs more than it should.
Kathy2: Laura- talk about heartless! My VP of HR told me he had bet on why I was asking about the policy 5 months before I told him why I was asking!! I almost fell over!
William: Thanks, Laura, and good luck! If you meet a nurse named Meredith, ask her about her nightmares and when she gives you a funny look, tell her that Bill and Shelton Panak say howdy :o)
Seeya, Vangie!
Pamela: Texasbb-- you just tell them that it is not personal. Do you have a friend that would file?
texasbb: William-
I agree totally. But would there measly efforts be construde as an attempt to be fair to all sides?
William: Kathy, so this VP was talking to others about your medical inquiries?...whoa, sounds like a VP asking for litigation, or was he just saying he had a hunch?
Laura: William I will
Jen: anyone here have endometriosis?
Kathy2: I think he talked to another HR person whom I had asked for the contract. Yes, I agree it was not appropriate. If questioned I am SURE he would say "figure of speech"
texasbb: Jen--- ME
Laura: Jen I had lap. for stage 2 1997.
Pamela: Mark is going to have leave the chat shortly. The last train and all of that...Does anyone have any last questions for him?
William: Yes, they could argue, "hey we're trying to cover what we can" but the data show otherwise. If you fail to cover the more effective procedures, people persist in using less effective procedures, but they also pursue these treatments more aggressively and thus increase the likelihood of twins, triplets, etc, and the high cost associated with these pregnancies. What it is more like is these companies have been told that the coverage is too expensive, usually by "benefits consultants" or "independent experts" who actually haven't analyzed true cost data.
texasbb: mark-- from what I've said... do you think filing with the EEOC is a good idea?
Kathy2: no last qustions, but THANKYOU Mark
Rochelle: Take care, Mark and thanks!
Laura: kathy2 I'm sure he would!! It took us probably 3 years to get insurance book from HR. That was 1 strong point when I fought them. I had to go by what the rep. said I had no book to see for myself.
William: Hey Mark, thanks for joining us, I'll give you a call on Monday to follow up on the DES and Medicare work, etc. Looking forward to working more with you, Pam and Rochelle on her case too! Thanks for joining us!
Mark: Yes, I think that filing with the EEOC is a good idea. Good luck.
Laura: Thanks
Kathy2: I got my contract after asking 17 thousand times
Laura: I am confused on the Medicare part is infertility considered a disablity?
chatlogger: Kathy, and don't tell me, I bet they acted like you had been the biggest pain in the back that they'd ever dealt with.
Laura: I think mine was because they had to pay for IVF treatment!!
texasbb: William- I couldn't agree more. I think if they would have pushed for IF coverage our premiums would probably still be the same if much different at all. I can't imagine there are many people in our company actually dealing with this. Not that this really matters... but their liability is so low. Why make such a case against it? What really sucks is that I'm made to feel like "what's the big deal, we are covering some" and like I'm asking for a favor.
Terese: William -- My firm just cancelled the IVF rider on our policy and now my insurance only covers "diagnosis and treatment including IUI." It specifically excludes any injectible meds though which is the biggest cost. Do you think there are any loopholes that I can get around this and get the meds covered?
Kathy2: Oh sure things like "in 20 years in this biz, no one HAS EVER asked for that"
chatlogger: oops, sorry Chatlogger is also William
Pamela: Laura - Disabled people - people who cannot work, are covered under medicare. Some of these people seek infertility beneifts and it should be covered under exsisting policy.
Rochelle: William and Pam,dh says HI!
Pamela: Hi Joel! Are you going to help Rochelle out at the White Plains AIA meeting tomorrow night?
Laura: Thanks,Pamela I was confused there.
Rochelle: No, he has to work till 7 in Rockland, but he supports my helping.
Kathy2: Does AIA have meetings in CT?
Laura: AIA stands for?
William: Laura, the Medicare stuff is based on the medicare regulations, the regulations state that infertility services should be covered under Medicare, but this doesn't address the disability argument made by Rochelle and others who have filed ADA lawsuits.
Yup, TexasBB, it's like, "gee, can't you be happy with less coverage than others?"
Terese, if the contract language is that specific, you have little chance of finding loopholes, but you may have success with an ADA lawsuit, mainly because excluding IVF cannot be justified from a cost perspective; the added cost of IVF and the meds is about $0.50/month/employee, and if they exclude IVF while maintaining coverage for things like voluntary sterilization, VIAGRA, etc, your case will look all the stronger
William: AIA = American Infertility Association, Pam here is the Executive director and their website is americaninfertility.org
Good for you, Rochelle, keep him working hahaha...hey Joel!
Pamela: I think that it is so important to keep talking. And it sounds like so many of you are! You are not hiding! If we just keep explaining that infertility is a disease, just like any other, after a while people do begin to understand. Simple illustrations such as "we pay for you when you tear your knee jogging, but not for my infertility. These kinds of statements do make a difference.
texasbb: William- We do have a right to ask for a copy of the contract? Right? And if they refuse to give it up? What?
William: Hey MelissainPA, you still in here? Have you met Pam before?
Kathy2: bite them!!! sorry that annoys me - why do they bother?
Laura: Thanks, is their anything in Iowa like that?
Rochelle: texasbb: yes, you do have a right and I believe that they have to respond within a certain timeframe.
Kathy2: 30 days by federal law
ERISA
Pamela: No we don't have a meeting site in CT yet. Want to start one! Membership in AIA will bring you our National Monthly Newsletter which is wonderful and access to our support line and other services.
William: Your right to review the contract is ensured by ERISA, which is federal law. You are a third-party beneficiary of the contract, so you have the right to review your benefits. IF they refuse, you can sue, it's pain in the butt but if they continue to refuse a judge will fine them $100/day for each day they refuse. They have to provide it within 30 days, and they must allow you to review the contract in its entirety, and also allow you to copy those sections you need to copy (they can charge you photocopy fees that are reasonable)
Terese: William -- So you think I would actually need to file suit? Unfortunately, I work for a law firm and they could spend limitless amounts of money fighting the lawsuit whereas I couldn't afford to fight it as aggressively. I gave all your info to our HR people too and they said that they checked 11 other insurance companies and our present one was the best rate still, but keeping the IVF rider added $67 to dependent coverage. They said it didn't add much to the employee coverage that they paid for, but it would add to those who had to pay for dependent coverage. I live in Texas if that matters at all. Do you think they are lying to me?
texasbb: Pamela- I think you are right. It has been hard and embarrassing to have to put out my private life to those I work with, but hey... I have a disease which I did not choose to have and for which I should not be shut out b/c it's too expensive. I've decided to fight. I may not have won the war, but I've won a battle or two and I wont' give up even though they think I will. :-)
William: not yet, but AIA nationwide. Pam is working on setting up chapters on the West coast, and a chapter in Iowa would be great. I know Brian Allen at UIHC would be very supportive (Brian can help you get the absolute most out of your insurance coverage)
Laura: I'll do whatever I can to help!!
texasbb: Terese- where in Texas are you?
Pamela: I think that all of our talking and educating helped get NY State Employees infertility benefits as of January 1st. Now our Senators have coverage! Next maybe it will be us!
Terese: And to top it off, when the HR person brought me in to tell me they were cancelling the IVF rider because of the added costs for people carrying dependent coverage, the HR person had the gall to make the comment that it wasn't like I had cancer or something. I was so floored that she said it, I couldn't even respond to her comment.
texasbb: William- are there any AIA people in the Houston area?
Terese: In an in Dallas, more specifically Garland, a suburb of Dallas.
Kathy2: I had similair lock jaw when VP of HR said my iui was like cosmetic surgery!!!!!!
Pamela: If you are interested in volunteering in small ways or big, or if you would like to help set up a meeting site in your area, just send me an email at remember our message board is always open and I am like William, I am almost always there!
texasbb: Terese/ Kathy2... OMG I would have freaked out!!!
Kathy2: Yes, I would say I freaked out
Terese: Why is it when people have no idea what they are talking about, they still feel it necessary to put their two cents worth in? IUI and cosmetic surgery? That is really a good comparison. What an idiot!!
michellewi: William, do you know if the law has past in Wisc. regarding mandatory IF coverage?
William: Terese, I don't think they are lying, but rather, misinformed. How large is their group? Small group plans have little bargaining power, but larger groups (say 100 or more) have more clout in the marketplace. Also, Texas is a tough place to get coverage because the mandate is useless there, and the insurers routinely quote outrageous premiums to add infertility. You might be able to get good coverage if you use a nationwide carrier such as AETNA or Massachusetts Mutual or United Healthcare, one that insures in states that have strong mandates and thus has the experience that shows the cost is far lower. Also, it should cost no more to cover this for dependents than it does employees; either can be the one who needs IVF. What they are probably saying is that it adds to the family policies, but not single policies, but even there, many people with single plans are married, their spouses are also working and have single plans through their own employer.
Bottom line: $67/dependent is about 50 times what it should really cost
Rochelle: Kathy2-Keep track of those stupid comments; believe me, it could come back to bite them.
Terese: I freaked out too and unfortunately thought of all kinds of good come backs 30 minutes after leaving her office. Not that I could go back and say them mind you. But damn I wanted to.
Kathy2: Terese- this is the same genius who said he had bet someone 10$ that infertility was why I wanted the contract
William: I don't believe the Wisconsin mandate has passed. Believe me, when one of these laws gets through I hear about it right away, but I think the Wisconsin bill has been stalled for at least a year.
How about this one: Can't you go adopt?
Kathy2: Rochelle- its in the BIG RED book! lol
Laura: I will e-mail you for sure. I would like to start out smaller and than maybe move on to somehting bigger, I feel something needs to be done.
Rochelle: Kathy2-Good girl!
texasbb: William- you are so right on about Texas. I keep seeing that Texas has a IF coverage mandate... but what good does it do when it doesn't require employers to choose the coverage only the insurance companies to offer it at higher rates. How is Phoenix Group for nationwide coverage? That is who we have and I don't know much about them.
Kathy2: Pam- I already emailed you! LOL, just a little excited
Terese: I do have United Healthcare, William. They are total idiots as far as I am concerned. I get one thing from them denying me something when they are already covering it. Like with the injectibles before they specifically excluded them. I can't seem to get straight answers from them.
Kathy2: Can anyone go to the White Plains mtg?
Laura: When they put our rider in effect it raised our rates about .35 cents, per dependent. Most of the people who know our situation were happy to pay it.
Terese: Are there any insurance companies that will write individual policies that cover fertility treatments and meds?
Rochelle: Kathy, yes, and I will be there; there's a peer support session @ 7 and the speaker is at 8, right, Pam?
nicole: I was wondering if anyone knows how the coverage is in charlotte nc? I know there is no state law so was wondering
William: I don't know about Phoenix, TexasBB, and I think it's United Healthcare that has good coverage for some plans, but not for others. Regardless, customer relationship managment is not the forte of the health insurers.
texasbb: Laura... .35 cents???? 99% of our employees wouldn't notice that if you pointed it out to them.
Kathy2: Rochele- that would be very interesting. I am hearing bad weather reports and it would take me at least 1.5 hrs in good weather and no traffic.
Pamela: Ofcourse anyone can go to any of the AIA meetings!!! We want you to come! Rochelle will be the hostess tomorrow as long as we don't get six feet of snow! To find out about the meetings times and sites that are currently available, check the web site. Dr. Stangel is speaking, he just wrote a new book. I think it is called the "unofficial guide to infertility".
Laura: When you talk about a state mandate it covers the state you work in not the insurance state? Isn't Ill. a mandate state? And Iowa isn't?
texasbb: william- you've got that right.
nothing else in life do you pay for out of your hard earned money and not only have not choice in what you get, but have to pull teeth to find out what you do get.
William: Thanks for that little bit of info, Laura, Terese, you hear that, $0.35/employee/month, a pittance.
Best coverage in NC that I know of is at the SAS institute in the research triangle. Bowman Grey Medical School at Wake Forest also has good coverage; in fact, I helped them improve the coverage there for women with secondary infertility (William puffs up with pride)
Rochelle: You must live pretty far away!It's in a hotel.
Terese: Well United Healthcare was great while we had that specific IVF rider, but now that it is gone and it only covers diagnosis and treatment through IUI, I think it stinks. I could certainly afford the $1,400 for the doctor more than I could the $5,000 for the meds for a month.
Kathy2: I would love to go, I will see how it is after work tomorow. Wow, that would be cool
Pamela: Yes, the peer support is at 7 and the speaker is at 8.
Alibre: Hi
mm: i have coverage through oxford. they cover 1 cycle of ivf with a $10,000 lifetime maximum. is there anyway to up the maximum..could my company inquire. i try to purchase a rider on my own but they don't do that...what do you suggest i do
Kathy2: Rochelle- I am near New Haven CT, it will be a bit of a drive
Terese: 35 cents! I know that those reps from United Healthcare lied to our people. Or they lied to me. I just know it and it burns me up!!
Marci: Hi all! So happy to run into this chat! Anyone in Virginia with any good IF coverage? Mine only covers drugs/some tests. Is there a private 1 I can buy? Can't find any info on the net and getting frustrated!
William: IL has a mandate, and IA does not. The coverage depends on where your employer is located; I don't believe that an employer in IL who has employees driving over the river can tell the IA residents that they can't have the same coverage as the IL residents.
mm: i have a second insurance that has been covering meds. i recently put a inquirie claim into them whether they would cover embryo freezing to feel them out and see what their ivf coverage is. they have been covering meds for iui and waiting to get reimbursed for my last cycle of ivf meds...i am keeping my fingers crossed.
Pamela: it is almost impossible to buy infertility riders. I wish I could tell you where to go! That is the problem. That is why we need state mandates! We can't even buy it!
Terese: William -- With having a group policy through a company, is there any way that I, as an individual, can find out what it would cost per employee to add the IVF rider back on? I mean do I have to take what they told me as the truth or is there a way that I can find out for sure?
cara: I am in South Dakota, My husbands policy does not cover infertily, It will cover processes that will "fix" infertility but not processes that " do not correct the inability to conceive," but only create conditions which individuals concieve through stimulating the natural reproductive system. Does that sound legal or right?
Rochelle: Kathy2:Yes, that is pretty far. I've traveled that far to RE's and occasionally a weekend mtg, but I can certainly understand how it'd be hard after work.
mm: what's the skinny on new york coverage?
nicole: I live in NY and my insurance covers everything except ivf (what i really need it to cover)
texasbb: I cant' imagine finding a private policy which will cover IF. My friend's DH owns his own company and from what her insurance company told her private policies are not even covering pg and delivery now... some law changed in Texas Jan 1. This seems incredible to me!
Kathy2: Does AIA plan any weekend meetings?
Laura: The headquarters are in Ill. and our company in SW Iowa. I don't know about now but when I fought them they had better coverage. How could I find out their benefits? Company will not give them to me
William: mm, how large is your company? A large company has more bargaining power and if they ask for better coverage and Oxford says no, they can threaten to shop around. Often that will provoke the insurer to quote a more reasonable rate for the IVF coverage. In the United Healthcare example, they quoted an outrageous increase to maintain IVF coverage, and the employer swallowed the bait rather than asking for competitive bids from other insurers.
Hi Marci, I have great coverage here in Virginia, but we're done with our treatment (three daughters thanks to IVF and the wonderful coverage we had at University of Northern Iowa)
Terese, I'd be more than happy to try to talk sense into your HR people, sometimes the HR people do get burned up when they realize they were rooked out of the benefits.
mm: what are the chances that my other insurance may cover ivf as submitted by separate procedures
mm: my other insurance which ahs covered meds is GHI
Marci: My next ?: I read that VA had a bill put out for mandated coverage, that it didn't pass, but it was going back to the table. Anyone know if that has happened yet and what the outcome is?
mm: WHAT IS GOING ON WITH NEW YORK COVERAGE RIGHT NOW?
Kathy2: Marci- resolve.org has alot of that info or at least links to it
cara: Where can you get a secondary insurance company that covers ivf? Is there such a thing? and is it possible to do that?
Pamela: In New York we are considered a mandated state. The Law requires insurers to cover the diagnosis and treatment of correctable medical conditions and makes clear that coverage cannot be withheld for a correctable condition solely because the condition results in infertility. However the law DOES NOT require coverage for the resersal of voluntary sterilzation experimental procedures, or procedures intended solely to produce a pregnancy like IVF. The law does not require anything that brings sperm and egg together. AIA has been working very very hard to pass a strong mandate here. We are very close. We passed in the Assembly and we are hot on the vine in the Senate. We have been promised a bill any day now. We do have problems with some religious groups, and we may need to play around a bit more in Albany before we bring home the pie!
Terese: I tried that William. I gave them your telephone number, your e-mail address and all the information that you sent me and they still didn't do it. I think it is because the HR person just doesn't want to take the time. When I found out we even had the coverage, the firm had had it for 6 years without the insurance company telling them they had it and were paying for it and it was available for use. No one used it because no one knew we had it until I found out. Now they are trying to say it is so expensive to keep!! I just can't seem to talk any sense into them. They just take everything the reps say as the gospel.
William: Cara, yes many policies exclude IUI and IVF on the argument that these don't treat the underlying disease, but cover surgeries that are more expensive and less effective because these are "treatments" of infertility.
Well DUH!...insulin doesn't treat the underlying cause of diabetes, it treats the symptom.
Terese, there's lots of good data out ther showing the actual cost of the infertility treatment...the problem is that the insurer has lots of propaganda showing the opposite, and it takes an expert to sort out the truth from the lies.
mm: SO WE ARE CLOSED TO IT THEN?
mm: HOW FAR AWAY FROM A MANDATE FOR IVF ARE WE? MONTHS? YEARS
Kathy2: mm- fyi: all caps = screaming...ouch
Marci: Willaim: who's your coverage with? Can I have a little of yours?!?!?LOL
I've been going thru IF for 11 years and thru the fortune I've spent, insurance has paid about $1,000 of it. We used to live in CA (mandated OFFER of coverage) but of course, my employee chose not to cover.
Pamela: Yes, we sometimes have special events on weekends. On March 5th we will be having a full day conference in NYC at the Grand Hyatt. Later this month there will be a IVF seminar on a Sunday. Check out the web site and look under special events.
texasbb: pamela- what is the web address?
William: mm, itemizing coverage sometimes gets more stuff covered, it's a good strategy and your clinic's business manager may know more about how to do that.
I don't know the status of the VA bill
Cara, secondary coverage is impossible to find.
Terese, sorry to hear your HR woman is a fool. Suffering fools is William's least favorite past time.
Terese: I guess you are right. And my HR person is far from an expert on anything and doesn't want to do anything that isn't absolutely, positively imperative!! So I guess I am @#%* out of luck, for lack of a better way to put it.
Kathy2: pam- thanks- I will be there!
Monty: I don't understand how a mandate could be all that effective when the states that have them don't even cover their own employees there is always a way to get out of paying and they don't have to look very hard.
nicole: if there is a mandate passed in ny for ivf does that mean that all companys will have it or no? i have independant health out of western ny
Pamela: Yes we are close in NY to a mandate. Can I tell you how close? No, not really. I have pockets full of promises. Maybe something by the end of the month--that is the current promise...but honestly they change their mind a lot!
mm: MY SECondary insurance has been covering 80% of the meds from iui. do you think they will cover them for ivf..i am still waiting to get my money. it takes the 6-8 weeks to reimburse. thefirst batch of claims was sent out nov 30 havent' heard yet...is that a good sign
mm: pamela: what does that ny mandate mean. how many cycles of ivf will it cover
texasbb: Terese- you have one of those too? i wonder what warrant's they HR manager's 100K salary where I work. They certainly don't pay her to look out for her employees... the must frustrating part is that they practically give money away in other areas...
William: I'm with Capital One Finance, we have coverage up to $20,000/couple lifetime max, it's decent coverage and I'm going to meet with my HR people to see if they can improve it.
cara: mm Where did you find secondary insurance? I'm very curious
mm: cara: it is my hubby's union insurance
Mariana: Hi, how is everyone?
Rochelle: Pam, if one has BC/BS Anthem of CT, would they be covered w/the NY mandate, provided of course they live in NY???
Terese: Hey TexasBB, get this. Her qualifications are that she was one of the shareholder's sleeping buddies. I guess that is what warrants that corner office and high salary and empty head!!
texasbb: mm- guess unions are good for something.
Pamela: The status of the Virgina bill is that House Bill 2403 passed the House of Delegates and was then sent off to the Senate committee for further play by a special advisory commission on mandated health insurance benefits. The commission was not our friend, and recommend against passing the legislation. I don't know any more than that. Sorry it is not good news.
mm: pamela: i hope it passes this month..i am starting my second ivf cycle. my insurance is a $10,000 lifetime max covering 1 harvesting and 2 transfers ni a 2 year peiod. accounting says alot of the $10,000 is left over for the next cycle. do you think if the mandate passes they will cover more ivf cycles
cara: If you switch insurance companies, for example if I got an individual policy for me that covers infertility, would it cover infertility for me because it is already a "preexisting condition" or not because it is my husband who has poor morpholgy
William: nicole, one benefit of a strong mandate is that once it is passed, the affected employers have to comply. After a while they gain experience and find out that, doh, the cost really is next to nothing. Then the insurers realize this. Then the larger, self-insured groups start to lose good employees who leave to join the smaller companies with better IVF coverage. Then the larger employees ask the insurers to start covering IVF. Suddenly you have a snowball effect when all the employers and insurers suddenly realize that the sky is not falling, the costs are reasonable, and if they continue to exclude coverage they will lose good employees to the companies across the street that do cover infertility. That's why the federal employees in MA and IL have such good IVF coverage; the state mandates stimulate voluntary compliance in self-insured groups.
texasbb: Terese- Are you sure we don't work for the same company? LOL Sounds like how some of our VPs got their jobs. I've heard rumor that our HR Manager didn't even grad high school... and she sure doesn't have a degree. It's laughable!
Kathy2: Rochelle- if one has BCBS Anthem of CT one has most definitely got headaches!!! That much I know.
mm: pamela: if an insurance mandate jpasses will i have more ivf cycles covered?
Kathy2: Who me, negative, nah
Pamela: The NY Mandate that we are working for would have a $60,000 life time cap. We are asking for four IVF cycles for the first child and two more attempts for the second child. The mandate will cover donor egg. The mandate will effect people who work in business of 25 or more. Again, everything is up for grabs until it is signed.
Sue: Pamela how about Pa ?? any coverage ..?
Rochelle: Yes, Kathy2, I know and that's actually my dh's plan; my new one was even worse; didn't even cover dx and you have to get reimbursed for everything, so I didn't even take it since it offered nothing.
Mariana: Sorry to interrupt the conversation, but I was wondering if those of you who have insurances that cover IVF could tell me what ins. companies you are with. I can't find one who'll cover more than 1/2 of one cycle per calendar year. thanx
mm: pameal: sounds promising. if it does passs this month i will be in great shape.will insurance companies automatically offer it or upgrade. it. eveyr year oxford ups the anty. last year it was 1 harvesting and 1 transfer. now it is 1 harvesting and 2 transfers...$10,00 lifetime maximium has been this way for a while
Terese: Oh trust me she has no degree in anything!! Except maybe for stupidity. My husband is a degreed HR person and she has called him several times to ask how to handle certain situations. That is how much she knows about HR.
Kathy2: it is just awful what one must go through
texasbb: Pamela-- sure wish you were working with our state. could you slip something to our next pres and my govenor... gwbush??? LOL
Laura: WOW that would be a great mandate!!!
Anything for sperm donors?
mm: mariana: my company has OXFORD FREEDOM
William: cara, you might not get the coverage because although you've had continuity of your coverage in general, the prior plan did not cover infertility, so they could deny IF coverage for up to 18 months under the new plan...this assumes that the new plan would actually have good IF coverage.
mm: mariana: my company has OXFORD FREEDOM
Terese: United Healthcare has coverage for IVF, but only if your company carries the IVF rider. It is separate from the regular basic insurance.
Sue: Marianna ..I was covered 80 % ..also drugs $9.00 co-pay ..United healthcare thru Tru-Serv corp ..of course the plant shut down but I was lucky and got pregnant ...thru IVF ..
texasbb: Terese- at least she tries to find out what to do... this one just ignores the problems. head in sand theory, maybe it will go away.
mm: OURS for oxford is a rider also...
mm: OURS for oxford is a rider also...
Pamela: In PA there is Assembly Bill 2016 which was introduced in October with 20 sponsors. The Senate Bill is 1031 which I believe was introduced in June. That is all I know. I don't have any updates.
Kathy2: they teach Head In the Sand 101- PHD in HR College
Laura: Mariana come to Iowa and work with me. At least now we get 2 IVF attempts and unlimited IUI's. My meds were paid for...welll I paid $5.00 per perscription. I was lucky on the meds.
William: Capital One has AETNA for their self-insured administrator, but of course many AETNA plans exclude IVF, ours covers it because CAPITAL ONE is the greatest employer in the world :o)
Terese: Well, most of the time she does bury her head, but when pushed, she has to find out what to do, even if it means calling someone else to get a lesson. She is a total airhead!!
Sue: Thanks pamela ..
texasbb: Kathy2- LMAO.... OMG... tears from laughing so hard....
Pamela: As AIA gets stronger and builds more membership we will be able to reach out to more states. We have some really good ideas about how to handle the federal situation.
Rochelle: Wow, William, I really do want to work for your company.
krg: our united healthcare ppo policy paid for 1/2 meds for ivf--but nothing else. something was better than nothing. . . and now i have a beautiful son--it's a lot of money though and we were lucky we could afford to pick up the rest.
cara: Somebody needs to come to South Dakota and help
Mariana: Sue and mm .. thanx for the info. I guess I should ask you where you live. Here in California, I'm not sure what options I have. I work for the Federal Gov., so I have to deal with what they offer me..Right now I have Kaiser, and they cover 100% of meds and injectibles, but not IVF. I wonder if it would be worth it to look for an ins. company on my own.. not through my employer?
Terese: Capital One huh? Do they have any offices in Dallas who need a VERY experienced legal secretary?
Kathy2: Pamela- I would love to help in Ct and Fed. Or however needed.
Sue: Marianna ..I live in Pa..
cara: Pamela what does AIA stand for
texasbb: ok ya'll. I've really appreciated the vent and the advice. I will sleep on this and think some more about my plight. Meanwhile, tomorrow I intend to put a request, in writing, to the HR Manager for a copy of our new insurance contract with Phoenix. For now, I have a needle full of Gonal-F calling my name... wish me luck. Thanks for all the hard work you all are doing "for the cause". Hey, do you think we could walk or hold "hands across America" or something... get some more publicity>>> food for thought. signing off from HOUSTON! and yes, we do have a problem. :-) goodnite.
William: Terese, we have offices in DFW. Send me your resume and I'll channel it to our HR people:

We hire the best in all areas; you'd probably make a great administrative secretary for one of our directors, or perhaps a project manager...
Rochelle, want to move to Richmond?
Pamela: Okay everyone, it is really getting late. I know that I am a kill joy but this little patient advocate is starting to fade. I will be glad to answer any more last questions : )
Kathy2: Nite Texaas!! I have to write the same letter!!
Terese: Thanks William. I just might do that. Thanks for answering questions again. I will sign off for now.
Laura: Thanks Pamela
Kathy2: No more questions from me, THANK YOU all, and good nite from CT, we have a problem too!!!!!!
Pamela: Sue - The American Infertility Association. If you would like to get a membership packet and a newsletter you can all our help line toll free at
Rochelle: Thank you so much for this session; its been great; and is sooo necessary for people to speak out!Good night, all. Good luck!
Kathy2: Rochelle- it was inspiring to "meet" you, thanks for the advice!
William: Yes, thanks to all for attending; the chat transcript will be posted on the FT and AIA websites later this week!
Mariana: Does anyone in here have PCOS?
Laura: Good Night all!!!!!!!!
KallyKat: Wow, thanks, Pamela for the number - i've been looking for it!
Pamela: Good Night everyone, next month, Feb 10th, we will be having another chat with our special guest Paticia Irwin Johnston. She will be speaking on making the transition from treatment to adoption...or just thinking about adoption...stop by..Bill and I will be there!
KallyKat: Mariana, I do. I'm taking Metformin for it. You?
William: Thanks again, William is taking off if there are no more questions at this time..
William: ok, g'night all!