ConnectiCare Can’t Follow Rules
Oh now I’m ramped up. I was going through my insurance handbook to photocopy the page on infertility and took a closer look. They do not cover IVF. (They do cover IUI.)
So they just recieved an email pointing out the STATE LAWS in MA and CT – both of which mandate coverage for IVF – and asked them why they do not. I’m pretty ticked. I’m willing to bet they’re going to reply with some loophole to the state-mandated coverage. I may need to contact RESOLVE. (Oh no, I am not letting this one go.)
Hopefully we will never need IVF. But god damn it pisses me off that we have a state law and the damn insurance doesn’t follow it.
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According to Fertility LifeLines, Connecticut’s mandate is a “Mandate to Offer.” Which means insurance companies are mandated to offer it to the employer – and the employer chooses which package to purchase. So it could be that the reason for the lack of coverage is Den’s employer – who, I might add, is the Federal Government. (Den’s military – Air National Guard.) If that’s true, they will be getting some letters from me as well.
On this site here it lists Connecticut under mandated coverage, not mandate to offer. I know Connecticut has had recent changes to their mandate (in 2005) so I’m wondering if that change was recent, causing the different information. I’m going to have to call someone to figure that out.
…I love the government -_-
First, thanks for stopping by my blog!
OK, here is the thing with mandate states: it’s complicated – as I’m sure you are figuring out! Beyond whether or not the company is based in CT or MA (I’m in CT too, btw) the question is whether the company is “self funded” or “self insured” (they mean the same thing). What this means is that the company pays claims directly to the doctors, rather than paying the premiums for insurance companies. You can imagine that in large companies, this is usually cheaper. If a company self funds, (here it comes), THEY ARE NOT SUBJECT TO STATE MANDATES. Sucks, huh? Yea. Self funded companies are overseen under the Employee Retirement Income Security Act (ERISA) and not the state.
Something like up to 50% of companies are self funded, even in mandate states. So that whole MANDATE thing – not universal.
My company (a university, in fact) self funds. However, I was very VERY surprised to learn that even though my coverage does not SAY that IVF is covered (in fact, it says that it’s excluded), I actually DO have excellent IVF coverage – 4 full attempts as long as I do it at the university run clinic. It’s worth finding out if there is additional coverage that is not spelled out in your benefits brochure.
OK, now I’m going to go read your archives :)
Thanks for that info!! It’s one big can of worms. Grrr, I’m going to be writing to our state government to encourage them to make better laws that apply.
and here I come to say something that might sound stupid… you havent found out if its ovulation or not right? If it is you still have the clomid, U/S to time insemination right at the time of ovulation confirmed by ultrasound and stuff yet right? There are things that come way before IVF I bet. Dont lose all hope. Dont start a war that will suck all your energies before you have to, I guess is all I am saying.
Oh, I know there are plenty of things to try first. :) I definitely am not seeing us doing IVF in the near future. But it really sucks that if we get to that point insurance won’t cover it. And for me, I’m just pissed off that infertility isn’t covered by insurance. So I think I’d carry this torch even if I did get pregnant, lol.
well trust me, i am all for having a fighting for a cause. hehe.