Between my husband and I, we have 4 different insurance companies to pick from. Thinking down the road... I'm still under 35 (by all of a year) and will need to TTC for one year before being able to go back to the RE (like with DD). My current insurer has records of my recent pregnancy/loss so in their eyes, my one year period hasn't even started yet. I'm contemplating changing insurance companies to cut that time down. I don't think records are shared so any of the other 3 companies, wouldn't know of this loss. Also we have a lifetime limit for IF coverage which basically resets which each company. Has anyone ever done this? Changed insurers to get around some of this? Obviously I hope we won't need it with #2 but this loss took a big chunk of time out of TTC a window so I need to consider other options.
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I’ve changed from mine to my husband’s to get IF coverage, but I’ve never had an insurer tracking the year of ttc so I don’t know about that part. (It was either - only testing covered - or IF covered without the year issue when we lived in MA).
If it’s pretty reasonable from a cost perspective (premiums deductible etc) I think it makes sense to switch. But if insurance costs are higher you might be better just paying cash for the re if they won’t cover.
It’s so hard to make insurance decisions. I sincerely hope you don’t end up needing the coverage!
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@bhbee: So DH's employer offers the same plans across 3 different providers. I have essentially the same coverage/benefits through either Aetna, United Healthcare or BC/BS. My work goes through Cigna. They usually can't track the one year period except I just had a couple months of pre-natal coverage and now loss-related testing. So they'll know I was pregnant if I go to the RE in 6 months and I fear they'll deny coverage of the RE then.
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@LindsayInNY: I’d check all the providers you like are in network and then switch. Why not if the cost to you is the same and there’s a chance it might help? I think insurers are pretty clueless in general ... UHC was sending me congrats on my pregnancy welcome packets well after my d&c ... so it could be better to cut ties.
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I would switch. We had to pay out of pocket for our treatments and I they add up quickly!! If we'd had any sort of coverage from either we would have switched.
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Insurance companies don't share info like that as far as I know, but if they require "proof" of having tried one year or not from the doctor, the doctor may have to provide that information to them and they would find out anyways. Unless you go to a new doctor and not tell them?
As far as switching plans to reset a life time max, that works for me even with the same insurance company. I've been switched plans for the last 4 years to reset my lifetime max, each time to a different type of plan all still under the same insurer. As long as you get a new member ID, which a different plan gives you, you're a 'new member' to them. I would imagine that changing companies all together would definitely reset any lifetime max since that is set by that specific company... UNLESS their fine print says otherwise. I have seen someone with BCBS say that their plan cover 6 lifetime IVF cycles.... but previous cycles, even covered by another company, counted. -
@bhbee: That's probably the worst of it - checking that all of our current doctors will take the new plan. I think they would but I'd have to do some research.
@PurplePumps: Good to know!! The annoying part is that, by the time we can start TTC again, one year will put me at age 35 and then I'll only need 6 months. So wtf! I don't want to need the RE again (I mean, who does), but if I can cut a couple months off the timeline, I will. Why is 6 months good enough for 35+ but not when I'm 34? With a history of IF? (rhetorical question)
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@LindsayInNY: if you have a documented history of IF, I don't think the one year wait will apply. You might want to check on that.
I have IF and I went right back to the RE when we wanted to try for our second.
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@KT326: Oh, didn't think of that. Maybe I'll call our current insurer to check first. Thanks!
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So I wouldn't recommend switching to a new doctor and omitting the information about the mc and D&C. They need to know that information and if there are problems in your next pregnancy it could come out in a malpractice lawsuit. I know it sounds far fetched, but your med team does need all of the info. I'd contact your insurance to see if you could get coverage now or if they will cover you on your 35th birthday because it has been 6+ months. It also might be worth booking an out of pocket consult with your RE. You got pregnant on your own last time, right? They may recommend giving it 6 months before starting interventions.
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@Pollywog: Oh no, I wouldn't change doctors - just insurance companies. I needed the RE to get pregnant with DD (had an early chemical before that). Got pregnant on my own this time though in maybe 4 cycles? Not sure the exact count. I could do 6 months from when we start, it's the year I don't like/want.
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Pregnancy doesn't overcome infertility. Live birth does. So a loss shouldn't reset your one year of trying. In fact, it should only add to the case of you needing to see a specialist.
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@MaryM: Really? I thought it was the "one year TTC without getting pregnant" and since I did get pregnant, I assumed it would restart the clock. Interesting...
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@LindsayInNY: It can sometimes vary by doctors (some won't put any stock in a single loss), but the medical definition of infertility is one year of trying to conceive without a live birth.
Those with recurrent loss can still suffer infertility.
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@MaryM: Thank you, that was helpful! Now I wonder if I should check with the RE or my insurance on that...
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@LindsayInNY: How do you prove you have been trying for one year? Isn't it sufficient to just say "hey doctor, I've been trying for one year." I don't think your unfortunate miscarriage will reset your year of trying. Best of luck with whatever you do!!
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@agold: Yes, generally speaking. Except I now have a pregnancy and loss on the books with my current insurance company. So I can't go to the RE in April for fear that the insurance says wait a second.
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My coworker switched and stayed with same doctor and RE, and her clock did not reset. BCBS even got the records, but it wasn’t during the period with them. Also, the RE did not reset her clock.
I switched from BCBS to Aetna, stayed with my doctor and had my two rounds covered without resetting my trying clock.
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@dc yoga bee: I went to the OB today and I think it's based on cycles sorta and not calendar year? Or that's my argument? The OB didn't think this would reset the calendar. The issue I'm having is the loss and how that calculates in to my trying window.
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Update: made the decision to switch insurance companies. Current one requires 12 months from last birth/loss/whatever before covering any IF stuff. No thank you. So a new one will know nothing now.
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