Should Medical Insurance Carriers Be Required To Cover Infertiltility Treatments?

Great Debates
21

It would be nice if they at least offered a rider you could purchase. Since most of us have limited insurance options (basically, the few plans your employer offers) it is difficult to job shop based of which insurance will cover your infertility. That said, we paid almost 5K just to conceive our 2 beautiful children (plus deliveries). And they are worth every penny. It would have been super swell if my insurance had helped out. I do pay over $500 a month for it. My brother and his wife just paid 18K for IVF to have the son she now carries. Unreal. Its hard to say whether it is truly “elective” until you are the one peeing on the little stick praying for 2 blue lines every month, and only get one.

As for adoption, if they would make it easier for folks to adopt children of any race it would be a great option. Unfortunately most kids up for adoption are mixed race or black. And the state apparently thinks the color of their skin is more important than the love they would receive in my home. It is very difficult to adopt a child if you are a white couple. I would happily take a child of any color. But the state is racist, and m,akes policies mandating that children go to parents the same “color” that they are. Stupid, stupid, stupid.

22

I’m not sure that the supply-and-demand thing is as simple as Stemba has made it. I work in a medical billing office for a radiology clinic and I deal with this daily. It doesn’t really matter where we set our prices.

The insurance carriers, including Medicare, set what they consider to be “allowed” for any given procedure. I don’t know how they set this, but I imagine it’s based on some mystical formula that includes the cost of supplies, the cost of equipment maintenance and wages, an industry-wide standard of sorts, divided by the phase of the moon, and minus the number of home runs Barry Bonds has hit this year. Or something.

If you’re lucky, your insurance will pay 100% of the allowed. (They say that last part quickly and chances are you don’t notice.) This “allowed” may or may not be the total of the actual bill. If your doctor is a preferred provider of that insurance, he agrees to take a lesser “allowed” amount and write off the rest. In other words, the full price is only what the doctor charges if you don’t have insurance.

Medicare operates the same way, except their “allowed” is smaller, ditto for state-run medicaid programs and military insurance carriers. In fact, the military insurance compels the doctor to accept a pittance in payment, then to write off the balance.

If you’re going to complain about insurance at all, I’d start with the notion that insurance carriers can decide your procedure was not “medically necessary,” which absolves them from paying a dime; or that your procedure is “experimental,” in which case they won’t pay anything either. Insurers are capitalists, as are we all in the U.S., so their business model is to charge more and cover less. I don’t know that I can entirely fault the doctors for the cost of healthcare, and they’re certainly not over-pricing themselves to drain money out of Medicare.

Our office does outside radiology reads for other clinics (where there are no board-certified rads). Our admin is constantly complaining that the other clinics send us all their feeble Medicaid and L&I claims, which pay jack squat, while the other clinic keeps all the relatively fat insurance claims. But overall, the insurers pay what they feel is “right.”

There’s plenty of reason to be upset at the health care prices of today. But I, at least, am not complaining that doctors are seeing money fall out of the sky through Medicare.

FISH

23

I had a minor surgery last year that seems comparable to a boob job (two hours on the table, fully knocked out, prep and post care, two follow up visits) and the total cost (and I’m basing this on the discount cost the insurance paid) was easily twice what I see advertised for many cosmetic procedures.