My Health Insurance Story

My Health Insurance Story

In the wake of the killing of United HealthCare’s CEO, many have been sharing their health insurance stories on social media.

Well, I’m going to share my health insurance story with you. Because I want you to know and understand that not having something covered that you want, need or feel you need to have covered isn’t always in the hands of the insurance company.

Twenty-two years ago my husband and I were trying to start a family and, as I’m sure you can sense where this is going, were having difficulties in doing so. I have a condition called PCOS (polycystic ovarian syndrome or disease) and one of the issues with it is infertility, which can be anything from irregular menstrual cycles to heavy menstrual cycles and lots of stuff in between.

Eventually we were referred for infertility treatment. Which is great if you can afford it on your own or if your employer offers it as part of their health insurance plan. Well, guess what? The employer I was at, which was an employer I was planning to leave as they were a shit employer, did not offer infertility treatments as part of the health insurance plan. Although the insurance company did offer infertility treatments (this is what I was told when I called the insurance company; but I was also told that my employer had not opted for that particular option). The employer had just opted for a plan (probably a cheaper plan) that didn’t offer that option.

As a friend in Human Resources explained to me, just about every year companies review the health insurance plans they offer their employees and decide what is affable and affordable for the company and the employees. A decent company will look at the kind of employees they have (how many have families, women, men) and based on the percentage of population will often decide what kind of coverage they should offer. The health insurance company they use (could be Blue Cross, Cigna, Tufts, you name it) will present them with many options (she told me the company she is HR rep for uses a health insurance company that offers twenty options). From those options, the HR people decide what is best for the majority of their employees.

I eventually found an employer that did offer infertility treatments as part of their health insurance plan and, as they say, the rest is history. Although I did go through two rounds of infertility treatments, neither was successful. As it turns out, I became pregnant on my own (which I attribute to the help of OTC Estroven–but that’s another story for another time). And nine-teen, almost twenty years later, here we are!

Fast forward to 2014 when my daughter was diagnosed as being on the autism spectrum. Only a few years before my state of Massachusetts had passed a law that required private health insurers and state health plans provide coverage for the diagnosis and treatment of Autism Spectrum Disorder (ASD).  And in 2014 the Autism Omnibus Bill was passed, which led to MassHealth starting to cover Applied Behavior Analysis (ABA) in 2015. ABA is a therapy that is often prescribed for people with autism. So there are ways that states themselves can actually help people get the health insurance coverage that they need and/or want.