So, I live in a mandated state! Which is pretty much a joke. It took almost took 2 years to actually get coverage because of the loopholes. llinois law requires HMO's to provide coverage for infertility to employee groups of more than 25. The law does not apply to self-insured employers or to trusts or insurance policies written outside Illinois. I had two PPO's prior. So, when I learned that HMO covers my husband switched to HMO once open enrollment took place.
Fast forward to now. I have read the insurance requirements and the entire section of the insurance booklet regarding infertility for my HMO. Unfortunately, my work only provides PPO insurance and that does not cover anything in/fertility related. These mandates are great... when they apply!!! It is our job to figure out when they actually apply so it can work in our favor.
If you have been reading I took Clomid for 3 cycles unsuccessfully. My ObGyn had me stop and was going to refer me to a Reproductive Endocrinologist but recommended weight loss. I am new to this HMO. I know a referral is needed for any specialist but unsure how exactly to get it. I went to my GP and he referred me. Well, finding a doctor was a bit tricky that accepted my BCBS HMO that was in our network. They found a total of 2 doctors. TWO! Coincidentally, I went to this clinic but had a different doctor a while back when I knew nothing of the insurance and paid out of pocket. I can only see the one doctor now in this clinic. I was so relieved to get this referral I called and set up my appointments. I called my ObGyn's office to send my records to the name of the clinic and Doctor's name. The ObGyn office called me stating I can't go to the clinic I have to see the Doctor I was given the referral for. I explained that I was the doctor is out of that clinic and it was the address and phone number of what the insurance company gave. Now, they are checking on it to be sure.
Oh Jesus please let this work out! It seems I get so close to only find yet another road block! Holy shit! Just because you live in a mandated state does not mean you will for sure be covered or everything is all roses and butterflies!
For more information on infertility related mandates in your state