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Body Watch | FIRST PERSON

All She Wants Is a Baby; All She's Gotten Is Grief

March 19, 1997|LINDA DACKMAN | SPECIAL TO THE TIMES

"If your husband is infertile, we'll pay for donor sperm," the lady on the other end of the line said. My medical history was before her on the screen.

"My husband?" I answered, the extra hormones kicking in at exactly the wrong moment. "But I'm not married."

"You're not married?" she clicked. "Then none of this is covered."

"My doctor's office received reauthorization," I protested. "I'm in the middle of fertility treatment right now."

"Those claims will be reversed immediately," the wicked insurance witch answered.

"That's discriminatory," I shouted.

"I am documenting this conversation," she hissed.

"I have to hang up now," I answered, understanding it could all be used against me.

My coverage included the fertility drug Pergonal at $100 a vial, ultrasounds, inseminations to deliver sperm right at the egg's front door. Even in vitro.

But because I was 44, the doctors recommended simply an extra boost: drugs to enhance my geriatric egg production and artificial insemination to shorten the sperm's swim. I had gotten pregnant easily the year before. That pregnancy ended in miscarriage.

Now I was happy again. I was making one last-ditch effort to conceive. Tom was happy too. He was a former boyfriend and close friend, my consistent partner in the long pursuit of shared parenthood. It was unorthodox, but we each had our reasons.

But after months of medical intervention, Tom's sperm completely flunked out. The doctors advised anonymous donor insemination if I ever wanted to conceive.

When you want a child, you go so far and then, to your surprise, you go even further.

"Read your insurance manual," the wicked witch hissed as she said "no" to not only that, but to everything else that had been said yes to before.

Our conversation came as I was making love (so to speak) with a man in a white coat with a big syringe. The syringe was elongated, the kind of long skinny tube that can reach all the way to your cervix on a good day.

"You have great mucus," the doctor told me.

"I've had better compliments," I answered.

The process was arduous and awful. I was flat on my back under bright lights with my legs in the air, trying to get pregnant by a gynecologist with an Oklahoma accent. Daily, for 10 days each month, like a sadistic game of darts, I injected hormones into my thigh by myself. My beauty marks were the bull's-eyes.

Immediately after that phone conversation, the insurance payments were reversed. I felt betrayed. I felt as if my last chance to have a child had been harshly revoked. Who was to blame?

I hadn't read the manual. I had done much more. I had called my employer's insurance agent, who told me to contact the doctor's office. I sat down with the doctor's full-time insurance liaison, who contacted the insurance company in my presence.

"You have great coverage," she assured me, never once mentioning marital status.

I pulled out the manual from my files. "All these tests must be met," it stated. "She and her husband have a history of infertility which has lasted at least one year. . . ." The word "husband" was where my eligibility teetered.

I filed an appeal. My doctor provided detailed medical records documenting my attempts to conceive over two years, including my brief pregnancy and miscarriage.

Backed into a corner by overwhelming medical proof, the insurance company's letter cut to the chase: "We must maintain our original decision. State legislation specifically states that she and her husband have a history of infertility which has lasted at least one year."

I contacted women's rights organizations, the California Department of Insurance and lawyers. I came up with no concrete information about my rights as a single woman.

All I could think of in my defense was the principle behind group insurance--that we all pay for those few who require treatment. If a married colleague was infertile, I paid for her treatment, so why shouldn't she pay for mine?

There were no more formal appeals. Pumped up on hormones, I wrote back to the insurance company anyway. "Since you are denying me based on California legislation, please cite the section and code and provide a copy of its language."

Two months later I received a breathtaking response.

"Our legal department informs us that our denials were incorrect. We are sorry for any inconvenience that we may have caused you."

Inconvenience?

I wanted to scream. It was heartbreak--failing to conceive a child. It was torture, caught as I was, between an invasive medical procedure and managed care run amok.

The entire apparatus of my insurance company--from the benefits booklet to the claims representative to the so-called appeals process--was designed to convince me I was ineligible. They sought to deny me, wear me down, and drive me away.

In the end, I prevailed--not with motherhood--but with collecting what was rightfully mine.

Why did they pay? Because despite my insurer's verbal and written claims, the California insurance code makes absolutely no mention of marital status.

Infertility is considered a medical condition similar to other illnesses or conditions. In 1990, the California Legislature mandated that insurers offer infertility coverage to everyone precisely because the market place was uneven and inconsistent.

In California (and many other states), you simply have to demonstrate through your medical records that you have been trying to conceive a child for a period of one year.

Perhaps my experience will prove a legacy to others struggling for their own life or for the life of a child. As for me, I finally got my benefits. But that's all.

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