TTC 1 year, 3 months, 19 days

Who knew infertility would force you to become a mathematician.

I'm generally not a pessimist, but one thing that sucks about this entire process is health insurance. Break out your calculators and old math books, cause you're gonna need them.

I have a good job.  I work for a large company and have pretty good health care coverage.  But apparently I have no infertility coverage.  None, zip, niente.  Apparently this is normal.  And, let me tell you, it sucks.

We have a deductible of $1,000 per year.  Beyond that there's a 20% co-insurance.  The testing I'm undergoing is covered by my insurance, but once it is no longer testing but is officially treatment, that won't be covered.  Where is that line? Apparently nobody knows.  In the meantime, my doctor's office is charging me 20% of the total office visits, the remainder of the balance, which I have been told by my insurance company, will simply be forwarded on to me until I hit the $1,000 mark.

So, the other day I had blood tests and a transuterine ultrasound.  The office visit cost a total of $650, I paid $128.  Our initial visit was $200, and I paid $50.  So, by my naive calculations, I will get the bill for the entire $850, and will be well on my way to meeting my deductible.  Awesome. Except, apparently as soon as I hit the $1,000 I will officially be in treatment- so no coverage.

So we have to sit down and determine if we should proceed with running things through insurance, or if we should go the cash route.  When things get billed through insurance, the doctors charge an incredible amount, knowing the insurance company will pay just a fraction (as in about 10%) of that.  If you offer to pay for things in cash, as opposed to insurance, the doctors will knock off 50% of their insurance price.  So the end result is that doctors tend to push you towards the cash price, telling you it's much cheaper.  But it's not that simple.

Let's we assume I am going to incur $10,000 in medical treatment.  If I pay with cash, I will pay $5,000 (50%) of the total amount, and none of that will go towards my deductible.  If I run it through insurance I will have to pay $1,000 (deductible) plus 20% of whatever the insurance negotiated rate is.  If we assume the insurance negotiated rate is $1,000, then I would pay a total of 1,200 (1,000 + 200).  Running it through insurance is cheaper. 

The equation is simple enough- but then you add in two "moving targets." The first is, I never know when I'm going to be deemed as in treatment by my insurance company, and once that happens, I have to pay 100% of the total.  So, let's say I incur $10,000 in medical treatment.  I pay the $1,000 deductible and the insurance company then decides I'm in treatment- I'm still on the hook for the remaining $9,000 (unless the doctor cuts me a break).

The other moving target is knowing what the lower negotiated insurance rate is.  Everyone will tell you what they are going to bill the insurance company- NOBODY will tell you what their contract with the insurance company says in terms of how much the insurance company will pay until after you've incurred the cost.  Because of my job, I know that the amount the insurance company will pay is already decided before you undergo the treatment- but for some reason that information is secret and you won't get it.

If you don't know when you're insurance is going to cut you off, and if you don't know the negotiated insurance contract rate, you really can't do any of the equations.  Instead, you're left doing hundreds of calculations to determine at what point would it be more cost effective to pay cash vs. insurance.

Later I'll have to add in the whole medical expenses deduction factors- if you pay over a certain percentage of your gross adjusted income in medical expenses, you can write them off.  I think it's anything over 7.5% of your AGI, but I'm not sure.  To be honest, I'm not really sure what my AGI is.  I hate hate hate math and taxes, so the less I have to do with them, the better.

These calculations have conjured up images of my 7th grade algebra teacher- and let me tell you, nothing is less sexy.