Thursday, June 12, 2008

Testing

I got married in my early thirties. Since I was considered an older bride, I wanted to be responsible and get a bunch of medical exams before the wedding, make sure everything was in working order so to speak, which of course necessitated a trip to the ob-gyn. I wanted to get a general fertility test...nothing invasive or extreme, just a simple test to find out if all my chemistry was ok. After all, I was planning on trying for kids right after getting married and I wanted to know if there would be any challenges up front. I also wanted to be tested for all the Jewish genetic diseases, like Taysachs and Gauchers, as The Ex and I were both of Ashkenazic descent and I wanted to know if I was a carrier.

So I had a regular physical exam and then spoke to my doctor. She told me that my insurance (which was a major carrier PPO at the time, one of the best available) would not cover any fertility tests until my partner and I tried to conceive for at least a year. I thought that was ridiculous. Why try for a year if you could find out before that there is a chemical issue that might need to be addressed? Then you have wasted a year. She asked me if wanted her to lie and say that my fiance and I had been trying to conceive unsuccessfully. I couldn't do that. She said she still might be able to test my blood for certain hormone levels, under the medical guise of suspecting something else. I felt uncomfortable with that, but she seemed okay about it. I wondered why insurance companies wouldn't cover basic fertility testing as part of pre-marital health checks.

Then on to the genetic screening. She had already taken my blood sample (quite a large amount of it too) at that point and said she would take care of all the pre-marital testing. She was rushing me out as we already spoken for ten minutes, so I thanked her.

Two weeks later, I got a notice from her office that they were happy to report that I did not have AIDS, syphillis or gonorrhea. I immediately called her office and asked them why I received this report and why this test was done. I was not sexually active before I got married, so I wasn't really concerned about any STDs and didn't recall authorizing a test for them. I was actually pretty angry about the test...it felt very presumptuous for them to assume that since I was over thirty, I must be at risk for an STD, regardless of my religious background. She came to the phone and after a little digging, explained the mixup. It seemed that her PA had misunderstood my asking for a pre-marital test. Though I was very specific about it being a genetic screening, she thought I meant just the "regular" pre-marital test and had sent my blood in for an STD test. "And anyway," my doctor explained, "your insurance won't cover a pre-marital genetic screening."

I didn't believe her. It seemed outrageous. I called my insurance company, and sure enough, the AIDS test was covered 100%, no problem. A blood test for genetic screening would have cost me $1,200.

Later on, after I was married, I had different medical coverage in another state where the co-pay for the screening was only $100, so I had it done (and Bee-Aitch, I'm not a carrier for anything).

Insurance companies don't seem to really be interested in promoting responsible pre-conception care. Pre-marital genetic testing is not covered at all, but a pre-marital AIDS test, well, that's de rigeur. Also interesting to me was what my doctor told me, that if my AIDS test had come back positive and I had ever lost my current coverage, I wouldn't be able to get health insurance ever again (which is why many people choose to be tested privately, off their insurance radar). Not sure if that's true, but it's pretty frightening. What if there had been a false positive?

Sometimes I think I am just very, very naive.

1 comment:

ClooJew said...

Nah your not naive. But I was, lulei demistafina, wondering why you declared yourself a non-carrier by hollering "Bee-Yatch!".

Then I realized what you wrote.

cool