Another CD1 = Another tussle with Incompetence

I keep hoping that I’ll be able to avoid IVF and the accompanying headache of dealing with my insurance by, you know… getting pregnant. I seriously hate this company. Just over the weekend, I got a bill from an appointment I had well over a year ago. They claim that they sent the check to me, and not the doctor’s office. Which is horseshit. And another story.

If these winners screw up perfectly run of the mill visits, imagine the wonderland of stupidity that awaits me now!

When Dr. Petrel suggested we go straight to IVF, I was cautiously optimistic. When I spoke with someone at the Infertility Hotline, they said that they required 6 cycles of something before they would approve IVF. Since I took Clomid for 6 cycles, I should be all set.

[But before I go on, I would like to pause for a moment to share some interesting information shared with me by Dr. Petrel. In the state where I live, most insurance companies (all the biggies) have moved away from a set requirement before IVF. Why? Because they crunched the numbers and found that most patients ended up at IVF anyway. Pragmatically speaking, it didn’t make financial sense to pay for treatments that have a lower probability of working BEFORE approving the one that has a higher probability of working. Logical, yes? Alas, my employer contracts with an insurance company out of TEXAS. And Texas may be many things, but rational about women’s health issues is not one of them.]

Anyway, as I was saying before I interrupted myself… I thought it would be a good idea to call and make sure I understood exactly what Incompetence meant by 6 attempted cycles with Clomid. Does it have to be done with IUI? Does it have to be done with accompanied monitoring? What kind of monitoring? Was I required to jump up and down three times before every cycle began? Rub my abdomen with juniper berries on every full moon?

So I called last week. I was on the phone for 45 minutes before someone told me that a specialist would call me back in 4 business days. This is the exact same crap I heard last time. 3-5 business days? How is this a HOTLINE, if I can’t talk to anyone for 3-5 business days? And did I REALLY have to wait on the phone for 45 minutes, only to learn I have to wait another 4 days? REALLY?!

Because the universe likes to kick me in the metaphorical balls, I get my call back from the Infertility Hotline the same day as I get by period. Let’s add frustration and elevated blood pressure to my pile of weepiness, desperation, and disappointment, shall we?

The good news is yes, my cycles with Clomid do count. This makes me feel a little bit better about the Great Clomid Experiment. In its own way, it has served its purpose. I just need to get something from my GYN saying that he did prescribe it. And provide some kind of “proof” that I took the medication and monitored it (OPKs count.)

Erm… proof? I started to panic, thinking I needed to have saved all my spent OPKs. I’m a pack rat, sure. But I have to draw the line at hoarding discarded OPKs. I mean, I PEED on those things.

In a delightful move back to civility, my word for it is proof enough. So I pull up my apps, report the dates of positive OPKs and scheduled sexy time. For the last 6 months. As I’m sure you can imagine, this took some time– 30 minutes to be exact.

The woman I spoke with was actually nice. Granted I waited 4 days to speak with her, so I sure hope she’d be nice. After we went through all the dates, she said she would start processing it so that I could be approved for IVF (pending some FSH test, I think? I dunno, whatever I’m getting done this week.) I hung up from that conversation not actively annoyed.

But just when you’d think that this could end on a happy note, I’m now embroiled in another bit of drama with my insurance company. Some of you may recall that I’ve been seeing a counselor to help me cope with “My Life”, aka the never-ending cyclone of very bad things I’ve experienced in the last year. Dr. Macaw has been so helpful. But because of a clerical error at Incompetence, they’ve rejected her claims so I’ve had to stop seeing her. I cannot fix said clerical error, Dr. Macaw has to. And they are not returning her calls, or sending her the forms she needs. Why?

Because they are assholes.

I’ve been okay with not seeing Macaw for now, but this shit is going to get cray once IVF becomes more real. I’ve already had one solid freakout after a Google session. (Sorry, but Egg Retrieval does not sound like a good time.) As one lovely friend pointed out, this might have to do with my total aversion to hospitals and medical procedures, thanks to my mom’s health situation. I NEED to talk about this with a licensed professional, but I can’t do it if my insurance company keeps denying claims because their records are out of date (and they seem to refuse to update them.)

Suggestions on how to strong arm your insurance company into delivering the services that you pay for are welcome.

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15 comments

  1. My Perfect Breakdown · August 18, 2014

    You just made me very happy to be Canadian. That said, it’s not all sunshine and roses here either when dealing with medical companies (I could and should write a post on it), but it does seem a bit easier then what many people in the US face. Anyways, wishing you a truck load of patience as you deal with your insurance company.

    • thecommonostrich · August 19, 2014

      I’ve had 5 different insurance companies, and this one is by far the worst! Some of them aren’t that bad, in fact one I had was excellent.

      This one? EVIL.

  2. waitingbetweenthelines · August 18, 2014

    Oh, red tape… So awful regardless of where on the world you are, and soooooo frustrating. If comparing yourself to others helps you feel better, we here in South Africa have to pay cash for all infertility treatments… We pay very expensive medical aid every month, but infertility is considered ‘voluntary’ like plastic surgery, and so not covered. It is also not offered in the government (ie. free) system, as it is very low down the needs scale.

    • thecommonostrich · August 19, 2014

      Damn… that is rough. It is a good reminder that all this red tape should eventually result in a large portion of this getting paid for. These idiots are making me work for every penny, though.

  3. Jenny F. Scientist, PhD · August 18, 2014

    I would look into whether the insurance company has a patient advocate, i.e. someone you can call and make it their problem. After that, I’d start sending registered letters with complaint forms filled out- start with the company’s, then move on to these helpful ones provided by the state of Texas! (http://www.tdi.texas.gov/consumer/cpportal.html). You can also file complaints with HHS. I would estimate it more useful as a stick to beat the HMO with rather than an actual means of revenge. Sadly.

    If you throw in as many magic words as possible, that can never hurt. HIPAA violation! Fraudulent denial of claims! Inaccuracy in the billing-related portions of your legal medical record! (This may or may not be true but it sounds good.)

    Failing that, I personally would call and remind them of that epic Blue Cross/ Blue Shield lawsuit from about 20 years ago, based on their policy of routinely denying legitimate claims. I mean, SURELY this company doesn’t want to establish a policy of denying your legitimate claims, RIIIIIIGHT? And this is super-frustrating and good luck.

    • thecommonostrich · August 19, 2014

      YES. I love this attitude. It some how didn’t occur to me that I could file a complaint. I’m going to circle back to my doctor and come up with a plan. Because this crap has gone on long enough.

      • Jenny F. Scientist, PhD · August 19, 2014

        I used to work for an EMR company. It is EXTREMELY helpful to know all the magic words and pressure points!

  4. AndiePants · August 18, 2014

    ” And Texas may be many things, but rational about women’s health issues is not one of them.” never have truer words been written.
    I have no suggestions, just a lot of empathy. My approach is to make threats I can’t keep, like “I will be calling my lawyer” or “this will be reported to _____” Sometimes effective, sometimes not.

    • thecommonostrich · August 19, 2014

      Yeah, it finally donned on me that I have to be a bit pushier with them. I’ve never had to do this before with any other insurance company.

  5. julieann081 · August 18, 2014

    I’m glad you got some good news in terms of the “great Clomid experience.” I’m really sorry to hear about more insurance madness. ❤ Do you have a separate number to call to deal with psychological/psychiatric claims for your insurance or is it the same as the "regular" number? If it's different, I would suggest calling them and explaining the situation. When they try to explain things away, get upset – but not mean upset. Start crying if you can. Seriously. Sound sad and desperate and tell them that you need to see your counselor and you can't because they're not billing correctly and blah, blah, blah. I did this once (not on purpose) and the problem got fixed within days. I kid you not! If you need mental health services and your insurance company is stopping you, it's a big deal. I know this may sound extreme, but sometimes the only person that can advocate for yourself is you. Hugs!!! ❤

    • thecommonostrich · August 19, 2014

      They do have a separate number, and I called them, but they were USELESS.

      It didn’t occur to me that they could be in serious trouble by denying me mental health benefits. I’m going to wave that in front of them to see if they can get their shit together.

      • julieann081 · August 20, 2014

        Oh dear! I hope that you can get it worked out. ❤

  6. conceptionallychallenged · August 19, 2014

    I’m sorry about all the hassle, and I’d second the suggestion of formal complaints. I do like your insert on other insurances becoming reasonable though.
    Also, my husband watched videos of egg retrieval. I declined. I also look the other way when they draw blood. Ask for anesthesia and take the day off.

    • thecommonostrich · August 19, 2014

      Thanks for the advice. I’m about 99% positive I’m working myself up over nothing. I’m not normally like this about medical stuff, which is why I’m certain I’m reacting to something else, i.e. my now deep-seeded mistrust of doctors.

      Ugh

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