Hotline Bling

A few weeks ago, a large packet arrived in my mailbox from my RE’s office. I remember this packet well. Lots of forms, check lists, maps to various offices… I didn’t open it.

“Oh, I know what’s in there.” Then like the diligent slacker I am, I completely ignored it until last night. I ripped it open, and started to fill out the forms.

The basic demographic stuff was fine. But when I hit the section on how long I’d be trying to conceive, I stumbled. I mean, how do I even answer that question? Do I go back almost 3 years to when this whole madness began? Do I start when Mr. O and I started talking about Deux? So I did what all of us do when faced with questions too difficult or painful to answer- I ignored them.

I could not, however, ignore the looming specter of Incompetence Insurance. You may recall that my insurance has a special phone number for us infertiles– the Infertility Hotline. In a flash, I flipped through those memories: the call, the laundry list of personal questions to someone who entered them into a database to determine my coverage… most of all, I remember the several days I had to wait for an appointment with one of their clinicians to open up. I don’t have days!

Well, shit.

I called this morning, prepared to through my very best diva-style temper tantrum. Lo and behold, I didn’t have to. Since I’m already diagnosed, I didn’t need the uncomfortable calls, the endless precertification processes, or treatment codes. Nope, I just roll into Dr. Petrel’s office tomorrow with a half completed questionnaire, and I’m all set.

It’s the tiny victories, my friends.

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The One Where I Cry at My Insurance Company

Before I left for the memorial service, I met my new doctor, Dr. Egret, for a check up. At this practice, I’m basically alternating between my doctor and my midwife until I make a decision about delivery. And I’m sucking at decisions right now, so I will continue to flip flop until I get my brain back.

Any way, I liked Dr. Egert a lot. I had to move up my appointment because of the memorial, so the office knew my mother had passed. It was the first thing Dr. Egert asked about. We spent about 10 minutes talking about how I can get the emotional support I need. She talked to me first as a person, secondarily as a pregnant person. Which I appreciated.

While we were there, we discussed Downs testing. Because I have a geriatric womb (i.e. over 35) they recommend testing, which I’m on board with. I’d like to know my risk factor so Mr. O and I can be prepared.

There is one in particular I’m interested in. Panorama Prenatal is a non-invasive blood test that helps determine your level of risk for Downs. It doesn’t confirm, but it does identify if the pregnancy is high risk. From my understanding, other tests are more conclusive but also more invasive and come with higher risks to the pregnancy. So this non-invasive test sounds perfect to me. The trouble is not all insurance companies cover this because it is still fairly new.

Enter Incompetence insurance.

I hate this company. So much. So so so much.

First, I check with the company to see if they cover this test. I am not given an answer. Nope, I am given a policy number. After searching for the policy and breaking down the insane jargon, it appears that because I am old, they will cover this test. They even list the brand name, Panorama, in the policy.

But I know better. I really do. Because though the test is covered, they may not cover the lab that performs the test. Soooo, I’m a good health care consumer, and I called Incompetence to see if the lab is covered. This led to yet another completely surreal discussion with an insurance rep (I’m going to have a collection by the time this is over.)

ME: I’m calling to see if the Panorama test by Natera is covered under my benefits. According to policy 12345,…

REP: Oh, I’m not allowed to review the policy with you, ma’am.

ME: Er… Why not?

REP: Those are written by medical professionals. I’m not a medical professional so I can’t discuss them with you.

ME: So you can’t discuss policies written by your own company?

REP: That’s correct, ma’am.

I lost my shit a little. After giving my “I’m trying to make responsible financial decisions when it comes to my health care!” speech, the rep finally conceded that  the lab does not appear to be in-network so would not be covered. But she can’t confirm this. However, if my doctor can call and receive prior authorization they will count it as an in-network request.

Okay. Fine. I have had enough painful conversations about my medical care for one day.

A few days later, I called my doctor’s office and explained that they need to get approval on the lab. Not the test, but the LAB. They thought I was crazy. It was like no one had ever asked this before. Given how stupid my insurance is, this is probably a first for their office.  Still, they took the information and did their best.

An hour later, I got a call back. They’d put in the request, but Incompetence takes 15 business days to review all approval requests. This seemed off to her, so she collected all the information I need (CPT, NPI, Tax ID, etc.) and suggested I call them too.

15 days?! 15 DAYS?! God created the earth in less than half the time, assholes!

I can’t wait that long because I’m taking a trip next week, then almost immediately heading to my mom’s funeral mass. I have 3 days this week when I’ll be able to get the test done. Not to mention, this is just stupid.

So I called Incompetence again. I got this rep who is clearly not into her job, which I can’t blame her for. She has to deal with people like me all day. I started off warning her that I’m getting frustrated because this is the 3rd time I’ve contacted them and cannot get the help I need. I patiently (okay, maybe not so patiently) explained what’s happening.

  1. I need to find out if the lab is covered because no one has been able to confirm this for me.
  2. I need to expedite my doctor’s request because a 15 day wait is not feasible.

Fairly quickly, I’m punted off to the “Patient Management” team, which I suspect is a euphemism for “Deranged Policyholders.” Here a woman calmly explained that Dr. Egret’s office did not specify that it needed to be expedited so there is nothing they could do, and the doctor was the only person who can request that. As a patient, I cannot.

I lost my shit again. Only this time I told them that my mom just died.

I started sobbing. Like those chest-heaving, snot-oozing sobs that come from the depths of your soul. I haven’t been upset like this much over my mom’s death. It isn’t that I’m bottling it up. More that there are a handful of occasions when I’ve felt truly pitiful about where I am in life right now. It turns out that arguing with my insurance company about prenatal testing is just such an occasion.

I started babbling about how this is my first pregnancy, I have no idea what I am doing, and though I respect that they have policies, this is just not working for me right now. (Yes, I actually talk like this.)

Ladies and gents, there was SILENCE on the phone. We now know what it takes to leave cold-hearted bureaucracy jockeys speechless: a first-time pregnant woman who has just lost her mother.

Perhaps their small hearts grew three sizes that day. I don’t know. What I do know is that in an instant two reps were on the phone, conference-calling their managers, and approving my request for expedited approval for my lab. I cried some more. I hung up the phone.

Wait? What was that? Yes, you read that correctly. All that drama did was lead to approving my request for expedited approval which should take 2-3 business days. I still don’t know if they will approve the lab.

I haven’t played the “Motherless and Pregnant Card” a lot. It feels icky and manipulative. I don’t want to be pitied, I just want things to stop being so fucking hard. Next thing you know, I’ll be audited. Or my car will spontaneously blow up.

The thing is I don’t remember my life always being so shitty. There have been long stretches when I felt down right fortunate. I do not feel fortunate right now.

I feel Rocky Balboa’s face.

Quick Update: All the Drugs are All Mine

It’s official. You are magic. I don’t normally go in for that sunshine and unicorns crap, but all your positive thoughts and support have resulted in an actual miracle.

What is this miracle? My insurance company has stopped acting like a jerk face! Folks, I have an authorization for my meds.

I will spare you the tactical play-by-play because it is boring and involves almost two hours of hold music. Over that last two days, I have talked to six different people at three different organizations. (Yes, I count things. It gives me the illusion of control.) Whatevs- I got my drugs.

Even better, the pharmacy will simply deduct my adjusted payment from my balance, and credit my bank account with the rest. So no claims forms to file.

Now I can get back to the task at hand… you know, making a baby…

Thanks for all your support, ladies!

The One Where I Spend Two Months Rent on Drugs

First off, my apologies for not writing sooner.  I’m happy to see the continued correlation between my taking a blogging break and several of you ladies getting pregnant. To all of you now on your way, my sincerest, heartfelt congratulations.

Unlike before, this break wasn’t for my own sanity. I’ve just been busy. Nothing exciting , but nothing terrible. I went to visit my folks and had some truly beautiful visits with my mom (who is still in the hospital. We just hit the one year mark.) I’ve also been insanely busy at work. So I haven’t had a lot of time to obsess over my upcoming IVF treatment.

Which has started. And started off poorly, I might add.

I got a call from Dr. Petrel’s office on Thursday that my IVF treatment was approved. Perfect timing, since my CD1 was just around the corner. On Friday, I got a call from the pharmacy asking if I’d like my meds delivered or if I wanted to pick them up. Wonderful. Things appear to be going smoothly.

On Saturday, shit gets real. As in real bad. At 9:00, the pharmacy calls and says that Incompetence Insurance requires two authorization codes– one for treatment, and one for the drugs. Though they’ve approved the treatment plan, I don’t have authorization for my medication. Because it is the weekend, no one is around to get authorization. And at noon, I get my period. Panic ensues.

I spent the next several hours playing a desperate game of phone tag with my doctor’s office, the nurse on call, and the pharmacy. I cried at four different people. Repeatedly. By 4:45, I had exhausted every possibility and realized I had to pay for the start of my meds out of pocket. Two mother fucking months rent on Gonal-F, ladies. I have until Wednesday to get an authorization code for the rest of my meds, or I’m SCREWED.

First thing this morning, I called the pharmacy and asked if their team was on the case. They claim to have faxed over the forms to my doctor’s office. I called Dr. Petrel’s office. They can’t find the fax, AND their computers are down so they can’t really do anything. Well, of course… If I don’t hear back in an hour, I’m phone stalking EVERYONE.

In the name of all that is holy, why would my insurance approve IVF treatment but not the medication? I’m so done with Incompetence Insurance. Just two weeks ago, they tried to deny a claim on the anesthesiologist for my hysteroscopy. Because that was optional? What? After I pointed out that a) this occurred in a hospital covered by my plan, and b) there wasn’t a way to have the procedure without it, they finally agree to accept the claim.

What makes me angriest about all this is that insurance companies prey on people when we are at our most vulnerable. Like when I’m recovering from a hysteroscopy. Or when standing at a reception desk crying because I can’t get the medication I need.

According to the pharmacy, the “good” news is the Incompetence says no, but then says yes. And they usually approve things retroactively. In the meantime, if I don’t get the authorization by Wednesday, I have no idea what I’m going to do.

Quick- which bodily organs can I sell that are also not required for a healthy pregnancy?

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.

Skirmish with Incompetence Insurance

I hate insurance companies. I really hate mine.

I just had to fight with an Incompetence Insurance rep to get estimates. At first, I got this weird run around.

ME: I’m trying to budget for my anticipated procedures. Can you help me get an estimate on IUI and IVF from my doctor?

REP: No, unfortunately I can’t do that without getting the procedure codes. Sorry!

ME: And where can I look up those codes?

REP: You would have to talk to your doctor.

ME: So you’re telling me that you can’t help me until I call the doctor’s office, get a list of all the associated codes, then call YOU back? Really?

REP: Yes, ma’am. That would be the only way I could give you an accurate estimate.

ME: I’m not looking for an accurate estimate, I’d be fine with a ball park…

REP: Unfortunately, I can’t look that up without the procedure codes.

And then I unleashed my fury. I asked to file an official complaint with the company because my doctor is in-network, and they should have records of what similar procedures have cost in the past. In fact, Incompetence Insurance’s stupid website even claims to offer this as a service.

The threat of filing an official complaint worked. After some huffing and puffing and 10 minutes on hold, the rep came back with two codes– one for IUI and one for IVF– and estimated fees from my doctor’s office. I seriously wonder if she just didn’t want to spend the time looking them up

What’s doubly hysterical about this is that I called my company’s “Concierge Services” line. That’s right- Incompetence Insurance wants my company’s business so bad, they have a special line for us. And I still manage to get terrible treatment. #lame

What I genuinely hate about all this shit with insurance companies is that they are pushing so much of the day to day management on to its customers. Fine, I can respect that this is my benefit which I pay for, so I need to take an active interest. Fine. But in this case, I wanted to hurl feces at someone. Here I am trying to make responsible decisions with my health and my finances, and I’m getting an INANE run around.

Yes, I did eventually get the information that I wanted. But I didn’t need to spend 25 minutes arguing with someone, elevating my stress levels, and acting like a dick. Contrary to what some might say, I don’t actually enjoy being that person who threatens to file complaints. Don’t make me be an asshole. Just fricking help me out.

I’m almost done with all my “homework” for my first RE visit in two weeks. Mr. Ostrich had to fill out a questionnaire yesterday, which was hilarious. My favorite moments:

“Are you sure you’re not supposed to fill this out?”

Um… it says MALE fertility questionnaire at the top.

“Why do they need to know when I started shaving?! Who remembers that crap?”

He tried to insist he started shaving at 12, which is just not possible. After some rational discussion, we discovered it was more like 15.

Gotta find something to laugh about throughout all this, amiright?

I just need to fax over the last of my release forms, and we’re good to go. August 7th, FTW!

The Infertility Hotline

First things first…

Thank you.

I was in such a sad place last week and I just needed a safe place to spew. Not only did you beautiful girls suffer through that post, many of you stepped in as my personal pep squad. I needed it. If I’m learning anything through this, it is that the kindness of strangers is a real thing. You all give me hope for humanity.

And now we plod onward…

There are so many reasons that I was hoping to skip what I am now learning is called “Advanced Reproductive Technologies.” Not just the emotional stuff, the doctors visits, the potential injectables… That actually didn’t scare me one bit.

It is dealing with my insurance company. We’ll call it “Incompetence Insurance”, shall we? Before this even got started, I’ve experienced so many errors, misinformation, and flat out idiocy. For example: because they failed to send claim information to an office in a timely manner, I was sent to the hospital’s collections department. (I DO NOT get sent to collections. I may have my shortcomings, but this lady gets her bills paid on time.)

There are more examples, but I will spare you the gory details. In short, I hate them. But they are the only one my employer offers, so there you have it.

As much as I was bummed to wait so long to see the RE (appointment August 7th,) I realized that this was probably a good thing since it gives me plenty of time to get my ducks lined up with Incompetence Insurance. Planning is my middle name, after all.

According to the rather large packet of information sent to me by the RE’s office, mine is the only insurance company that requires I call an “Infertility Hotline” before they will authorize treatment. (No, really. That’s what they call it. A hotline. Call now for all your hot and heavy infertility needs!) So I need to get 1) a referral from my PCP, and 2) authorization from the Infertility Hotline. Thanks for making a painful process so much easier, guys.

Any way, after I hauled myself out of my sadfest the other day, I realized I should get that started. Who knows how long that’s going to take? 2 days, apparently. I called. Was put on hold for 10 minutes. Was told that all infertility specialists were busy and someone would call me in 2 business days. I continued hating Incompetence Insurance. #rage

Eventually, I get a call back and proceeded to have the first and likely last helpful conversation I have ever had with my insurance company. I had to answer all the questions I’ve answered a bazillion times: How long have we been trying, which tests have you run, are you having timed intercourse, blah, blah, blah. After a 28 minute interview and two calls to my RE’s office, I’ve been given an authorization number. Victory, albeit a small one.

The only thing my insurance doesn’t seem to suck at is the actual coverage. Though not a reproductive free for all, it appears to be “fair.” (Wait until the bills start coming in, and I’ll let you know if this holds true.)

One interesting bit: Unless there is a medical need, my insurance will not authorize IVF until at least 6 cycles of other infertility treatments have been tried. (Clomid counts, BTW.) I guess that makes sense, but for those of us that fall in the “Unknown” category, that’s sorta shitty. Not that I want IVF… I don’t know… I guess I’m just bristling at the bureaucracy involved with something that feels so heartbreaking and personal.

In the meantime, I’m going to start taking Synthroid. Wait… What? Remember those blood tests I had a few weeks ago? It turns out my TSH is a little high. I’m at 2.75. Whereas that is in the range of “normal,” it is on the high side for baby making. I was resisting it for a while- I don’t like taking extra medication if I can avoid it. But then I realized I’m about to introduce all sorts of foreignness into my body. Why not start now?

The good news from the blood work is that I do not seem to have any autoimmune diseases. Victory yet again, though this one is a much bigger weight off my shoulders. Whew…

Round 5 of Clomid starts today. Wish me luck.