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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Well, Hello There!

To make a long and painful story short, Incompetence denied the request to go through the lab for the Panorama test. I will spare you the gory details, and summarize:

My doctor’s office says that there is one lab (Natera) that does this test. Nope, no one else.

My insurance says their preferred lab does the test too, so won’t accept Natera.

They are incorrect, but I’m fairly certain they have yet to update their files to reflect the change. This, sadly, has happened two other times, resulting in delays in treatment.

Sigh… This left me with only one Downs screening option and exactly two days to do it in. This screen, consisting of an ultrasound and blood work, has to be done between 11 weeks and 13 weeks 6 days. Today I am 13 weeks 5 days. If ever there was a reason to utter the phrase “Fuck my life,” now felt like the time.

So I spent the ENTIRE DAY running around signing consent forms and finding the one office that had an opening today for an ultrasound. (Weather in my next of the woods is shit right now, so many offices are closed.) Luckily I was able to get an appointment at 1:30 today– again due to the weather, this office had a cancellation so I could slide right in.

I walked into the office and thanked them profusely for getting me in. I was exhausted, had not showered, and was hungry because I hadn’t eaten anything except some oatmeal I picked up at Starbucks between stops. Not to mention that I was anxious because I was worried that they would tell me there was something less than perfect* about my wee one.

I was, essentially, a train wreck.

And then. Oh, ladies and gentlemen, and then… I saw the little thing that has set up camp in my uterus. It is real. Like, really real. It has hands and feet. Hands! And it waved. (Okay, it was probably passing gas or something, but I prefer to think of it as waving.)

It waved at me. It said “Hi, I’m here.” (Okay, it didn’t saaay anything, but I was having a moment.)

That’s when this whole pregnancy thing became so motherfucking real to me. This is happening. And it is awesome.

As should come as no surprise, there were some oddities. Mostly that it is on the longer side. Depending on which range you use, it is either a wee too long or just right. Baby Ostrich is either right on schedule or 14 weeks 1 day.

I couldn’t figure out why this mattered, so I kept pressing the nurse. She gave me some pat answer, so I made it completely clear. “What I’m asking is there anything I could Google and freak-out about later?” She assured me that no, there was nothing to freak out over. And she is right. I have Googled and there is nothing terribly conclusive about these ranges.

[Aside: This seems weird to me. Different labs use different ranges? Wouldn’t something like baby growth be fairly standard and generally accepted?]

But in case you thought I couldn’t find something to panic about… I learned that I have actually lost weight in my first trimester. Lost weight. Aren’t I supposed to be gaining weight? I suspect this is because I have been backed up a lot, what with the rampaging constipation. To put it bluntly, it is really hard to put food in when it won’t come out. Or maybe it is grief. Because, you know… I’ve heard that can put a damper on one’s appetite.

Again, I find myself wondering if the cause even matters. Ultimately, I need to find a way to get more in my belly.

Barring a natural disaster, I will be heading to California tomorrow. It seems like a delightful way to spend the week wait until I get the results of the blood work back. Not to mention, I hear they have amazing food trucks where I’m headed.

And I could certainly use the sunshine.

*I hesitated to use this word because I don’t think there is anything wrong with people who have Downs or other disabilities. If I am being honest, there is a part of me that would be upset if my child had Downs. Not that I wouldn’t love them or care for them. But every parent wants the easiest road for their child, and I would be disingenuous not to recognize that this was all tumbling in the back of my head in the waiting room.

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?

The Perils of Letting Go

(Warning: This is kind of heavy. But then again, you’re reading an infertility blog. Were you expecting sunshine and rainbows?)

After a few month hiatus (brought to you by the letter “I” for Incompetence Insurance,) I’m back to seeing Dr. Macaw, my therapist. The timing could not be better, really. After my non-emotional tubing incident a few weeks back, I could tell that something wasn’t right. Luckily, Macaw has finally got Incompetence to accept her claims, though comically they keep sending her payments to a different address. Baby steps, my friends.

At last week’s session, I brought her up to speed on what has happened in the past few months. Mom is still in the hospital. I’m still infertile, though now at least I have some plan of attack. And yet I feel more detached from my life than before.

I started talking about my upcoming hysteroscopy. To be 100% open and honest, this scares the crap out of me. More than anything I’ve done in my entire life. This is not normal for me- I’m pretty fearless. If something scares me, that only gives me more reason to do it. Screw comfort zones!

I’ve been thinking about it since my appointment was scheduled last week. I didn’t used to be afraid of medical stuff. Why now?

“Because you think you’re going to die.”

The moment Dr. Macaw said it, I burst into tears because I knew it is true. I have never ever been afraid of dying– whenever that thought popped in my head, I would feel okay with it because I knew all the people I love know how much I love them. I could go out as long as I had that covered. I didn’t recognize this fear because frankly I’ve never felt it before.

I get that my fear is a smidge irrational. The risks from a hysteroscopy are so low. I’m having this done by a doctor I trust at a well-respected hospital in what is arguably the medical capital of the country.

But I cried anyway because it hit a nerve. As we talked more, it came up again and again. I can’t plan anything anymore. I don’t want to move on with my life. Get this, I’ve saved up more than enough for a down payment, but I have no desire to buy a house. I’ll drive by lovely homes that I could afford, and think “That’s nice… for other people.”

I know you all don’t know me that well, but trust me when I say that this is WEIRD. Not just the house thing, but all of it. I’m a planner! I make responsible life choices! Now I’m seriously entertaining getting a tattoo and picking up smoking again. Because who cares?

If I start working backwards, I can find the origins. I pull on the thread, following it back to November of last year. My mom went in for a routine test, woke up two months later. She has spent 10 months of her life in a hospital bed. My greatest hope for her is that she can get checked out by the end of the year, and into rehab. Not home, but into a rehab center. I dare not think much beyond that.

IF teaches us that nothing is certain. But right now LIFE seems to be telling me that all plans are for suckers.

So how do I let go without losing myself?

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.