Checking in

It's been a while, as the suppression phase is quiet. I took my last birth control pill last night. I had only one migraine (brought on almost certainly by dehydration rather than the BCPs), so it was definitely easier than last time. We go in to see the doctor on Tuesday, with fingers crossed that the suppression has worked. If so, we'll start the shots that day.

There's no news about the insurance. They're reviewing the contracts with the doctor to figure out whether I really need to pay the balance. It's slow, but the woman I've been talking to at the insurance company has been very responsive and has promised to keep track of this next cycle too.

Thanks to our 10 days on vacation, I'm feeling pretty relaxed. As of yesterday, I'm restricting my coffee intake. And I've stopped drinking wine as of this weekend, rather than waiting until transfer.

Approved!

That is all.

Revving up -- or rather, revving down

We're underway! Prescriptions have been ordered; the doctor's office will get the pre-approval from the insurance company; and my first appointment (suppression check and payment) is July 13. I'm keeping my fingers crossed that everything goes more smoothly this time around. I'll start the birth control pills for suppression this Thursday. And if I'm properly suppressed (no follicles, no cysts), we're looking at the last week of July for retrieval and transfer.

I've finally made contact with the insurance company. No results yet, and probably not for another couple of weeks. But I have a human being with a name who answers the phone, so that's progress. And the doctor's office is being reasonably patient.

The waiting game

The official letter of complaint went in the mail to the insurance company yesterday, in the hope that they might agree to pay some of the outstanding charges. I've been fortunate; this is the first big medical situation I've had to deal with. I guess this is just the way they do business; right? They deny, deny, deny, then only pay after you put up a fight. The gamble is that most of us won't fight. Silly me, I thought the business model was about pooling risk so that we got the coverage we paid for. Some people pay in and need little care, taking out less than they've put in. And some of us, pay in and take out more than our share. But I left out the profit-making piece.

I know, I know that I should be grateful that the insurance covers any of it. The meds alone were a huge chunk that we didn't pay for. But the frustration stems from the fact that I am paying the entire premium out of pocket. That $9000 would nearly have covered a complete IVF cycle without any of this hassle. So now it feels like I am double-paying.

I'm also waiting for my cycle to rev up again. More than once over the last month I've thought we were just about ready. But I've been temping and using OPKs in vain ... no sign of ovulation, much less my period. If nothing's happened by the end of next week, I'll put a call in to the doc, and see if they'll do an ultrasound and bloodwork to figure out what's happening in there.

In the meantime, the pool is open, and I am going swimming this morning!

Frustration

All I want to do is focus on getting strong and healthy for cycle #2. But I have been spending hours dealing with the insurance and bills from the first cycle. Despite the fact that we properly obtained pre-approval, the insurance company has denied all but about $600 of the $10,000 charges!!! They paid $600 to my doctor (of the $2500) he billed, with no explanation for the denial of the rest, then proceeded to deny all of the charges from the hospital and the anesthesiologist. At different times I've received different explanations: 1) once the doctor was paid, no one else could be paid for the same services (ridiculous, don't doctors and hospitals bill separately all the time???); and 2) the name of the facility of the preauthorization was the clinic not the hospital (even though the clinic is just a subsidiary of the hospital). Happily, the hospital appears to have absorbed its costs and is taking responsibility for the mix-up. But not so much the doctor's office, and I still haven't heard from the anesthesiologist.

I have a call in to the business office at the doctor's office to see what explanation they received for the denial, and I have an email in to the insurance company about filing an appeal.

And in the back of my mind I keep worrying about how to make sure this doesn't happen next time.

5dp3dt: For Leo

We are celebrating here Chez Blangsdau. The bill isn't perfect (infertility coverage, anyone?) but it means that my friend Leo True-Frost will not be inhibited by lifetime caps, pre-existing condition exclusions, or chronic condition limitations. And that's a great thing.

Approved!

Insurance company approved 1 cycle. So if doesn't work, we'll have to go through this process again. But for now, I'm just going to celebrate -- approved! Drugs are scheduled to arrive tomorrow. Stay tuned for a picture of the stash.

Seriously? -- UPDATED

After 10 days of antibiotics and birth control pills, shouldn't my skin be gorgeous and clear? Not so much. Hrrmph.

It's been two days ... time to harass the poor business manager at the clinic again, I think.

**Updated: According to the insurance website, the IVF pre-approval request is now in the system, pending medical review. Keep your fingers crossed!

Getting closer

I finally got ahold of the business manager at the fertility center, and they've finally accepted that I do have insurance. Yay! Unfortunately, they're out-of-network for IVF (even though the doctor is in-network as an OB/GYN -- weird), so I'll have to meet my deductible and pay 20%. But I'll take it! The business manager sounds totally on top of things and is getting all the paperwork taken care of, and they'll call before our next appointment on Feb. 17 to tell us how much money we'll need to bring. The business manager was super-friendly and super-helpful; I was really relieved to talk to her.

And the drugs have all been ordered with no problem, completely covered -- $3000 worth of drugs for a mere $150 or some such.

We're getting there.

An up-and-down update

We had a doctor's appointment this morning, and everything went well. From the doctor's perspective, everything looks good to start the IVF cycle. We have all our appointments set up for the next six weeks and are looking at egg retrieval between March 1 and 3.

Unfortunately, I got a call from the front office woman this afternoon saying that they didn't think my insurance covers IVF. I called back, and she was more annoyed than helpful. She kept saying that my chart says "diagnostic tests only," but wouldn't tell me where she got that information -- because, of course, my insurance documents don't say that! But she couldn't seem to get me off the phone fast enough. I efaxed the documents (which they already have) to her late this afternoon, and she said she was going to check with my insurance company. I'll give her a few days before following up. I know most people out here don't have infertility coverage, but I can't for the life of me figure out why she was being so difficult about it.

In the meantime, I've started to worry that some slightly abnormal (nothing to worry about!) results from a regular doctor's appointment may lead either the insurance company or the doctor to want to postpone this cycle, which would be really disappointing.

Fortunately, we are only in the suppression stage, so this stress will only serve to further suppress me rather than interfere with the stimulation phase! And hopefully in 30 days, when stimulation is supposed to start, it'll all be worked out. Keep your fingers crossed.

Choosing a clinic

Assuming our last round of IUI (whenever that happens) doesn't work, we'll need to choose an IVF clinic. We have four options:
*Our current clinic at the University. We really like the staff and find it to be a calming place that offers personalized attention. But it's a relatively new program.
*The other clinic in the city. It's a much bigger and older program, which means less personalized service but more experience.
*Colorado Center for Reproductive Medicine. It's the number one clinic in the country, according to Parents Magazine. I have a friend who had great success there. It's the place that all the IF bloggers go when all else fails. But it's out of network, which means meeting my deductible and huge co-pays.
*Presbyterian Hospital in Dallas. It used to be the number seven clinic, though the personnel has changed. And it's out of network. So this one seems easy to eliminate.

In patients under 35, all four clinics have roughly equal success rates: 57-65 percent. But in the 35-37 age range, the numbers vary wildly: our clinic had a 38 percent success rate in 2007; the other clinic in the city 51 percent; and CCRM 58 percent.

Technically, we have time for two IVF cycles before I move from the under 35 group to the 35-37 group. But my FSH levels suggest my eggs are old, so I wonder if I should just assume I'm going to behave like the 35-37 age group, which probably means switching clinics.

Health care portability

I'm lucky to have always had good employer-sponsored health insurance, so I don't (yet) need a public option. But one of the big lessons of infertility for me has been the value of insurance choice and portability. Massachusetts requires insurance coverage of infertility, one of the things that has made universal health care in MA so expensive. So our two cycles of meds, two inseminations, and a multitude of doctor visits and tests cost us only my co-pay (and those ultrasounds in the basement didn't cost anything). Actual cost: at least $3200. Our cost: less than $100, plus my regular insurance premiums. Insurance: priceless.

My current employer, like most, does not cover infertility treatment. No problem, I thought, I'll just take advantage of COBRA and maintain my Massachusetts insurance. Even at $500/mo, it's cheaper than paying out of pocket. But then I realized that my Massachusetts insurance was only good in Massachusetts, and I couldn't exactly spend two weeks a month living at the Brigham. Panic set in, until I realized that old employer had an out-of-state insurance plan for it's out-of-state employees. And, thank goodness, moving out of state is a "qualifying event" that lets you switch insurance plans, even if you're no longer employed. Under COBRA, you're still entitled to take advantage of a qualifying event. So I am continuing to shell out $500/mo for Massachusetts-level coverage.

So far, it's probably been a wash: one complete cycle and one canceled cycle here in OK have probably not cost more than $2000, and I've now paid $2000 in COBRA premiums (though I've also used that insurance for other medical care, so I'm still a bit ahead). But if I maintain COBRA for the full 18 months, it will cost $9000, significantly less than IVF would cost if our next Clomid cycle doesn't work. And we should have time for two IVF cycles in 2010.

Regardless, I feel so lucky to have been able to bring my insurance with me. I'll gladly pay the additional premium for the infertility coverage. But in OK I don't have that choice. I should have been able to bring my insurance with me no matter what. And my medical records should have followed me, but they didn't. My current insurance carrier tried to deny my first OK IUI because it didn't have my records from Boston, even though I'd requested them from the B&W six weeks earlier. I think we've worked it out, but it shouldn't have been that hard.