Wednesday, March 26, 2008

introducing: the end of my rope

Yesterday was a Very Bad Day. Very Bad. As I said to M on the phone this morning, I'm pretty sure we can call that rock bottom.

I went in for my CD3 bloodwork yesterday. It was supposed to be Estradiol and CF screening (FSH was tested about a year ago and RE said the level was low enough that we didn't need to retest). Well, the CF screening was out because of the insurance BS I wrote about the other day. When I sat down in the lab, the woman said "Just Estradiol and FSH today?" I was about to correct her but then I decided to let it go. My FSH test was a year ago, they were taking blood anyway, and what do I care if they want to run one more basic test through my insurance? Maybe it'll even give us useful information. So I said yes, she opened the vein, and I went to check out. Usually when I go to the lab at my RE's office, I just drop the slip and dash - no co-pay or anything. This time, the cashier did some quick math and asked me to turn over $162. I asked why and she said that since my last visit, they learned I have an insurance exclusion on all infertility coverage and I would have to pay everything up front and out of pocket from here on out. They will not submit another claim on my behalf, no matter what the service is for, and I will have to pay for all future services up front and at the fee-for-service rate (which is usually about 2 to 3 times the insurance negotiated rates). So I did what any hormonal, stressed person would do - I burst into tears.

I asked if it was too late to cancel the FSH test ($90-something of the total cost) and the cashier said she'd check. She got the nurse who explained to me (slowly and condescendingly) that the test would give them important information about how my ovaries are functioning and they need this to make good decisions about my treatment. I told her through my kleenex that I understood and wasn't trying to cut corners, but that my doctor had told me specifically she was comfortable using my old FSH results and I'd rather not pay out-of-pocket for tests I don't need. What I should have said, had I had my wits about me, was this: "No YOU listen, I know all about your freaking tests as I have been getting them regularly for the past year and a half. The reason I'm contesting an unnecessary charge is because I'm preparing to write your clinic a check for $16,000, so I resent your implication that I'm being cheap or neglecting my healthcare in any way." I did muster the presence of mind to look at the chart she was waving in front of me and I saw right on it that my doctor had written "WNL" (within normal limits) next to my FSH on their IVF prep checklist. I asked the nurse about it and after reading the notation, she admited that it did look like we might be able to skip it but she couldn't say for sure without talking to the doctor, who was unavailable at the moment. She said she would follow up and reverse out the charges if I happened to be right about the FSH not being needed. (She called 15 minutes later to say they'd cancelled the FSH test, btw.)

At this point, I was late for work and not in any state to go in anytime soon. I called my boss to say I'd be in eventually. I then called M and sat in my car in the parking lot getting strange looks from the security guard who was ticketing cars on either side of me. (My clinic has reserved parking for IVF patients - I guess they probably all do? - so here I am, sitting in the "green circle" parking with tears streaming down my face. The security guard probably knows better than to approach the hormonal women who park there.) M and I talked for a while and I tried to figure out if there was any, any, ANY way not to go in to work. I'm so far behind this month because of our vacation and some extra meetings I've had, and there were just things I had to get done, mental health crisis or not.

I've made this story longer than I should have. The bottom line is that I made it in to work, eventually, and limped through my day feeling the most fragile I've been since this whole thing started. I couldn't stop crying or focus on anything I needed to. Fortunately, the woman that sits in the cube adjacent to mine was out yesterday so there weren't any witnesses to my pity party. M took off work early to take me to lunch but of course, the sight of her just opened my floodgates all the more. Am I the only one that happens to? When I was younger, my mom had that effect on me. Now, it's M. It seems that no matter how well I've pieced myself together, there are certain people I'll come undone with upon contact. I think it has to do with a feeling of safety. Anyway, I simply couldn't pull myself together, and it didn't seem to be getting any less acute as the day went on. I knew it would be a bad decision to go home to our empty house for the evening, so I invited myself out to dinner with a friend and her fiance. I felt like I was maybe 15% there most of the night, but she's a good friend and knew what was up, so it was okay.

It wasn't the $162. I know that. I think I finally just broke. I hate that we have come to IVF at all. I hate that one single try is going to cost more than half of my annual take-home salary, and more than I spent on my first brand new car, and our chances of success are still only 52%. I hate that people around me continue to get pregnant without having put in 1/2 or 1/8 or 1/965 of the effort, emotion, and money that we have. I continue to grieve the fact that I will never be one of those women who floats blissfully through their easily-acheived pregnancy. I envy their untarnished spirits and the sense of control they have over their bodies, their futures, and their destinies. I used to think I could do anything I wanted if I worked hard enough, but this experience is showing me how naive that was. I feel so powerless, and so sad. The clinic is totally screwing me on the insurance situation, and I hope to have the strength to fight them on it somewhere down the road.

I am unbelievably, desperately terrified that this IVF won't work. I would feel so differently if this were covered by my insurance. It would just seem like the next step. I mean absolutely no disrespect to those who are fortunate enough to have coverage - I think we should all be in your shoes, not vice versa - but covered v. uncovered cycles are simply horses of a different color. We all have the heartbreak of our past failures behind us, the desire to be pregnant sooner rather than later, and the desperate want to have our children in our arms, but in one case, there is also the desire not to have spent $16,000 dollars in vain and in the other, that isn't a factor. I know in some people's worlds, $16,000 isn't a lot of money, but it is in mine. It's unfathomable, really.

If this IVF and any subsequent FETs do not work, we'll be taking a long break to regroup and relocate. This means I'll be job-hunting, and I'm sure you can guess what my #1 criterion will be. I'll take my Masters degree to the Gap if they have infertility benefits, which I believe they do. I'll have no shame. I was thinking about this the other day and if IVF was covered by my insurance and if we did only three cycles per year, that would be like adding $40,000 to my annual salary. I could do just about anything for that kind of a raise, couldn't you? I'm not saying we won't try at all during that time, but it will be a long time before we can afford anything but unmedicated ICIs again.

I'm doing much better today. I just keep looking around me and wondering how I got here. I never dreamed I would have this much trouble getting pregnant. Never. I think it all just caught up with me yesterday.

We've run into another delay with the home appraisal and the loan application, so it looks like we have a while longer to wait before we can finalize our IVF calendar. I know I will feel better once that is in place. And in the meantime, one foot in front of the other, right?


Lizzie said...

Oh, honey. I'm sorry. $16k is a fuckload of money. And the insurance people are bastards and the world is unfair. And I'm sorry you reached the end of your rope today. I'm not as far down the path as you are - but I understand the tears and the rage and the frustration and the longing. I've had my own small versions of the 'i can't believe this is my life and i'm the person having this much trouble' already and it's so strange and disempowering and awful. Sending hugs.

veeandjay said...

I hear you. Terror and rage - hand in glove.

Mrs. Bluemont said...

I'm so sorry love. I understand the unavoidable fall apart in front of M. I think we do that when we trust someone enough to put us back together. We realize how much strength it's taking to hold it in and having that person near gives us the permission to put all our bulging seams into their hands.

The insurance situation is fucked upl. It is so mindblowing to me how some people can be covered for some things and not others while there are some with total coverage and some with none. Completely unfair.

The latest issue of Conceive magazine has the top 50 companies for fertility insurance. It breaks it all down to what exactly is covered and how much. Very impressed with some big, main stream businesses. I think it's tempting to anyone faced with your dilemmas to consider something like that.

Much love. oxoxo

Sarah said...

I am so with you. We ended up nto being able to start oru first cycle for a couple of months because of travel issues with my husband, and I was a wreck. My first IVF got coverted to an IUI, which means we're out of Shared Risk, which means that if it never works, we are really behind the 8 ball in terms of the next option. It sucks, sucks, sucks that it is this hard to get pregnant, and that is rarely covered by insurance.
Take care.

Inlocoparentis said...

No one should have to go through this much shit to bring a desperately wanted child into the world, but especially not you guys. I'm so sorry.

bleu said...

I am so so very sorry. I really feel like that clinic or that nurse and cashier are just not being kind enough. Sometimes things can be run through insurance with different codes to help them go through. Most clinics do that. My RE gets my Lupron covered with a code for something totally unrelated to fertility. The Metformin goes under a pre-diabetes code. I know this because one time the Lupron was denied and then they re-submitted it and it went through. Even my insurance company told me that was fine.
I wish I could make this better for you. Just know I am here, and rooting you on so much and sending much love and light your way.

K said...

Bleu, get this... I asked whether they could bill at least the CF screening under another code (seeing as it kind of has to do with the OPPOSITE of infertility) and the cashier looked at me like I'd suggested she shoot someone. She said, "We can't do that. That's illegal!"

My old NP used to bill EVERYTHING under another code. She got everything except for my HSG and my IUIs covered. I like my RE, but I hate her clinic. The icing on the cake of getting pregnant will be not having to deal with them anymore!

bleu said...

It just makes no sense. Being on patients sides, going to bat for them, would increase their clientele. I would seriously consider even calling your insurance. They may at least be able to give you some clear parameters on what you can and cannot do. Tell them you have been having the RE order everything because he can and you have been there often and instead of going to the regular ob but if going to the ob can get things checked then all the better.

Janet said...

Oh, DG. I owe you an e-mail. Know that I am here, holding you in the light. I had a similarly baffling and exasperating conversation with the billing person at our RE's office today. Couldn't help but think of you, and marvel at the length of your rope.

Inlocoparentis said...

Trust me on this one. It's not illegal. They're just lazy. Our doc bills everything using the "female infertility" code - even our initial health screening/MMR shot before we started trying. I had a big showdown with the billing administrator about the use of this code (this is what I do for a living, lady) and they re-coded all twelve IUI office visits. For some reason, the insurance has covered three IUIs on completely random dates, and we were charged the negotiated rate for two random others. The billing administrator told me that she could not tell me what specific codes were used for the services on particular dates because the information was protected by HIPAA. I almost fell over. I think I said (probably condescendingly), "the same HIPAA that was created to give me unfettered access to all of my medical records, including billing and payment information?" She wouldn't budge, though, and we ultimately just gave up and paid the bill.