Fertile Schmertile

February 18, 2008

Is it Any Wonder My Head is Pounding?

Filed under: IVF,money money money,Uncategorized — by M. @ 5:29 pm

It has all been set into motion, this plan of ours, for better or for worse.  Last Friday, I began my first injection, the Lupron, which basically shuts down my ovaries so I don’t go doing something crazy like ovulating on my own.  That would put this whole thing right down the drain.  Those injections, though, were pretty easy, no pain, no side effects.  I got through the week more or less injecting at the same time each night without a fuss. 

I got to go to the RE’s office on Weds when my cycle started to get my ultrasound, bloodwork, the rest of my calendar filled in, further education on the other meds I’m starting, and got a chance to ask some last minute questions. I felt GREAT and PURPOSEFUL and HEADED FOR SUCCESS as I headed towards the reception desk to make my next appointment.  I proceeded to get out my debit card to pay my copayment for the visit when the receptionist whipped out the dreaded fees paperwork–due upon the start of the IVF cycle.  But if you read here before you’ll remember this post, and so I simply smiled and asked that she submit to my insurance because it had been all worked out already.  She indicated to me with a similar simple smile that I was mistaken, that my insurance has never, and wouldn’t possible, and won’t ever cover IVF (well, she didn’t use those words, but that’s what she said).  She offered kindly to call again my insurance, even though I had already called and specifically spoken about coverage and exclusions and such last year, and had coverage verified through the hospital finance office, and had already received my meds at 50% with written approvals mailed to me…and she verified right there that my insurance will not cover IVF, related meds, or procedures.  Obviously THAT CAN’T BE because I’m a smart consumer who takes notes about who says what about coverage, and makes health care decisions based on what the insurance company says and dammit, ALREADY STARTED PUMPING MILLION DOLLAR MEDS INTO MY SYSTEM WITH THE INTENT OF FOLLOWING THRU WITH THIS WHOLE PLAN.

After I threw up a little in my mouth, mumbled something about “we’ll just see about that,” and wrote a check from our line of credit loan, I hustled my butt back to the office to think for one minute before I called said insurance company and asked for someone who knew what the hell they were talking about (please).  Just a side note, when I was approaching the adoption of my little one a few years ago, and was checking on just when the insurance company considered “placement” for the purpose of coverage, I spoke to someone who seemed to never have heard of adoption before, talked to him at length twice, and still came to no resolution before having to ask for…you guessed it…someone who knew what the hell they were talking about (please).

Anyway, Mrs. Customer Service was very good at her job, because after spewing forth my story about how HER reps had verified coverage not once, not twice, but THREE TIMES, she placated me nicely, suggested I appeal that, told me how, and after all that, I didn’t even want to kill her.  Very good at her job indeed.

So, I spent all of Thursday writing a letter, gathering my notes, approvals, etc. and making hopefully a nice little case for myself with the request that they cover this cycle of IVF as they stated they would.  If it doesn’t work, there’s another round we can appeal, and after that we’ll see.  In the meantime what this means is that we are on pretty much a one shot deal with this.  What I want to tell the insurance company is that if they don’t pay now, they may pay much more later…one of the questions I had for the nurse was whether the doctor ever only transferred just one embryo instead of two…we were feeling a little more leisurely about the whole thing and our chances thinking that our coverage would allow us three rounds.  If this one didn’t work we’d move on to the next, but with one embryo we’d drastically reduce our chance for multiples.  But now, if this is the only shot we’ve got, we’ll definitely (if we have them) let him transfer two.  The darn insurance company can pay for TWO babies instead of ONE for the next 18 years.  It’ll be far more costly to them in the long run…That’ll show ’em 😉

So that’s put to rest for the next several days until I hear back from them.  Then on Saturday, I got to start twice a day injections of the Gonal-f (to stimulate my ovaries into producing multiple egg follicles), and a once a day of Luveris, which kind of gets the ovaries back up and running again.  I’ll still take a reduced injection of the Lupron for the next several days.  The Gonal-f is easy…the pen makes is super easy and is painless.  The Luveris on the other hand, had me freaking out.  Its one that comes with an ampuole of fluid and one with powder and you need to mix them with one size syringe, then replace the tip with a smaller one.  Guess what?? Crappy specialty pharmacy that my insurance company makes you use for specialty meds for things like IVF that they don’t cover (???) didn’t send any of the smaller syringe needles in the BABM.  So I’m sweatin’ it…But a huge blessing is that I never threw anything away from my last IF treatment several years ago, and I had both sizes of syringes I need to last several days.  It took me awhile to figure out the mixing again, but I think I got it.

We will likely travel to have egg retrieval one day the last week of February and return five days later for embryo transfer (always a chance none will fertilize).

Just one shot.  I cannot believe it.  By the end of this month, it will be over, and we’ll find out a few weeks into March whether it worked or not.

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6 Comments »

  1. OH MY GOODNESS

    Thats a lot to be thinking about.

    I’ll sprinkle some babydust on you. Hopefully that will help.

    Comment by erinthebeekeeper — February 18, 2008 @ 5:52 pm |Reply

  2. Good Luck! We’re def. on the same cycle. Started my Gonal-F on Sat.

    Comment by mrsyak — February 18, 2008 @ 9:21 pm |Reply

  3. Oh wow. I’m going to put in some extra prayers for you!

    Hmmm – who is the patron saint of insurance companies?

    Comment by StorkWatcher — February 19, 2008 @ 7:10 am |Reply

  4. Ha, Stork! Perhaps its still St. Dymphna (isn’t she the one for the mentally ill??)

    Erin–thanks! How are things going on your plans–both fertility AND possible adoption??

    MrsYak–we’ll keep in close touch. How is the Gonal f treating you? Did you get a headache?? I’ve had one for two days.

    Comment by M. — February 19, 2008 @ 8:01 am |Reply

  5. St. Dymphna will probably work just fine…she’s a McNally favorite for many reasons 🙂 What a craziness! I have my fingers crossed for you!

    Comment by Michelle — February 19, 2008 @ 8:21 pm |Reply

  6. Babydust is a nice thought…but fighting for insurance coverage might do more good. It’s completely insane and offensive that insurers will give a 67 year old man who’s smoked his whole life and eaten foot long subs until he weighs 275 pounds a pace maker, which can make his heart act 30, but won’t give a 35 year old woman infertility drugs that will make her eggs act 21.

    The insurers get away with this because infertile couples are embarrassed and ashamed and don’t want to come forward and yell. Time is of the essence – every month counts – and insurers count on the fact that you’ll do what they require instead of fighting them, because if they take 90 days to respond to your appeal, you’ve wasted three months (to hear no, most likely!).

    Find out who your state representative is, and write to him or her. Explain your anguish – ask why your state doesn’t mandate infertility coverage. If your state does, find out why/how your insurer can break the law. If your state has a cap, ask your legislator how your insurer can tell you that you only have 4 tries to have a baby, but don’t tell other fertile women that they can only have four births covered – after that, they have to give birth in their bathtub.

    We can do something about this – the only thing more powerful than organized money (i.e. insurance companies) is organized people with a similar goal.

    Comment by Lucie — May 15, 2008 @ 7:45 pm |Reply


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