The nurse called me back and directed me to the toilet.  I told her I had literally just gone to the toilet 2 minutes before she called me and that I apologised profusely that I did not know I was required to do a pregnancy pee test! Whoops!!!  But the silly thing is that almost two weeks ago we did a blood test after IVF cycle 2 and it was a big fat negative.  I am currently on Cycle Day 11 so it would actually be a miracle if I was pregnant right now!! But hey, I guess stranger things have happened.  The nurse took my blood pressure and temperature as usual, but this time we did something different!  A finger prick to test my hemoglobin levels.  I told her it’s always fun to try something new at the clinic, just to mix it up a bit!  I suggested a fertility test card bingo game, I might be on way my way to winning by now!!  Winning what exactly, I’m not sure…

The nurse explained that she was going to order in to my pharmacy a prescription of two cytotec pills that I need insert vaginally an hour before arriving for my hysteroscopy next week (basically I will need to do that at 0530 on the day of the procedure!!! :-s).  Cytotec is actually primarily used to prevent stomach ulcers when taking Non Sterodial Anti Inflammatory Drugs such as Ibuprofen or aspirin.  But cytotec does have an off label use – to ‘ripen the cervix’ (Haha I love the fact that one ‘ripens the cervix’ like an apple or banana)  Basically it helps dilate the cervix so it is easier for the camera to get into the uterus.  So this adds 4 types of drugs I’ve used during infertility treatment that is off label use – Letrozole, vivelle dot estrogen patches, methotrexate and now the cytotec. Off label use means that the FDA hasn’t approved that drug for the manner in which the doctor has prescribed it.  But all of these drugs are commonly used off label, so I am not worried about it.  But at no point have I ever been told these are drugs are being prescribed off label.  It’s an interesting practice!  I digress….

After being prodded and poked by the nurse I saw my doctor who went over the procedure with me and updated my medical history.  The procedure is relatively simple.  I arrive at 0630 AM at the surgery operating room, they get me prepped and ready in a fabulous gown.  No eating or drinking after midnight until after the procedure.  No make up, jewellery etc.  Similar to the egg retrieval.  The anesthetist will give me a cocktail of sedation drugs, probably similar to ones to the egg retrieval.  Once I am knocked out, they insert a camera through my cervix into my uterus – there are no cuts required.  Then they take a look around.  If there is anything there that shouldn’t be there, they will remove it there and then.  They will probably also take a biopsy of my uterus.  The whole procedure typically lasts 15 minutes.  Then I am back out of surgery into recovery for about an hour for the sedation to wear off, then I am driven home by my lovely, patient, husband.  So it really is a quick and simple procedure.  I might be in a bit of pain afterwards, but there is no requirement for me to rest afterwards, however, I won’t return to work until the next day because of the anesthesia drugs.

Simples!

Finally after my doctor gave me the low down and I signed my life away for all potential risks, I moved to the business admin office to pay my dues.  Here is the complicated bit.

My insurance provider is United Healthcare.  Well kind of.  My actual insurance company is Allianz.  I work for an international organisation where the majority of its employees work in Europe, but there are a small number of us here living in the US, so although Allianz provides us with worldwide coverage, it doesn’t have a primary market in the US.  So, Allianz pays United Healthcare to be the ‘front man’ for all of us employees who live in the US.  This means that Allianz gets access to all the in-network negotiated benefits and doesn’t have to worry about administration costs of billing etc in the US.  So all my healthcare providers bill to United, United then bill Allianz.

Have I lost you yet???!!

For anything dental or vision I have to pay for it upfront then claim it back from Allianz, then they re-imburse me 90%.  But I also have the choice of paying for any other healthcare service upfront and then claiming it back directly from Allianz,  I don’t have to go through United.  Most of the time this isn’t beneficial because of the in-network negotiated costs can sometimes be ridiculously discounted so it is better to go through United.  Except in the case of my hysteroscopy….

United demand that the hysteroscopy procedure is performed at a hospital and not the clinic.  If it is not performed at a hospital they won’t pay up.  If I went to the hospital, there is a longer wait time, particularly co-ordinating it so my doctor from the clinic can go to the hospital to do the procedure.  Then there is the high cost of doing it in a hospital – approximately $20 000!  Now, there would be in-network discounts on that, but still that is a lot of money when you compare it to what my clinic charges – just $1300 if you self pay.  Also, it is also far more convenient to have the procedure done at the clinic, especially as I know their surgery room well now!  So it doesn’t take a rocket scientist to work out what needed to be done.  Today I payed the $1300 ($400 of it in cash for the anesthetist, sounds dodgy right??!) , and then I will claim that back from Allianz directly in a couple of weeks time when I get the itemised bill.   Allianz don’t care where I have it done as long as it doesn’t cost more than the limit.  This made me think may be I could pay for all my IVF treatment upfront and claim it back – I reckon I could save about $500 if I did that.  But then I remember how many bills I got through and realised that there is no way I could easily track all of that and then track all those claims to Allianz in addition to also handle the pre-approval process.  I did that for my IUIs and it was a headache.  It’s not worth the stress.  Even if it were to give me a crap load of credit card points!!!!

Insurance in the US – what an absolute nightmare.  But I think I probably have it easy despite the unusual arrangement we have with United & Allianz.  I have it easy because I have amazing infertility coverage, and for that I am truly grateful.

Anyway, here I am, ready to go now for my hysteroscopy procedure next Tuesday!!! Who’d have thought I’d be excited for a diagnostic procedure that requires anesthesia!  This is what infertility does to a woman, it turns you into a masochist-craaaazy!