What drives you to advocate?

Last night I was talking with my local Resolve infertility support group leader about some things.  I asked her how she was able to find the courage within to tell her story to the world in order to advocate for change in family building policies.  She has done many inspirational things as an advocate and has an amazing way with finding the right words that hit home.  Quite frankly, sharing your infertility journey in the public’s eye is terrifying.  She told me her courage comes from an underlying belief that we have to fight for change so that our children don’t have to go through what we have been through.  It is so so simple, but so so powerful.  And it probably seems obvious, but it really hit me hard. In fact, I love it.

If I don’t advocate for change in family building policies…who else will? Who else will make the difference so that my unborn child and her friends won’t have to struggle with the road blockages that face us in growing our families when infertility hits?  Financial stresses, friend and family stresses, work stresses all on top of the physical and mental stresses of being infertile.  Some of these stresses can be removed with a little help of legislation and education.

I’m going to raise my voice and share my story of success.  I may be judged, I may be scrutinised, others’ words might hurt me on the way…but that won’t compare to the potential opportunity for positive change in the future for my children if I don’t speak out.

My blog is one way…writing letters to politicians is another, but there are many other ways, and I’m going to start by having the courage to fight with this mantra supporting me.

Watch this space my friends, I’m feeling empowered 🙂

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The Pre Hysteroscopy Surgery Appointment

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!

The cost of a suspected ectopic pregnancy

You can’t put a price or a value on having both your fallopian tubes intact.  In fact I imagine that anyone who has lost one or two of their fallopian tubes wouldn’t be able to put a price on how much they are willing to pay to have them whole and functioning again.  Without a doubt.  And so when the doctor told me that there is a risk that I had an ectopic pregnancy and a fallopian tube could rupture at any point, you simply don’t think about the $$$ money.;

After I found out that my pregnancy was non-viable, the whole process of determining whether or not I had an ectopic pregnancy was absolutely soul destroying and mentally exhausting.  I tried to research what the likelihood was of having an ectopic pregnancy was with IVF.  I tracked my hCG levels to try and determine what my odds were.  I even joined several online groups to talk to other women who had experienced what I was going through.  (I have probably mentioned this before, I dislike online forums because you get exposed to some real stupid, dumb, insensitive and simply irritating people.  And you just can’t get rid of them.)  All of this led me to some tiny hope that I was going to be one of those women who was going to beat the odds and carry a pregnancy despite the slow doubling hCG levels.

The doctors cared a lot about my wellbeing and were concerned of an ectopic.  I mostly followed their recommendations:  We both dropped everything to come in to the clinic for blood tests, consults and ultrasounds.  What they didn’t tell us was how much it is all going to cost.  Like I said, when there is a risk of losing a body part or even worse, your life, the money doesn’t matter.  And now I can finally say how much it all cost.

I am not complaining about the cost because we are lucky, we have amazing insurance and we can afford to pay the bills.  What I would like to know is what about those people whose insurance wouldn’t cover the costs?  It’s just another slap in the face if you have saved up or taken on debt to pay for IVF.  Of course, most insurance companies cover the cost for maternity healthcare, but the treatment of an ectopic or any other type of pregnancy loss doesn’t come for free.  Remember I told you about the woman who couldn’t afford to have an ‘abortion’ to end her life threatening pregnancy at her hospital because of a CRAPPY law? (You can read about it here).

When you save up and take on debt for IVF, no one tells you to save a little bit extra in case things go slightly wrong.  I have discovered, however, that most hospitals and healthcare providers will negotiate the costs if you can’t afford this type of care.  There are also some charities out there that can help.  I also believe that friends and family will be there too to help out.  We have helped out some friends in the past when they got caught out with unexpected medical bills.  It’s not only a difficult emotionally, it can quite quickly become difficult financially.

So how much did it cost?  Luckily for us, not much.  The total cost was $3,107 of which our insurance covered most of it, and so cost us $140.   I have updated my ‘Cost Lowdown’ page with the breakdown of where the biggest costs lie here. But this has made me think about putting aside more savings specifically for unexpected healthcare costs.

My appreciation for the UK National Health Service has simply sky rocketed.

Abortion and the grey space

We hear this word used in everyday life – abortion. We can all formulate an idea of what abortion is….someone choosing to end the life of their baby. But this isn’t a wholly accurate or fair description and is certainly not what medical professionals use the word ‘abortion’ for.

According to Wikipedia, the term ‘abortion’ can be defined as:

“The ending of a pregnancy by removing a fetus or embryo from the womb before it can survive on its own.”

The unintentional expulsion of an embryo or fetus before the 24th week of gestation is called a ‘spontaneous abortion’. This is the clinical term that is used by medical practitioners in their notes to describe what most lay people would understand to be ‘miscarriage’.

The intentional expulsion of an embryo or fetus is called an induced abortion. Reasons for intentionally inducing abortion are either therapeutic or elective:

  • Therapeutic abortion is performed to save the life of the pregnant woman; prevent harm to the woman’s physical or mental health; where indications are that the child will have a significantly increased chance of premature morbidity or mortality or otherwise disabled.
  • Elective abortion is voluntary when it is performed at the request of the woman for non-medical reasons.

And then there are the methods of abortion, including medical abortion and surgical abortion:  Medical abortion (sometimes also called chemical abortion) is induced by drugs or pharmaceuticals.  Where as surgical abortion includes procedures such as vacuum aspiration, Dilation and Curettage (D&C), Dilation & Evacuation (D&E) and hysterotomy.

The use of methotrexate to terminate my pregnancy of unknown location or ‘ectopic’ pregnancy is described as a medical abortion and can also be described as therapeutic abortion. Clinically, I did not miscarry.  Although I am sure I had started the process of miscarrying before I took the methotrexate, and would consider it to be a spontaneous abortion – or – miscarriage – or – early pregnancy loss. However you want to ice it, in my medical notes it will be described using the word abortion.

For those who are not aware that this is actually a clinical term it can come as quite a shock to see those words on their medical records.  For example, here is a link to a news article: “Mom to be shocked when miscarriage called ‘abortion’ in medical records” that shows how easy it is mis-perceive the term abortion.

But definitions of abortion vary across and within countries as well as among different institutions. Language used to refer to abortion often also reflects societal and political opinions and not only scientific knowledge. Popular use of the word abortion implies a deliberate pregnancy termination, whereas a miscarriage is used to refer to spontaneous fetal loss when the fetus is not viable (i.e. not yet unable to survive independently outside the womb).

Paul Freeling and Linda Gask* explain the problem well:

“As children many of us learnt the old rhyme “Sticks and stones may break my bones but words can never hurt me”. As we grew older we discovered that the adage was untrue. For most of us whose profession involved interacting with other people it became obvious that clumsy or inapposite use of language could cause pain. An attempt to avoid such pain has provoked…to suggest that distress in women who have miscarried would be reduced if changes were made in the language used by professional carers…the word “abortion” should be avoided because the lay public interprets it as applying to a termination of pregnancy.”

And then there is the grey space in between all of this. This is where in the US definitions and clinical descriptions are all important for insurance companies.

I recently read about a lady who fell right in between this grey space….

At a 13 week scan several doctors told her that her baby had a heartbeat, but the organs were not inside its body, the hands and feet are curled, one limb was missing, the neck was not right. Overall, the baby was unlikely to survive and should be removed as soon as possible before it could cause serious health issues. By definition, in Ohio, this situation was considered by the insurance company as an optional abortion because there was still a heartbeat, therefore, they would not cover the cost of the $10000 operation at the hospital. Planned Parenthood would be able to perform the surgery at a cost of $800.

Eventually, after the doctors re-worded the case, the insurance company agreed to cover the costs. But it came at a cost. You should read the whole article to fully appreciate what this poor woman went through: http://www.huffingtonpost.com/tamara-mann/heartbeat-involuntary-miscarriage-and-voluntary-abortion-in-ohio_b_2050888.html

This blog post is not about pro-life or pro-choice. It is merely a brief peek into the complexities of the use and definition of the term ‘abortion’.

For me personally, the insurance company did not initially cover the cost of my methotrexate treatment because it was being used as an abortion drug. Eventually we managed to claim the cost back directly via our European insurance provider.

I don’t have a solution to propose, I just know that abortion – whether it is spontaneous, elective, optional, surgical, medical – is a confusing grey mess of an area in the US.

* Freeling, P. & Gask, L., Changing terminology is no substitute for good consultations skills BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7165.1028 (Published 17 October 1998)

NaBloPoMo November 2015

Last chance saloon…well kind of

Last chance for natural conception

Today it dawned on me that as a result of my last cycle being shorter than expected, I am probably going to be away for a work conference right at peak ovulation time. DOH.  This is going to be our last chance to conceive naturally before we start IVF. (Yes I still have hope that we can beat the odds!)  Soooo, what’s a girl to do? I’m thinking an ice box and turkey baster will be required.  Wait.  That’s NOT natural!

I can just hope that I ovulate later than expected or have another short cycle!

OR Chis will just have to drive 4 hrs to DC and stay with me for one night and then get up super early and drive 4 hrs back before work. Ummmm, do you think I will be able to convince him to do it?? I’m pretty sure he will be not be down for that.

Love you honey!!!

Love you honey!!!

Oh well. It will be what it will be.  Nature is unpredictable anyway.

Lost blood work frustrations

When I first had all my infertility testing back in December last year, my doctor gave me TWO orders for blood work.  The first order was to test my cycle day 3 hormone, FSH LH etc.  The second order was to test for baddies that can affect the health of a pregnancy, such as HIV, Hep B & C, syphilis, in addition to having an immunity to Rubella and Chicken Pox (I’ve had these jabs, so I hope I have immunity!!) which are all a legal pre-screening requirement for IVF.  I received my results for Day 3 tests, but never saw my results for HIV etc.  I just assumed all was good, and never thought anything more of it until…..I met my IVF nurse the other month.

After much hunting, it turns out they never drew blood for my second order.  I KNOW I gave them that second order, so I am really annoyed.  It was only last month I received the bill for this blood work back in December, so I had no clue they never did the tests.  The bill I received for $500 I thought would have covered all these tests.  But it turns out it costs over $1000 for both orders of blood work!! So, frustratingly, the nurse had to send me a new order which took almost a week to get to me in the post (I forget how snail snail mail is here, I should have just picked it up from the office).

This time I went directly to the lab who does the analysis rather than to hospital to have my blood drawn.

Now, you would have thought that going straight to the specialists who take blood day in day out would be good at it.  But oh no.  Not this one.  After one vial of blood was collected with the needle still in my army, the nurse was like… “Come on….where did it go?  Why is nothing coming out? Hmmm…” as he wiggled the needle and I tried very hard not to shout out ‘OWWWWWWW THAT FRICKING HURTS!!’ Thankfully after what seemed like forever “Oh!! There’s the vein!”.  But I won’t be totally mean about this nurse.  He was entertaining, and did immediately recognise my accent and asked where in the UK I was from.  I congratulated him on his talent for recognising a British accent and we talked about how surprising it is how many people have no clue where I am from.  He even understood what I meant when I said “Cheers” as I left.  So I’ll let him off the hook.

So after all that, let’s hope I do have immunity to rubella, otherwise I am going to have to wait ANOTHER cycle to start IVF.  Now that will make me pretty mad 😐

The $$$ lowdown

I have created a new page on my site that sums up all the costs of our infertility journey so far.  I will keep this up to date as much as possible…I have copied the text from it and pasted it below (or here is the link to the page)

We are very lucky that our medical insurance includes coverage for the treatment of infertility, including IUI and IVF.

We are being open and honest about these costs because it is important for people to understand the difference having insurance coverage can make.  Only 15 states in the US make it mandatory for insurance providers to cover infertility treatment, and even some of those are extremely limited.  There is much debate on whether infertility should be covered as an essential health benefit.  There are many campaigns ongoing to change state law in this regard (www.resolve.org)

There is definitely a lot to be said about the psychology and stress to infertile couples over spending this vast amount of money if they do not have insurance coverage for infertility.  Chris and I find this process stressful enough as it is without the added burden of the actual cost.  I cannot even begin to imagine what it would be like without coverage.  At each stage of our journey we have had to get approval from our insurance company and with having an ‘unexplained’ diagnosis we have always been nervous that they will not cover us.  However, we have been fortunate so far. Fingers crossed they will cover our IVF too.

Item Full cost Insurance covered? Final cost to us
Ovulation Kit (pack of 20) x3 $70.00 No $70.00
Pregnancy Tests (various types) x4 $85.00 No $85.00
Basal Thermometer x1 $13.00 No $13.00
Pre-seed Lubricant x1 $24.00 No $24.00
Chris blood tests $572.00 Yes $10.25
Dani blood tests $560.00 Yes $14.43
Reproductive Endocrinologist Consulting Fees (Doctor visits) x3 $340.00 Yes $5.85
Ultrasounds x4 $900.00 Yes $71.72
Anti-biotics for HSG $15.97 Yes $1.60
Sperm Analysis $110.00 Yes $1.53
HSG $835.00 Yes $29.18
Letrozole x3 $8.53 Yes $0.86
Ovidrel x3 $371.16 Yes $37.11
IUI x3 $765.00 Yes $36.81
Sperm Wash x3 $320.00 Yes $16.80
Progesterone suppositories x3 $147.00 No $147.00
Running Total* $5,136.66   $565.14

A note about our healthcare insurance.  We pay a 10% co-pay for each bill of the ‘in-network’ cost, not necessarily 10% of the whole cost.  Our current infertility clinic (or ‘provider’ as it is also called) is ‘in-network’ so we get extremely preferable rates; for example our new doctor visit it was $190.00, our insurance paid $0, so we paid $0.  This is because our insurance company has negotiated these types of ‘bulk’ discounts in advance with our provider.

Choosing an ‘out of network’ provider can increase overall costs.  There is one other fertility clinic in our area we could have chosen, but is out of network.  It was something we considered, but we went on recommendation and did not think too much about this at the beginning.

Currently my insurance premium is ~$500 a month, plus my employer contributes ~$1100 a month, this covers both Chris and I for all medical expenses including dental and optical.

*As of 10th May 2015

Surprise surprise!!!! IVF!

Well my blog post title has given the game away, so in summary…our next step will be In-Vitro Fertilisation!

This morning we met with our RE who reviewed our progress so far, or lack there of.  Our tests were all normal, the three IUIs all went according to plan (except of course for the pregnancy part), I responded well to the letrozole with 2-3 follicles, Chris had awesome sperm.  We remain unexplained, but she does still suspect endometriosis.  If my period pains were so bad that they affected my life and I wanted that to change then she would recommend a laparoscopy.  This surgical procedure comes with risk, side effects and can take several months to return to normal, so if my periods were so bad this would be the way forward, however, in my case the benefits are unlikely to outweigh the downsides.  So she recommends we move straight to IVF.  She explained the overall process:

Week 1 to 2 – after menstruation I start birth control pills for about 14 days, these help to control my hormones

Week 3 – start injectable medications to control ovulation and stimulate follicles to grow – many many more than the 2-3 that were stimulated with letrozole in order to get the best chance of retrieving some ‘good eggs’.

Week 4 – continue injectable medications…have ultrasounds every other day to monitor follicle growth, along with blood work to monitor hormone levels.  When the follicles are ready, we will inject the hCG Ovidrel trigger and 36 hours later I go for egg retrieval surgery.  Under sedation my eggs are extracted from my ovaries.  Chris provides his sperm and my eggs are fertilised in-vitro.  After the eggs have been fertilised, the embryos grow for a few days under close watch.  Then if they survive, one or two embryos are transferred directly into my uterus.

Week 5-6 – start injectable progesterone until the big pregnancy test either says – “woohoo you are preggers”! then I stay on progesterone, or…”booooo it’s a BFN my friend”, then we will…..well, let’s not go there right now.

This is everything I expected her to say, except for two things slightly different.

  1. First, I need to go for a hydrosonogram.  This procedure will produce a 3D ultrasound of my uterus.  I will have this last test because I have a severely retroverted uterus they could not see it very well on the HSG X-ray, they want to double check that there is nothing preventing the implantation stage.
    My HSG X-ray with my retroverted uterus (it's hard to see because it's hiding behind the catheter)

    My HSG X-ray with my retroverted uterus (it’s hard to see because it’s hiding behind the catheter)

    I have been promised this does not hurt quite as bad as the HSG.  THANKFULLY!!!!

  2. Secondly, she thinks it would be a good idea to do Intra-Cytoplasmic Sperm Injection (ICSI) because we are ‘unexplained’.  ART_logoThis is a procedure where a single sperm is selected and injected directly into the egg rather than normal IVF where the sperm is placed near the egg.  This procedure is an extra $2,420 so we need to check whether our insurance would cover this or not.

Talking of costs….it is going to cost $9,075 for the IVF which includes office visits, endocrine monitoring, ultrasounds, retrieval, transfer and first pregnancy test.  Plus, it is an additional $400 for the anaesthesia. Medication will be approximately $4,000 to $6,000.  Then the ICSI procedure is $2,420.  Cryopreservation is $1000 then $60 a month for any embryos frozen.  Yikes!!!!  But we roughly knew this anyway, it’s just a bit scary seeing it listed out like this.

So for now, we start the negotiating with our insurance and the diary planning. It’s looking like a late June start.

Ultimately, today I walked away with this one key figure she gave: for us – a 50% chance of success.  In my mind that is pretty amazing.  I’ll take that.  I’ve always been a glass half full kind of girl, lately it’s been half empty, today I think I’ve been topped back up 🙂

Thank you for all your support and kind thoughts so far, I’m feeling pretty encouraged this will work!

Third time’s a……

Three Times a Charm

I think I am getting the hang of this IUI thing now.  I understand exactly what is going to happen each day, what drugs to take, what side effect will happen and when, who to speak to on the phone, who NOT to speak to on phone, how to ask for what I want, how to make myself understood, how to refill my various prescriptions, what bills to expect, even what emotions I am probably going to feel on this roller coaster of a cycle.  For example, I am on Cycle Day 4, and having taken two 2.5mg of Letrozole last night at 7pm, I knew at approximately 4pm Today I was going to be mega sleepy.  And I was! Where I work, if you have done something more than twice you are considered an expert, so I’m going to declare myself “IUI Subject Matter Expert” on my “CV of life”.  I’m feeling quite chilled out about it all, that is except for one, teeny, tiny, annoying thing.

INSURANCE.

The thorn in my side right now.  Needles have nothing compared to this pain in the….

You may recall before we started IUI that my insurance company wrongly stated that I did not need pre-approval for IUI treatment.  It was only after I started my first cycle all became apparent that we needed pre-approval before any fertility treatment.  Since then, we have been trying to get things straight with our insurance company.  I am not entirely blaming the insurance company here.  I am blaming ‘the system’.

It seemed so simple, our insurance company required copies of our medical records to determine pre-approval for our IUI treatment.  Well that’s easy! No? Fertility clinic – please provide our insurance company with our medical records.  “No problem, we will get the nurse right on that” they said.  Well each week we chased them, they claimed no knowledge of this request, but wait, what is this? …oh there is a note in our records to do this.  Hmmmmmm.  At our last appointment 2.5 weeks ago, the nurse promised us the request to send the medical files was with their business team and they were going to action it that day.  Well it turned out that was all bull.  No medical records were ever sent because we had to fill out a release ‘form’.  And after the number of people we spoke to try to make this happen, not one person mentioned a form.  Things also got complicated when the fertility clinic realised that our insurance’s medical office is located in Belgium.  This would be impossible! Sending medical records abroad – there are different laws for this. They were not quite sure how they are going to do it,  come on, surely there is a form for that too!  How about I google it, I bet google knows the answer.

So after we hit this road block, Chris tried a different approach.  He has given the half completed ‘pre-approval’ forms to our insurance company to chase up with our fertility clinic.  When my insurance company emailed me this morning to say could I please provide them with a contact number for my doctor, oh, by the way we would need approval for each round of IVF….I flipped!  As you can imagine we had dutifully and carefully provided a contact number and address, but most importantly, it clearly stated on the form the treatment was IUI.  I even provided them with a breakdown of all the costs for each procedure and medication.  Aghhhhhhhhh!

I have no idea what is going on right now, but it is all now in the hands of the insurance company and our fertility clinic to figure our laws, methods of handling medical records, procedures, money and what not.  Why couldn’t we have got to this stage two months ago?  At this rate we will probably get our “pre-approval” for IUI after we have finished all three rounds of IUI!

Without pre-approval we have paid for our first round of IUI out of our pockets and hoping we will be able to claim some money back.  Soon the bills will be coming in for the second round of treatment.  It would be nice if they figured it out before then.  My worst nightmare is that they deny the claim because there was a small test we had to do or form we had to complete before we started with the IUI.  There is little advice the insurance company can provide us on whether we are covered or not until they have our medical records.  Similarly, they can’t answer if we are covered for IVF until they see our medical records.  This makes financial planning for the future a little challenging.  But we are planning for the worst, just to be safe.

I should point out that we do have a rather strange insurance arrangement – because my organisation is international, Allianz, our insurance company, provides coverage for all staff across the various countries.  Allianz uses United Healthcare as their service provider in the US to purely deal with admin for claims made in the USA and negotiate in network deals with providers.  This makes things complicated for medical providers here in the US when we try to explain that they have to provide medical records to Allianz, not United Healthcare.  I hope I didn’t lose you there!

Third time...

Third time…

So to sum up today’s post – Insurance sucks and starting IUI cycle 3 is going to be a breeze.  As the saying goes….third time lucky!  Or….third time a charm!  Let’s hope it’s not like the other google search term on the list above – third time out :-s

A new day, a new cycle and new worries!

Yesterday sucked.  Today sucks still, but not quite as much as yesterday.  Cycle Day (CD) 2 and tomorrow is start of Letrozole!  Wait – tomorrow??!?! Wow, where is the time to breathe?  I don’t even have a prescription yet.  The nurse didn’t mention anything about my medication for a new cycle.  She just told me that if I was pregnant I was to call in and arrange a blood test and keep taking the progesterone, but if I was not pregnant, to stop the progesterone and my period would come (late, not to worry, that’s normal because of the progesterone) and then we would follow my doctor’s plan.  At the time, this all made sense.  But my period came full flow three hours after I took my pregnancy test (seriously, what a waste of a test!!!).  My period wasn’t late, and suddenly I realised I don’t have my prescription ready for CD 3.  In addition I realised that CD11 for my first ultrasound was due the day I was planning on returning from Paris for a work trip. Uhoh.  And if all went to plan as the last round of IUI, we would be doing the IUI either the Saturday that my brother is visiting from the UK (sorry bro, you’ve come all this way and we just got to pop to the doctors for half a day) or potentially the day I will be travelling to DC for work (sorry bro, was supposed to be taking you to DC with me for some site seeing). Aghhhhhhh!  Too much to think about. How much of my best laid plans could I reschedule?

All of this came quickly.  I thought about it yesterday, but was in no state of mind to deal with it.  So I dealt with it all today…I decided to still go to Paris, just come back one day early (fingers crossed my flight isn’t delayed by more than 24hrs), we have a plan for when my brother is visiting, and I can delay my DC work trip (My boss has been helpful in this respect).

Today I called the clinic to schedule my CD11 ultrasound, check about medication, how I go about refills and to check the status of them passing on our medical records to our insurance company.  It turns out some of my prescriptions were on refill, but not the Letrozole (the nurse asked me if I still wanted to carry on with it – I guess so??).  The nurse said she would arrange it immediately.  However, when it came to my medical records, there was no note to say that my medical records had in fact been sent to my insurance company.  However, there was a note to say that they needed to do it… But not to worry, because I can always check again when I come in for my CD11 ultrasound.  Well I do worry because I still do not have approval from my insurance company to have IUI treatment – and there is nothing I can do but let them figure it out together.  We can afford the IUI, we have the savings for it, but we would rather know now than later down the road what we do and don’t have to pay for.

On a more positive note, today is our 3 year wedding Anniversary.  We celebrated this evening and I enjoyed a lovely big glass of Merlot.  Good timing 🙂

Happy Anniversary Mr F!

Happy Anniversary Mr F!

Is it my British accent that confuses you?

I have concluded that it must be my British accent that confuses people at the other end of a phone line, namely my insurance company, Allianz, and freedom fertility.  Or they are just morons.  I am sure these big companies wouldn’t hire morons to man their phones, so it must be the former.

You may remember a couple of weeks ago I had a mild panic about whether my insurance company needed a pre-approval before fertility treatment?  When I had called my insurance company the nice Irish lady, who held me the line whilst she thoroughly checked the answer to my simple query, concluded I did not need approval for IUI.  Turns out she was wrong.stop  The only reason I know this is because my fertility clinic requested to see proof that my insurance covers fertility treatment.  So yesterday when I asked my insurance company for an email confirming this, they replied today stating that in fact their representative was incorrect and I needed prior approval.  To get the approval I need to send to my insurance: medial records, history, diagnosis and costs of planned treatment.  I could easily have collected all this the several times I have been at my clinic in the last few weeks, had the representative supplied me with accurate information in the first place.  Is this a normal situation, for insurance companies to request all this? I had thought that insurance companies would usually liaise directly with the healthcare provider?

Who knows what the heck is going on with my insurance.  Chris has kindly volunteered to deal with it.  I don’t mind if we are not covered, but what annoys me is that this process is not exactly the smoothest of rides as it is.  I know people make mistakes, but this mistake is a pain in the backside.  At least Allianz apologised and realised their initial mistake, we had a response back from their ‘senior customer sales representative’.  So I am not mad at them, but all these coincidences of mess ups on the phone, I’ve decided the only common factor is me.  The only obvious explanation is my accent.  From now on it’s email all the way, guvn’r…